Qualitative study on the influencing factors of delayed medical treatment in stroke patients from the perspective of triadic reciprocal determinism

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Objective To explore the influencing factors of delayed medical treatment behavior of stroke patients. Methods From the perspective of triadic reciprocal determinism, purposive sampling in qualitative research was adopted to obtain 17 stroke patients with delayed medical treatment in a tertiary hospital in Yangzhou from April to June 2025, and they were interviewed by a semi-structured questionnaire. The in-depth interview data was analyzed by using deductive content analysis. Results The influencing factors of delay to medical treatment in stroke patients were divided into 3 themes and 13 sub-themes. ①Individual level: dual constraints of subjective ideas and objective conditions, including lack of knowledge of early warning signs, negative coping, low educational level, lack of role behavior, and constraints of economic conditions. ②Environmental level: synergistic impact of medical environment and social environment, including medical accessibility barriers, previous adverse medical experience, insufficient social support, and social role expectations. ③Behavioral level: coping mode under cognitive and environmental tension, including exploratory wait-and-see, dependence on non-professional advice, medical choice preference, and nocturnal morbidity. Conclusion In order to reduce the delayed medical treatment among patients with acute ischemic stroke, it is necessary to formulate a precise intervention plan based on the multidimensional theoretical model of individual, behavior and environment. (目的 探讨影响脑卒中延迟就医患者就医延迟行为的影响因素。方法 在三元交互决定论视角下下, 运用质性研究方法, 通过立意抽样法选取2025年1月—4月在扬州市某三甲医院住院的18例急性缺血性脑卒中就医延迟患者进行半结构式访谈, 采用定向内容分析法分析访谈资料。结果 将脑卒中患者就医延迟的影响因素纳为3个主题、13个亚主题。①个体层面: 主观理念与客观条件双重制约, 包括早期预警信号知识匮乏、消极应对、教育程度低下、角色行为缺失、经济条件制约; ②环境层面: 医疗环境与社会环境协同影响, 包括医疗可及性障碍、既往不良就医体验、社会支持不足、社会角色期待; ③行为层面: 认知与环境张力下的应对模式, 包括试探性观望、依赖非专业建议、医疗选择偏好、夜间发病。结论 为降低急性缺血性脑卒中患者就诊延迟率, 需基于个体、行为及环境的多维理论模型, 制定精准化干预方案。)

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