Witness response at acute onset of stroke: a qualitative theory-guided study.
BACKGROUND
Delay in calling emergency medical services following stroke limits access to early treatment that can reduce disability. Emergency medical services contact is mostly initiated by stroke witnesses (often relatives), rather than stroke patients. This study explored appraisal and behavioural factors that are potentially important in influencing witness behaviour in response to stroke.


RESULTS
Semi-structured interviews with 26 stroke witnesses were transcribed and theory-guided content analysed was undertaken based on the Common Sense Self-Regulation Model (appraisal processes) and Theory Domains Framework (behavioural determinants). Response behaviours were often influenced by heuristics-guided appraisal (i.e. mental rules of thumb). Some witnesses described their responses to the situation as 'automatic' and 'instinctive', rather than products of deliberation. Potential behavioural influences included: environmental context and resources (e.g. time of day), social influence (e.g. prompts from patients) and beliefs about consequences (e.g. 999 accesses rapid help). Findings are based on retrospective accounts and need further verification in prospective studies.


CONCLUSIONS
Witnesses play a key role in patient access to emergency medical services. Factors that potentially influence witnesses' responses to stroke were identified and could inform behavioural interventions and future research. Interventions might benefit from linking automatic/instinctive threat perceptions with deliberate appraisal of stroke symptoms, prompting action to call emergency medical services.
Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, United Kingdom. stephan.dombrowski@ncl.ac.uk
Stephan U
SU
Dombrowski
Falko F
FF
Sniehotta
Joan
J
Mackintosh
Martin
M
White
Helen
H
Rodgers
Richard G
RG
Thomson
Madeleine J
MJ
Murtagh
Gary A
GA
Ford
Martin P
MP
Eccles
Vera
V
Araujo-Soares
D001519:Behavior; D004632:Emergency Medical Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D036301:Qualitative Research; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000628:therapy