Help-seeking at the time of stroke: stroke survivors’ perspectives on their decisions

Abstract

Stroke is a major cause of death and disability in many countries. Early access to the most appropriate medical treatment can improve health outcomes. Despite this, only 30-60% of people who experience a stroke seek medical help within the recommended 3-hour timeframe. This study used open-ended interviews to explore patients' views on factors that influenced their decision to seek help at the time of stroke. Twenty participants were recruited from five centres: three hospitals, a community-based stroke support service and a primary healthcare service focused on providing health care for Maori. A qualitative methodology drawing on Grounded Theory informed data collection and analysis. Four main themes influenced the decision to seek help: making sense of symptoms, maintaining a sense of normality, presence and influence of another person and perception of medical services. Participants appeared to go through a process of recognition, interpretation and negotiation during their decision-making. Each of the four themes seemed to influence this process, either assisting or delaying help-seeking behaviour. The more time spent going through this process (or repeating each step), the longer the delay appeared to be. Our key findings which add to current help-seeking literature, include: (1) people tended to prioritise everyday commitments and responsibilities over their own health; (2) at times the presence and influence of another person contributed to delays in seeking help; and (3) people had different personal thresholds for when they perceived themselves to be 'sick enough' to seek medical help.

Determinants of patient’s decision-making in seeking care when experiencing stroke-associated warning signs

“…Therefore, they decided to ignore or, in the best-case scenario, to postpone seeking health care until finishing their work-related commitments. These findings were supported by a study where participants described prioritizing routine responsibilities over their own health needs when making decisions of how to react to their sudden unexplained symptoms (Moloczij et al, 2008).Urging of a Valued Individual was captured in the study participants' narratives as a careseeking factor. Having someone; a spouse, friend, neighbor, or individual whose opinion was valued, such as a nurse, with the individual experiencing stroke symptoms reflected positively in pushing them toward seeking immediate medical attention.…”

“…Failure to recognize stroke warning signs by individuals, families, or observers may result in delays in receiving life-saving management within this timeframe (Fugate & Rabinstein, 2014). In previous research, the percentage of individuals presenting to a specialize stroke center within 180 minutes of the onset of stroke warning signs was estimated to be 30% to 60% (Moloczij, McPherson, Smith & Kayes, 2008). This indicates that at least 40% of individuals experiencing stroke symptoms fail to access health services within the recommended timeframe (Moloczij et al, 2008).…”

“…In previous research, the percentage of individuals presenting to a specialize stroke center within 180 minutes of the onset of stroke warning signs was estimated to be 30% to 60% (Moloczij, McPherson, Smith & Kayes, 2008). This indicates that at least 40% of individuals experiencing stroke symptoms fail to access health services within the recommended timeframe (Moloczij et al, 2008). Theoretical knowledge about stroke warning signs does not automatically lead the affected individual to react appropriately by seeking immediate medical attention.…”

Stroke and the emergency medical services – enhancing performance within the chain of survival

“…The help-seeking patterns of different individuals have been shown to be complex. Interview-and population-based studies report that the decision to seek help was affected by symptom severity, living alone, knowledge of stroke, fear of the consequences of stroke, previous negative experience on hospitals, perceptions of the remit of medical services, belonging to an ethnic minority, presence of bystanders and involving a friend or relative in the decision of contacting medical services (Moloczij et al 2008, Mackintosh et al 2012. Better stroke knowledge has not been necessarily associated with correct stroke response behaviour or the decision to call the emergency telephone number (Schroeder et al 2000) of the symptoms have been suggested to play an important role in the help-seeking process (Rosamond et al 1998, Schroeder et al 2000, Iguchi et al 2006.…”

Influential variables on the timing of help-seeking behavior in lung cancer patients.

“…A knowledge deficit can in turn significantly influence symptom appraisal, and symptom appraisal that is not interpreted as serious and alarming can lead to delays in seeking help (Howell et al, 2008;Mason & Strauss, 2004a;Moloczij, McPherson, Smith, & Kayes, 2008).…”