The Impact of Symptom Recognition on Help-Seeking: A Comparison Between Rheumatoid Arthritis, Bowel Cancer and Angina

Gwenda Simons, J Belcher, Kanta Kumar, Marie Falahee, CD Mallen, Rebecca Stack, Karim Raza

Research output: Contribution to journalAbstractpeer-review


Background: RA requires early treatment to reduce the risk of joint damage and disability. However, due to delays at various points in the patient’s journey following symptom onset, this therapeutic window is often missed. Patients themselves are an important source of delay. Help-seeking begins with the patient recognising their symptoms and identifying them as worthy of medical attention. In order to understand symptom recognition by members of the general public, we conducted a qualitative and quantitative study of symptom recognition and its effect on help-seeking, comparing responses to RA symptoms with those of angina and bowel cancer.

Methods: We conducted a qualitative interview study with 31 individuals (16 females) and a postal survey of 1088 members of the general public (without RA). Both studies used vignettes describing the symptoms of RA, bowel cancer and angina. For each vignette, participants made causal attributions and rated the seriousness of the symptoms and the urgency with which they would seek medical help.

Results: Only a small proportion of participants in both studies recognized the symptoms of RA as such, whereas the symptoms of bowel cancer and, to a lesser extent angina, were accurately attributed to those diagnoses. In both studies, the symptoms of bowel cancer and angina were also considered to be more serious than those of RA, and participants indicated that they would seek help faster for the symptoms of bowel cancer or angina compared with the symptoms of RA. Survey data further showed that a correct causal attribution had a positive effect on help-seeking for angina and bowel cancer, but less so for RA symptoms. Furthermore, the relationship between urgency and seriousness ratings for the RA vignettes was less strong than for either angina or bowel cancer.

Conclusion: Accurate symptom attribution and the perception that symptoms are indicative of a serious underlying condition are both important drivers for rapid help-seeking. However, the finding that the relationship between seriousness and urgency ratings was not as strong for RA, and that an accurate causal attribution did not have such a clear-cut effect on the help-seeking for RA symptoms, suggest that other factors play an important role in driving help-seeking in RA. In the case of angina and bowel cancer, recent public health campaigns have promoted not only symptom recognition and seriousness, but have also emphasized the consequences of not seeking timely help. Our results suggest that these consequences should also be addressed in any public health campaign for RA.

Disclosure statement: G.S. has received research funding from the Dunhill Medical Trust. C.D.M. has received research funding from the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research, Care West Midlands, NIHR School for Primary Care Research and NIHR Research Professorship in General Practice. All other authors have declared no conflicts of interest.
Original languageEnglish
Pages (from-to)i44
Number of pages1
Issue numbersuppl1
Publication statusPublished - 2016


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