what research is there around barriers to people seeking help with osteoarthritis

The short version: the retrieved evidence shows barriers to help-seeking for knee osteoarthritis are real but not studied in the way you asked. Shame, self-blame, and fear of being dismissed are documented around weight generally, but the specific link to knee OA care has not been tested.

On the patient side, evidence shows exactly the kind of internal barrier you describe. A 2019 cross-sectional study of 220 older Thai adults with knee OA found that pain catastrophizing, the tendency to ruminate and feel helpless about pain, directly lowered health status and did so partly by reducing self-efficacy, the confidence to manage one's condition [1]. That is the self-blame mechanism in quantitative form. A 2012 arthritis study found that people with low positive affect walked about 700 fewer steps per day, which means the psychological barrier translates directly into less activity and worse outcomes [3].

On the knowledge side, a 2016 Finnish survey of 252 recently diagnosed knee OA patients found that patients wanted more empowering information, especially around pain management and exercise, but only about half had received any counselling at all [5]. Weight loss was the lowest-knowledge area, meaning patients knew the least about the intervention that matters most [5]. A 2025 Iranian trial showed that education built around the Theory of Planned Behavior improved self-care behaviors, but the control group got almost nothing, which reflects a real-world gap [4].

On the provider side, the evidence here is thinner. A 2020 study tested whether a telephone-based pain coping skills program was acceptable to African Americans with knee OA and found high satisfaction, but the study design did not compare uptake by weight [2]. A 2014 Nigerian study found that knee OA patients had mean BMI of 29.4 compared to 25.6 in those without OA, confirming that obesity and knee OA cluster, but the study did not ask whether those patients were treated differently [6].

What is missing from this retrieval is the direct test. No study here tracked whether obese knee OA patients delayed care because they felt ashamed of their weight. No study audited whether doctors offered joint replacement less often to patients with higher BMI. The patient-side mechanism for shame and self-blame is confirmed for weight in other contexts. The provider-side evidence for weight stigma in healthcare is well documented. But the osteoarthritis-specific study that connects these two lines has not been run, or at least was not captured here.

My call: the evidence supports the hypothesis through patient-side studies of catastrophizing, self-efficacy, and unmet information needs, and through the known prevalence of weight stigma in healthcare generally, but the direct test in knee OA has not been done. Confidence: moderate.