An individual or group's capacity to search for, understand, and incorporate health behaviors and resources into their lives. High literacy increases self-efficacy and adherence to healthy lifestyle changes, whereas low literacy can impede access to medical care and accurate information. 
The 3 main categories of health literacy are: functional, interactive and critical health literacy.

Health Literacy 

- Feeling overwhelmed due to lack of health literacy or self-efficacy
- Mental health comorbidities such as depression, anxiety, and BDD
- Psychological distress in response to symptoms

Grand Valley State University

 Barriers are defined as factors that obstruct or prevent behavior changes. Physical and psychological comorbidities as well as percieved lack of opportunity due to suboptimal risk assessment and internal motivation present a complex and interconnected set of challenges to the long-term management of PCOS.

Viewing Barriers to PCOS Treatment Through the COM-B Model

Ee, C., Pirotta, S., Mousa, A., Moran, L., & Lim, S. (2021). Providing lifestyle advice to women with PCOS: An overview of practical issues affecting success. BMC Endocrine Disorders, 21(1). https://doi.org/10.1186/s12902-021-00890-8

Providing lifestyle advice to women with PCOS: An overview of practical issues affecting success

- Altered gut hormone regulation, energy expenditure, and metabolic dysfunction in PCOS complicates traditional weight loss strategies
- Excess weight contributes to difficulties with movement and exercise
- Higher prevalence of eating disorders, disordered eating, fatigue and sleep disturbances like sleep apnea

Barriers to Physical Capability in PCOS

Barriers to Psychological Capability in PCOS

- Aversion to "mundaneness" of restrictive diet
- Inaccessible/unsuitable exercise conditions to anxiety or embarrassment
- Family and work commitments 
- Lack of social support and advocacy

Barriers to Opportunity in PCOS

- Ambivalence towards future complications
- Suboptimal risk perceptions
- Lack of intrinsic motivation/personal fulfillment regarding lifestyle change
- Low prioritization of health

Barriers to Motivation in PCOS

- Screening for and management of eating disorders, disordered eating, depression, and Obstructive Sleep Apnoea 
- Prioritizing the treatment of depressive symptoms prior to pursuing weight loss
- Promoting a weight neutral approach, especially for patients with a history of disordered eating and/or body image issues
- Increasing social support resources and greater coordination of care within the community
- Focusing on self-management strategies and finding enjoyable aspects of lifestyle change
- Training endocrinologists, dieticians, and other essential health providers how to be sensitive to the needs of individuals with chronic hormonal disorders

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