Prehospital Delay and its Associated Factors in Time-Sensitive Emergencies (Myocardial Infarction and Stroke) Among Residents of Bisha, Saudi Arabia: A Cross-Sectional Study

Abstract

Background: Early recognition and timely response to myocardial infarction (MI) and stroke are critical for reducing morbidity and mortality. Public awareness and behavioral factors play a key role in prehospital delay. This study aims to assess awareness, intended response toward MI and stroke, and identify sociodemographic and behavioral predictors of delayed decision to seek urgent medical care among adult residents of Bisha, Saudi Arabia. Methods: A community-based analytic cross-sectional study was conducted in Bisha, Saudi Arabia, among 476 adults using convenience sampling with age and gender stratification. Data were collected using a structured questionnaire covering demographics, knowledge of warning symptoms, perceived confidence, behavioral attitudes, and intended help-seeking practices. Chi-square tests were used to identify factors associated with delayed care and intention to call emergency medical services (EMS). Results: Most participants recognized MI 416 (87.4%) and stroke symptoms 398 (83.6%). Immediate help-seeking was reported for MI by 412 (86.6%) and stroke by 420 (88.2%). Although 411 (86.3%) intended to call an ambulance, 129 (27.1%) preferred private transport. Knowledge of the stroke therapeutic window was limited 246 (51.7%). Confidence in symptom recognition was modest. Comorbidity was the only factor significantly associated with EMS use (p<0.001). For MI, delayed decision-making was mainly predicted by the belief in waiting for symptom improvement (p<0.001). For stroke, female gender (p=0.046) and the same behavioral belief (p<0.001) were significant predictors, while knowledge and most sociodemographic variables were not. In regression model, male gender reduced delay heartcare seeking for both conditions; comorbidities predicted stroke delay. Waiting for symptom improvement strongly increased delayed decision-seeking in MI and stroke (p<0.05). Conclusion: Our study shows that despite good general awareness, gaps in detailed knowledge and delay-promoting beliefs persist. Behavioral factors, rather than knowledge alone, were the main determinants of delayed care. Targeted interventions addressing attitudes toward ambulance use and the risks of waiting are essential to reduce prehospital delay and improve outcomes.