Patients' anticipated actions following transient ischaemic attack symptoms: a qualitative vignette-based study.
Transient Ischaemic Attack (TIA) requires urgent investigation and management. Urgent management reduces the risk of subsequent stroke markedly, but non-presentation or delays in patient presentation to health services have been found to compromise timely management. We aimed to explore general practice patients' anticipated responses to TIA symptoms.



This was a qualitative study employing semi-structured telephone interviews. Participants were recruited from respondents in an earlier quantitative study based in Australian general practices. Maximum variation purposive sampling of patients from that study (on the basis of age, rurality, gender and previous experience of stroke/TIA) continued until thematic saturation was achieved. After initial interviews explored knowledge of TIA and potential responses, subsequent interviews further explored anticipated responses via clinical vignettes containing TIA and non-TIA symptoms. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis and constant comparison. A schema explaining participants' anticipated actions emerged during this process and was iteratively tested in later interviews.



Thirty-seven interviews were conducted and a 'spectrum of action', from watchful waiting (only responding if symptoms recurred) to summoning an ambulance immediately, was established. Intermediate actions upon the spectrum were: intending to mention the episode to a general practitioner (GP) at a routine appointment; consulting a GP non-urgently; consulting a general practitioner (GP) urgently; and attending an Emergency Department urgently. The substrate for decision-making relating to this spectrum operated via three constructs: the 'individual set' of the participant (their inherent disposition towards action in response to health matters in general), their 'discriminatory power' (the ability to discriminate TIA symptoms from non-TIA symptoms) and their 'effective access' to health-care services.



Policies to improve patients' accessing care (and accessing care urgently) post-TIA should address these three determinants of anticipated action.
Discipline of General Practice, University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. parker.magin@newcastle.edu.au.
Parker
0000-0001-8071-8749
P
Magin
Discipline of General Practice, University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
Terry
T
Joyce
Centre for Translational Neuroscience and Mental Health, University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
Christopher
C
Levi
Nuffield Department of Medicine, University of Oxford, Oxford, Oxon, UK.
Daniel
D
Lasserson
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice; D058005:General Practitioners / Q000706:statistics & numerical data*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D002546:Ischemic Attack, Transient; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012017:Referral and Consultation; D013997:Time Factors; D057832:Watchful Waiting / Q000706:statistics & numerical data*
Delivery of health care; Family practice; General practice; Health behaviour; Health care quality, Access and evaluation; Ischaemic attack, transient; Stroke