title: Help seeking behavior of women with self-discovered breast cancer symptoms: a meta-ethnographic synthesis of patient delay.
abstract: OBJECTIVE
  Patient delay makes a critical contribution to late diagnosis and poor survival in cases of breast cancer. Identifying the factors that influence patient delay could provide information for adopting strategies that shorten this delay. The aim of this meta-ethnography was to synthesize existing qualitative evidence in order to gain a new understanding of help seeking behavior in women with self-discovered breast cancer symptoms and to determine the factors that influence patient delay.
  
  
  METHODS
  The design was a meta-ethnography approach. A systematic search of the articles was performed in different databases including Elsevier, PubMed, ProQuest and SCOPUS. Qualitative studies with a focus on help seeking behaviors in women with self-discovered breast cancer symptoms and patient delay, published in the English language between 1990 and 2013 were included. The quality appraisal of the articles was carried out using the Critical Appraisal Skills Programme qualitative research checklist and 13 articles met the inclusion criteria. The synthesis was conducted according to Noblit and Hare's meta-ethnographic approach (1988), through reciprocal translational analysis and lines-of-argument.
  
  
  RESULTS
  The synthesis led to identification of eight repeated key concepts including: symptom detection, initial symptom interpretation, symptom monitoring, social interaction, emotional reaction, priority of medical help, appraisal of health services and personal-environmental factors. Symptom interpretation is identified as the important step of the help seeking process and which changed across the process through active monitoring of their symptoms, social interactions and emotional reactions. The perceived seriousness of the situation, priority to receive medical attention, perceived inaccessibility and unacceptability of the health care system influenced women's decision-making about utilizing health services.
  
  
  CONCLUSIONS
  Help seeking processes are influenced by multiple factors. Educational programs aimed at correcting misunderstandings, erroneous social beliefs and improving self-awareness could provide key strategies to improve health policy which would reduce patient delay.
authors.affiliation: School of Nursing and Midwifery, Mashhad University of medical science, Mashhad, Iran.
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Khakbazan
authors.affiliation: Health Sciences Research Center, Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Taghipour
authors.affiliation: Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Robab
authors.initials: R
authors.lastname: Latifnejad Roudsari
authors.affiliation: Medical Sciences Faculty, Nursing Department, Tarbiat Modares University, Tehran, Iran.
authors.forename: Eesa
authors.initials: E
authors.lastname: Mohammadi
mesh_terms: D000884:Anthropology, Cultural; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology; D016504:Breast Self-Examination; D005260:Female; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D012307:Risk Factors