{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:20:24Z","timestamp":1783059624563,"version":"3.54.6"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cerebral infarction (ischemic stroke) is a highly time-sensitive acute cerebrovascular event, yet prehospital delays in patients\u2019 accessing medical care remain prevalent across various countries and healthcare systems. Previous studies have primarily attributed delays to inadequate symptom recognition or barriers in healthcare accessibility, with limited systematic exploration of their formation mechanisms from a decision-making process perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study integrated the Self-Regulation Model and the three-stage delay model, employing an explanatory sequential mixed-methods approach to examine the cognitive and decision-making processes among cerebral infarction patients who delayed seeking care. A total of 68 patients completed the Brief Illness Perception Questionnaire, and semi-structured interviews were conducted with 16 of these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Findings indicate that delays in seeking medical care result from distinct mechanisms operating at different stages. During the appraisal delay stage, patients tended to normalize early or atypical symptoms. In the illness delay stage, optimism bias, self-regulatory overestimation, and doubts about medical efficacy reinforced a \u201cwait-and-see\u201d strategy. At the utilization delay stage, considerations of financial burden, family responsibilities, and societal role consequences significantly inhibited immediate healthcare-seeking behavior. Both quantitative and qualitative analyses revealed a cognitive-behavioral disconnect between illness perceptions and actual healthcare decisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study extends the explanatory power of Self-Regulation Model in healthcare decision-making contexts from a process-oriented perspective and offers a theoretical basis for designing staged, cognition-focused interventions aimed at reducing treatment delays.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1823472","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:40:32Z","timestamp":1783057232000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["From symptom onset to care-seeking: a process-oriented mixed-methods study of prehospital delay in cerebral infarction"],"prefix":"10.3389","volume":"14","author":[{"given":"Biao","family":"Xu","sequence":"first","affiliation":[{"name":"School of Government, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Qiang","family":"Ge","sequence":"additional","affiliation":[{"name":"School of Government, Nanjing University","place":["Nanjing, China"]},{"name":"Department of Medical Office, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Fan","family":"Shao","sequence":"additional","affiliation":[{"name":"School of Government, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Xiao","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1177\/10547738251344818","article-title":"Patient delay and ischemic stroke prognosis: a systematic review and Meta-analysis","volume":"34","author":"Zhang","year":"2025","journal-title":"Clin Nurs Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1177\/09287329241296739","article-title":"Research progress on influencing factors and intervention measures of pre-hospital delays in acute ischemic stroke","volume":"33","author":"Shi","year":"2025","journal-title":"Technol Health Care"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"jrm42506","DOI":"10.2340\/jrm.v57.42506","article-title":"Delayed inpatient rehabilitation and functional outcomes for acute stroke: a retrospective cohort study in an Australian regional hospital","volume":"57","author":"He","year":"2025","journal-title":"J Rehabil Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2376","DOI":"10.3390\/jcm9082376","article-title":"Temporal trends and risk factors for delayed hospital admission in suspected stroke patients","volume":"9","author":"Kielkopf","year":"2020","journal-title":"J Clin Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"10.1161\/STR.0000000000000513","DOI":"10.1161\/STR.0000000000000513","article-title":"2026 guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association\/American Stroke Association","author":"Prabhakaran","year":"2026","journal-title":"Stroke"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e013101","DOI":"10.1161\/JAHA.119.013101","article-title":"Reasons for prehospital delay in acute ischemic stroke","volume":"8","author":"Fladt","year":"2019","journal-title":"J Am Heart Assoc"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1186\/s12883-025-04361-8","article-title":"Study on delay factors and time to hospital arrival after acute stroke in patients at Shahid Rajaei hospital, Tonekabon (2022\u20132023)","volume":"25","author":"Farokhfar","year":"2025","journal-title":"BMC Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.09.036","article-title":"Response to symptoms and prehospital delay in stroke patients. 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