Exploring the multifactorial reasons for treatment-seeking delays among young and middle-aged stroke patients: a qualitative study

Objectives To identify multifactorial contributors to treatment-seeking delays among Chinese young and middle-aged stroke patients using socioecological model. Design Descriptive phenomenological interview study. Setting A tertiary hospital in China. Participants Twenty acute stroke patients with treatment-seeking delays and 16 family members were recruited for dyadic semistructured interviews. Primary and secondary outcome measures Barriers influencing treatment-seeking delays across individual, interpersonal and systemic levels. And how do interlevel interactions shape decision-making trajectories? Results Data analysis revealed 5 overarching themes encompassing 12 subthemes: (1) limited stroke-specific health literacy; (2) psychological barriers at symptom onset; (3) inadequate interpersonal support systems; (4) structural impediments to timely care; (5) decision-making dynamics across levels. Delay was characterised as a sequential cascade mediated by cognitive misattribution, emotional paralysis, relational dependency, institutional constraints and cross-level feedback loops. Two dominant pathways, silent progression and diverted seeking, were identified. Conclusion Treatment-seeking delay among young and middle-aged stroke patients arises through dynamic interactions across socioecological strata rather than isolated factors. Integrated interventions targeting public awareness, familial preparedness, workplace policies and healthcare accessibility are required to disrupt this cascade.