From symptom onset to care-seeking: a process-oriented mixed-methods study of prehospital delay in cerebral...

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.

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.

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.

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.