From symptom onset to care-seeking
A process-oriented mixed-methods study of prehospital delay in cerebral infarction
Bibliographic Data
| ID | 22086758 |
|---|---|
| Authors | Biao Xu (0000-0001-8695-7396, Nanjing University), Beibei Xu (0000-0002-0392-153X, Government of Jiangsu Province), Zhi-Qiang Ge (Government of Jiangsu Province), Yi-Fan Shao (Government of Jiangsu Province), Cheng-Xiao Ma (Nanjing Drum Tower Hospital), Li Li (0000-0001-9700-9682, Nanjing Drum Tower Hospital, corresponding author) |
| Year | 2026 |
| Volume | 14 |
| Publication date | 2026-07-03 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Frontiers in Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2296-2565 • E-ISSN: 2296-2565 |
| Publisher | Frontiers Media SA (PUBLISHER • CH) |
| DOI | 10.3389/fpubh.2026.1823472 |
| OpenAlex | W7167211465 |
| Language | EN |
| References cited | 35 |
Background Cerebral infarction (ischemic stroke) is a highly time-sensitive acute cerebrovascular event, yet prehospital delays in patients’ accessing medical care remain prevalent across various countries and healthcare systems. Previous studies have primarily attributed delays to inadequate symptom recognition or barriers in healthcare accessibility, with limited systematic exploration of their formation mechanisms from a decision-making process perspective. Methods This study integrated the Self-Regulation Model and the three-stage delay model, employing an explanatory sequential mixed-methods approach to examine the cognitive and decision-making processes among cerebral infarction patients who delayed seeking care. A total of 68 patients completed the Brief Illness Perception Questionnaire, and semi-structured interviews were conducted with 16 of these patients. Results Findings indicate that delays in seeking medical care result from distinct mechanisms operating at different stages. During the appraisal delay stage, patients tended to normalize early or atypical symptoms. In the illness delay stage, optimism bias, self-regulatory overestimation, and doubts about medical efficacy reinforced a “wait-and-see” strategy. At the utilization delay stage, considerations of financial burden, family responsibilities, and societal role consequences significantly inhibited immediate healthcare-seeking behavior. Both quantitative and qualitative analyses revealed a cognitive-behavioral disconnect between illness perceptions and actual healthcare decisions. Conclusion This study extends the explanatory power of Self-Regulation Model in healthcare decision-making contexts from a process-oriented perspective and offers a theoretical basis for designing staged, cognition-focused interventions aimed at reducing treatment delays
Cognition · Health care · Infarction · Optimism · Perception · Psychological intervention · Qualitative research · Acute Ischemic Stroke Management · Stroke Rehabilitation and Recovery · Traumatic Brain Injury Research
The Brief Illness Perception Questionnaire
Patient-centred access to health care
Identification of high-risk factors for prehospital delay for patients with stroke using the risk matrix methods
Status and influencing factors of pre-hospital delay in young and middle-aged Chinese patients with acute ischemic stroke
Nudging epidemic policy compliance
Effect of Health Care System Distrust on Breast and Cervical Cancer Screening in Philadelphia, Pennsylvania
Determinants of Three Stages of Delay in Seeking Care at a Medical Clinic
Linking parents’ self-stigma to the adjustment of children with disabilities
Code Saturation Versus Meaning Saturation
What Influences Saturation? Estimating Sample Sizes in Focus Group Research
| Highly cited | No |
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