Published Online
on March 23, 2006

A more recent version of this article appeared on May 1, 2006

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Submitted on October 10, 2005
Revised on January 12, 2006
Accepted on February 2, 2006

Perceptual, Social, and Behavioral Factors Associated With Delays in Seeking Medical Care in Patients With Symptoms of Acute Stroke

Lori Mandelzweig PhD; Uri Goldbourt PhD; Valentina Boyko MSc; and David Tanne MD^*

From the Neufeld Cardiac Research Institute (L.M., U.G., V.B.), Sheba Medical Center, Tel Hashomer, Israel; the Department of Epidemiology and Preventive Medicine (U.G., D.T.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and the Stroke Center (D.T.), Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.

^* To whom correspondence should be addressed. E-mail: tanne{at}post.tau.ac.il.

Background and Purpose--Despite availability of reperfusion therapy for acute ischemic stroke, most patients remain ineligible mainly because of late hospital arrival. We hypothesized that perceptual, social, and behavioral factors affect delays in seeking help after symptom onset.

Methods--Patients presenting with stroke symptoms were interviewed about symptom experiences, interpretations, and reactions. Odds ratios (95% CI) for risk of delay >3 hours were estimated, and variables associated with increased risk and representing demographic, clinical, perceptual, social, and behavioral factors were included in an assessment of the effect of combined risk factors on delay.

Results--Among 209 patients (mean age 61.8±12 years, 69% men) the median time interval from symptom awareness to seeking help was 2 (0.5 to 9) hours and to hospital arrival, 4.2 (1.3 to 14.5) hours. On multivariate adjustment, perceiving symptoms as severe (odds ratio [OR]: 0.42; 0.17 to 0.95), advice from others to seek help (OR: 0.18; 0.05 to 0.63), and contacting an ambulance (OR: 0.26; 0.10 to 0.63) were associated with decreased risks of delay, whereas perceived control of symptoms (OR: 2.45; 1.08 to 5.71) increased risk of delay in seeking help. Risk of delay in hospital arrival was 3 times greater in women than in men. Increasing proportions of patients who delayed seeking help were observed with increasing numbers of combined risk factors, ranging from 17% to 94% for 0 to 1 and 6 to 7 factors, respectively.

Conclusions--Perceptual, social, and behavioral factors contribute to delay in seeking medical care in acute ischemic stroke beyond demographic and clinical variables, and, when combined, further increase risk of delay. These findings may be important for designing programs to reduce delay.

Key words: acute stroke • behavior • educational activity • stroke care

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