Exploring the reasons stroke patients do not use emergency medical services: A qualitative study

Despite the well-established benefits of using Emergency Medical Services (EMS) in the management of stroke, the rate of EMS usage among stroke patients remains significantly low. This study was undertaken to explore and elucidate the underlying reasons for the underutilization of EMS by individuals experiencing stroke.

This qualitative content analysis was conducted in 2025 in hospitals affiliated with Lorestan University of Medical Sciences and Shahid Beheshti University of Medical Sciences, Iran, with 17 participants, including stroke patients and their family members. Participants were purposively selected, and data were collected through semi-structured interviews. The data were analyzed using Graneheim and Lundman.s conventional content analysis approach. To ensure the trustworthiness of the findings, the recommendations of Lincoln and Guba were followed. MAXQDA version 18 software (VERBI Software, Berlin, Germany) was used for data management.

After the analysis of the interviews, the findings were categorized into three main themes: deficiency in awareness, inappropriate organizational context, and attitudes and misconceptions. Seven subcategories were also identified, namely, lack of knowledge of EMS, symptom underestimation, negative experiences with EMS, limited access to EMS services, secrecy, fatalism, and high threshold for seeking help.

The findings indicate that patients often lack sufficient knowledge about stroke and the benefits of using EMS. Factors such as limited awareness of EMS, inadequate access, and various cultural and social influences contribute to the underutilization of these services. It is recommended that targeted community education initiatives be implemented to enhance public awareness of stroke symptoms and emphasize the critical role of EMS in the prehospital management of stroke patients.