Behavioural determinants of engagement with vestibular care pathways in adults: a COM-B scoping review

BACKGROUND: Adults experiencing dizziness or vestibular disorders frequently encounter barriers to help seeking and healthcare engagement. However, the behavioural determinants underlying these behaviours have not been systematically synthesised. OBJECTIVE: This scoping review aimed to identify behavioural determinants influencing vestibular help seeking and healthcare engagement among adults with dizziness or vestibular disorders and map these determinants to the Capability-Opportunity-Motivation Behaviour (COM-B) framework. DESIGN AND STUDY SAMPLE: A systematic search of PubMed/MEDLINE, Scopus, CINAHL, and Web of Science was conducted from database inception to 22 January 2026. Sixteen studies were included and synthesised narratively in accordance with PRISMA-ScR guidelines. RESULTS: Determinants influencing vestibular healthcare engagement were identified across multiple stages of the care pathway, including help seeking, healthcare access, diagnosis, treatment engagement, and vestibular rehabilitation. Determinants were mapped across all six COM-B domains. Physical and social opportunity were most frequently reported, followed by reflective motivation and psychological capability. Automatic motivation and physical capability were less frequently examined. CONCLUSIONS: Vestibular healthcare engagement is shaped by structural, social, motivational, and capability-related determinants across the care pathway. The COM-B framework provides a useful structure for identifying stage-specific behavioural targets to improve access to vestibular assessment, rehabilitation participation, and sustained engagement with care.