Despite campaigns to increase public awareness of
stroke symptoms by advocating FAST (Face-Arms-Speech-Time), some
stroke patients still show delays in the recognition of and response to
stroke symptoms and miss the golden first 4.5 h to receive rt-PA (recombinant
tissue plasminogen activator) treatment. The aim of this study was to explore how
acute ischemic stroke patients with prehospital delay seek help and undergo the decision process before arriving at the hospital. A qualitative approach using a grounded theory was applied. There were 24
ischemic stroke patients recruited by purposive sampling. Our main findings were: "Hesitating and puzzling" was the core category to describe and guide the process of
acute ischemic stroke patients with prehospital delay. During the process, "Awareness the sudden change of physical sensation and/or function" was the antecedent category. In the prehospital delay experience, the following five interaction categories were identified: (1) "Self-judgment and interpretation according to previous experience," (2) "Puzzling and doubting-it may only be a minor problem," (3) "Self-treatment or seeking medical attention nearby," (4) "Unexpected symptoms getting worse" needing immediate advanced medical help and (5) "Rushing to ER with different transportation-self-alerting that serious disease is coming." Eventually, the patients "Regret to delay seeking treatment and become a disable person." The process of prehospital delay provides some hidden cues for patients to increase their knowledge about
strokes. The study emphasizes the importance of educating community residents about identifying
stroke symptoms, breaking the myth of folk
therapy, and seeking medical attention immediately. These results will assist healthcare providers by offering references for designing patient-centric educational strategies for preventing
stroke prehospital delay to improve the quality of
stroke medical care.