title: Decisions and delays within stroke patients' route to the hospital: a qualitative study.
abstract: OBJECTIVE
  We examine acute stroke patients' decisions and delays en route to the hospital after onset of symptoms.
  
  
  METHODS
  This was a qualitative study carried out in the West Midlands, United Kingdom. Semistructured interviews were conducted with 30 patients (6 accompanied by partners). Patients were asked about their previous experience of having had a stroke and their initial engagement with health services. "One sheet of paper" and thematic analyses were used.
  
  
  RESULTS
  Three potential types of delay were identified from onset of symptoms to accessing stroke care in the hospital: primary delays caused by lack of recognition of symptoms or not dealing with symptoms immediately, secondary delays caused by initial contact with nonemergency services, and tertiary delays in which health service providers did not interpret the patients' presenting symptoms as suggestive of stroke. The main factors determining the speed of action by patients were the presence and influence of a bystander and the perceived seriousness of symptoms.
  
  
  CONCLUSIONS
  Despite campaigns to increase public awareness of stroke symptoms, the behavior of both patients and health service providers apparently led to delays in the recognition of and response to stroke symptoms, potentially reducing access to optimum and timely acute specialist assessment and treatment for acute stroke.
authors.affiliation: NHS Lanarkshire, Bothwell, UK.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Mellor
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Sheila
authors.initials: S
authors.lastname: Bailey
authors.affiliation: Nuffield Department of Primary Care Health Sciences, National School for Primary Care Research, University of Oxford, Oxford, UK.
authors.forename: James
authors.initials: J
authors.lastname: Sheppard
authors.affiliation: Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Carr
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Quinn
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK.
authors.forename: Amunpreet
authors.initials: A
authors.lastname: Boyal
authors.affiliation: Heart of England NHS Foundation Trust, Birmingham, West Midlands, UK.
authors.forename: David
authors.initials: D
authors.lastname: Sandler
authors.affiliation: University Hospitals Birmingham NHS Foundation Trust, Birmingham, West Midlands, UK.
authors.forename: Don G
authors.initials: DG
authors.lastname: Sims
authors.affiliation: Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK. Electronic address: s.m.greenfield@bham.ac.uk.
authors.forename: Sheila
authors.initials: S
authors.lastname: Greenfield
authors.affiliation: Nuffield Department of Primary Care Health Sciences, National School for Primary Care Research, University of Oxford, Oxford, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D036301:Qualitative Research; D018454:Spouses / Q000523:psychology; D020521:Stroke / Q000523:psychology* / Q000628:therapy; D013997:Time Factors; D006113:United Kingdom