Factors associated with decision time to seek care in the face of ischemic stroke

Muniz, Ludimila Santos; Moraes, Mariana de Almeida; Sales, Rilary Silva; Ribeiro, Laís Silva; Cunha, Brenda Silva; Jesus, Pedro Antônio Pereira de; Sampaio, Elieusa e Silva; Baccin, Camila Rosalia Antunes; Teles, Carlos Antônio de Souza; Mussi, Fernanda Carneiro

doi:10.1590/1980-220X-REEUSP-2023-0075en

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Original Article • Rev. esc. enferm. USP 57 • 2023 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0075en copy

Factors associated with decision time to seek care in the face of ischemic stroke^* * Extracted from the Master’s Thesis: “Fatores associados ao tempo de decisão para procura de serviços de saúde por pessoas com acidente vascular cerebral isquêmico”. Universidade Federal da Bahia, 2022.

Factores asociados con el tiempo de decisión para buscar atención médica por accidente cerebrovascular isquémico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To verify the association between sociodemographic, clinical, environmental, cognitive, and emotional factors and the decision time of people with ischemic stroke to seek a health service after the onset of symptoms or wake up stroke.

Method:

Cross-sectional study carried out from March to October 2019, with 304 patients, in a public hospital, a reference in neurology. Data obtained through interview and from medical records. Decision time was analyzed as a geometric mean. In the bivariate and multivariate analyses, linear regression was used and the Akaike Information Criterion was used to select the best model. Statistical significance of 5% was adopted.

Results:

The geometric mean of decision time was 0.30h (95% CI 0.23–0.39). The final model explained this time in 41%, showing an increase of 0.5 min for people with arterial hypertension; 10.8 min for those who waited for symptoms to improve; 1.4 min for those who were alone at the onset of symptoms; 3.9 min for those at home; 3.2 min for the ones at work; and 2.1 for those on the street/public space.

Conclusion:

The mean decision time for seeking a health service was high and influenced by clinical, environmental, cognitive, and emotional variables. The results guide nurses regarding health education.

DESCRIPTORS
Stroke; Time-to-Treatment; Emergency Medical Services; Nursing; Health Education, Health

Sociodemographic variables	Frequency n (%)	GM decision time in h (CI 95%)	Coef.	Standard error	Value of p*
Age range in years
21 to < 40	19 (6.3)	0.13 (0.04; 0.41)			0.222
40 to < 60	76 (25.0)	0.27 (0.15;0.48)	0.32	0.26	0.067
60 to < 80	162 (53.3)	0.37 (0.26;0.54)	0.45	0.25
≥80	47 (15.5)	0.24 (0.13; 0.48)	0.28	0.27	0.310
Sex
Male	150 (49.3)	0.33 (0.23; 0.50)			0.454
Female	154 (50.7)	0.27 (0.19;0.39)	0.09	0.12
Self-declared race/color**
White	49 (16.2)	0.22 (0.11; 0.44)
Black/brown	254 (83.8)	0.32 (0.24;0.42)	0.15	0.16	0.336
Marital status**
With a partner	141 (46.5)	0.26 (0.17; 0.38)
Without a partner	162 (53.5)	0.35 (0.24;0.51)	0.14	0.12	0.255
Level of Education**
Unfinished high school to higher education	94 (31.3)	0.25 (0.15;0.39)
Up to elementary school	206 (68.7)	0.32 (0.23; 0.45)	0.12	0.13	0.356
Monthly family income***
≥ 3 minimum wages	29 (9.8)	0.22 (0.10;0.49)
<3 minimum wages	267 (90.2)	0.30 (0.23; 0.40)	0.15	0.18	0.418
City of residence
Salvador	244 (80.3)	0.30 (0.22; 0.40)
Other cities	60 (19.7)	0.32 (0.18;0.54)	0.02	0.14	0.872
Employment situation
With activity	111 (36.5)	0.29 (0.18;0.47)
Without activity	193 (63.5)	0.31 (0.22;0.43)	0.02	0.13	0.868
With whom the person lives
Does not live alone	245 (80.6)	0.25 (0.19;0.33)
Lives alone	59 (19.4)	0.66 (0.33;1.33)	0.42	0.16	0.009

Clinical Variables	Frequency n (%)	GM decision time in h (CI 95%)	Coef.	Standard error	Value of p*
Arterial hypertension
No	65 (21.4)	0.16 (0.09; 0.29)			0.014
Yes	239 (78.6)	0.36 (0.27;0.49)	0.35	0.14	0.014
Diabetes**
No	214 (71.6)	0.25 (0.19;0.35)
Yes	85 (28.4)	0.40 (0.23;0.70)	0.19	0.14	0.176
Prior myocardial infarction**
No	268 (88.7)	0.30 (0.23;0.40)
Yes	34 (11.3)	0.31 (0.14;0.71)	0.02	0.18	0.916
Smoking
No	179 (58.9)	0.27 (16)
Yes	40 (13.2)	0.49 (29.5)	0.25	0.19	0.182
Former smoker	85 (27.9)	0.29 (17.5)	0.01	0.14	0.930
Previous stroke**
No	199 (65.7)	0.27 (0.20;0.38)
Yes	104 (34.3)	0.37 (0.23;0.59)	0.13	0.13	0.297

Variables	Frequency n (%)	GM decision time in h (CI 95%)	Coef.	Standard error	Value of p*
Environmental
Site of onset of symptoms
Emergency Room or Hospital	8 (2.6)	0.03 (0.01;0.05)
Street/public space	32 (10.5)	0.22 (0.09;0.53)	0.92	0.22	0.000
Work	21 (6.9)	0.28 (0.10;0.81)	1.03	0.24	0.000
Home	243 (79.9)	0.35 (0.26;0.47)	1.12	0.13	0.000
Was alone when the symptoms started
No	238 (78.3)	0.22 (0.17;0.30)
Yes	66 (21.7)	0.89 (0.47;1.68)	0.60	0.15	0.000
Cognitive and emotional
Judgment of severity of symptoms**
Severe	190 (64.0)	0.23 (0.17;0.32)
Not severe	107 (36.0)	0.50 (0.31;0.82)	0.34	0.13	0.009
Association of symptoms with stroke**
Yes	122 (40.3)	0.23 (0.16;0.35)
No	181 (59.7)	0.37 (0.25;0.53)	0.20	0.12	0.098
Took something to improve
No	242 (79.6)	0.24 (0.18;0.33)
Sim	62 (20.4)	0.69 (0.37;1.30)	0.45	0.15	0.003
Waited for symptoms to improve**
No	226 (74.6)	0.14 (0.11;0.18)
Yes	77 (25.4)	3.20 (2.00;5.09)	1.37	0.12	0.000
Hid the symptoms
No	279 (91.8)	0.27 (0.21;0.36)
Yes	25 (8.2)	1.07 (0.36;3.13)	0.60	0.23	0.010
Who decided to seek care
The victim	76 (25.0)	0.27 (0.16;0.45)
Another person	228 (75.0)	0.31 (0.23;0.43)	0.07	0.13	0.613

Variables	Model A (CI 95%)	Model B (CI 95%)	Model C (CI 95%)	Model D (CI 95%)	Model E (CI 95%)	Model F (CI 95%)
Clinical
Hypertension
No
Yes	0.33 (0.04;0.62)				0.18 (–0.89;0.45)	0,24 (0,01;0,47)
Diabetes
No
Yes	0.17 (–0.13;0.47)				0.08 (–0.15;0.31)
Smoking
No
Yes	–0.02 (–0.15;0.12)				0.06 (–0.06;0.17)
Cognitive and emotional
Symptoms associated with stroke
No
Yes		–0.00 (–0.20;0.20)			–0.01 (–0.22;0.19)
Took something to improve
No
Yes		0.06 (–0.18;0.30)			0.09 (–0.14;0.33)
Waited for symptoms to improve
No
Yes		1.33 (1.07;1.59)			1.26 (1.00;1.51)	1.27 (1.04;1.50)
Hid the symptoms
No
Yes		0.08 (–0.31;0.48)			0.04 (–0.33;0.41)
Symptoms severity
No
Yes		–0.05 (–0.27;0.18)			–0.01 (–0.22;0.21)
Environmental
With whom the person was at the onset of symptoms
Wasn’t alone
Was alone at onset of symptoms			0.66 (0.35;0.97)		0.50 (0.18;0.82)	0.53 (0.26;0.80)
Where the person was at the onset of symptoms
Emergency Unit (UPA)/Hospital
Street/public space			0.87 (0.41;1.33)		0.58 (–0.03;1.18)	0.65 (0.04;1.26)
Work			0.83 (0.37;1.30)		0.75 (1.19;1.32)	0.79 (0.19;1.38)
Home			1.04 (0.73;1.35)		0.79 (0.26;1.29)	0.87 (0.33;1.40)
Sociodemographic
Age range
21 to < 40 years
40 to < 60 years				0.37 (–0.15;0.88)	0.03 (–0.35;0.42)
60 to < 80 years				0.47 (–0.01;0.95)	0.14 (–0.26;0.54)
> 80 years				0.23 (–0.31;0.76)	0.12 (–0.33;0.59)
With whom the person lives
Does not live alone
Lives alone				0.44 (0.11;0.77)	0.98 (–0.22;0.42)
AIC	812.37	710.74	791.56	809.007	693.40	677.76
R2	4.5%	10.3%	33.1	3.0%	42.0%	41.0%

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Ludimila Santos Muniz Avenida Ulysses Guimarães, nº 2954 41213-000 – Sussuarana, Salvador, BA, Brazil ludimuniz@hotmail.com

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Factors associated with decision time to seek care in the face of ischemic stroke* * Extracted from the Master’s Thesis: “Fatores associados ao tempo de decisão para procura de serviços de saúde por pessoas com acidente vascular cerebral isquêmico”. Universidade Federal da Bahia, 2022.

Factores asociados con el tiempo de decisión para buscar atención médica por accidente cerebrovascular isquémico

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Factors associated with decision time to seek care in the face of ischemic stroke^* * Extracted from the Master’s Thesis: “Fatores associados ao tempo de decisão para procura de serviços de saúde por pessoas com acidente vascular cerebral isquêmico”. Universidade Federal da Bahia, 2022.