14–19 However, for simplicity sake, this study protocol will refer to sex differences throughout, while assuming that gender constructions influence both men and women, thus

also requiring investigation. Help-seeking and sex differences Rickwood et al20 have defined help seeking as “the behaviour of actively seeking therefore help from others. It is about communicating with other people to obtain help in terms of understanding, advice, information, treatment and general support in response to a problem or distressing experience” (p.4). Health-related help-seeking is the conscious decision to seek assistance to change one’s health status (illness). Help or assistance might be sought from a health professional or friends and family. One paper analysed the term help-seeking and supported Rickwood’s definition by concluding that help-seeking is an intentional action to resolve health issues.21 The paper also added that in order for a help-seeking intentional action to occur, there must be an acknowledgement of the existence of a health issue and

ultimately acceptance that external help is needed.21 Help-seeking decision-making for both men and women is a complex and multifaceted process and concept. Literature in general suggests a higher tendency for women to report symptoms to friends and family than men.22 23 Yet when it comes to consulting a health professional, there is some divergence of opinion in the literature with the balance of evidence supporting higher general practitioner/health professional

consultation rates in women, although the evidence for gender difference is weaker for particular conditions (eg, headache and back pain).22–26 Sex differences in cardiovascular disease and help-seeking The literature on sex differences in help-seeking for cardiac disease in emergency situations is conflicting. However, on balance, the evidence suggests that women delay help-seeking longer AV-951 than men—the opposite behavioural pattern assumed of general help-seeking for most other conditions. However, most studies reporting that women delay longer than men cited challenges in symptoms presentation as the result of biological sex differences in anatomy, rather than focusing on gender constructions, as possible explanations.1 3 14–19 A typical presentation of cardiac chest pain often involves central crushing chest pain, radiating down the left arm and into the jaw, a pattern widely experienced by men. However, it is well documented that this ‘classical’ presentation is not so often experienced by women, who experience more varied symptoms of lower intensity.