{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:03Z","timestamp":1782366483213,"version":"3.54.5"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T00:00:00Z","timestamp":1782345600000},"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>Introduction<\/jats:title>\n                    <jats:p>Stroke remains a leading cause of mortality and disability globally, with a disproportionate burden in low-and middle-income countries. While early intervention is the clinical gold standard, pre-hospital delays remain a significant barrier to effective treatment in rural South African contexts. This qualitative study explored the socio-cultural, cognitive, and structural factors influencing stroke survivors\u2019 decision-making pathways in rural South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An exploratory qualitative design was employed. Ten stroke survivors were recruited from rural Limpopo Province using snowball sampling. Data were collected through semi-structured interviews and analysed using thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three primary themes emerged as determinants of pre-hospital delay factors. Knowledge of stroke, severity of the symptoms, belief system and distance to medical health facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Pre-hospital delay among rural South African stroke survivors is a complex interplay of knowledge, cultural causal attributions and systematic healthcare inequalities. Efforts to reduce pre-hospital delay must move beyond hospital-based education and enter the community\u2019s primary networks: the home, the church, and the traditional healer\u2019s office.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1848220","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:30:04Z","timestamp":1782365404000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing pre-hospital decision-making among stroke survivors in the rural area of South Africa: an exploratory study"],"prefix":"10.3389","volume":"14","author":[{"given":"Rudzani Marry","family":"Mhlari","sequence":"first","affiliation":[{"name":"School of Social Science, Psychology Division, University of Mpumalanga","place":["Nelspruit, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bontle","family":"Kgopa","sequence":"additional","affiliation":[{"name":"School of Education, Department of Educational Psychology, University of Pretoria","place":["Pretoria, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nare Judy","family":"Masola","sequence":"additional","affiliation":[{"name":"School of Health Care Science, Department of Psychology, Sefako Makgatho Health Sciences University","place":["Pretoria, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tukiso","family":"Moloantoa-Sewapa","sequence":"additional","affiliation":[{"name":"University of Limpopo, Research Administration Development","place":["Polokwane, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/s1474-4422(21)00252-0","article-title":"Global, regional and national burden of stroke and its risk factors, 1990\u20142019: a systematic analysis for the global burden of disease study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1093\/bmb\/ldp028","article-title":"Global and regional causes of death","volume":"92","author":"Mathers","year":"2009","journal-title":"Br Med Bull"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/S1474-4422(07)70031-5","article-title":"Preventing stroke: saving lives around the world","volume":"6","author":"Strong","year":"2007","journal-title":"Lancet Neurol 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