Symptom Denial and Cultural Constraints: A Qualitative Exploration of Pre‐Hospital Delay Determinants in Myocardial Infarction Patients in China

OBJECTIVE: To explore the pre-hospital delay experiences of myocardial infarction patients in China from a patient-centered perspective. BACKGROUND: Pre-hospital delay remains a globally prevalent issue, influenced by subjective and context-dependent factors that are not easily captured through quantitative methods. Traditional metrics may oversimplify the psychological processes involved and fail to account for individual variability and contextual influences. DESIGN: A descriptive qualitative study. METHODS: Semi-structured interviews were conducted with MI patients at a tertiary hospital in Qingdao between November 18 and 30, 2024. Participants were selected through purposeful sampling. Thematic analysis was performed using MAXQDA software to code and analyze the qualitative data. The study followed the COREQ checklist. FINDINGS: We interviewed 16 patients and conducted four core themes: (1) limited disease awareness, (2) inappropriate symptom response strategies, (3) constraints of traditional cultural beliefs and (4) family influence on decision-making, along with 12 subthemes. CONCLUSION: Patients' pre-hospital delays frequently stem from cognitive limitations in symptom recognition coupled with maladaptive coping strategies contributes to treatment postponement. Notably, familial decision-making intervention demonstrates potential in mitigating such delays. And traditional Chinese culture exerts a profound influence on pre-hospital delays among elderly MI patients. IMPLICATIONS FOR PATIENTS: Patients' experiences of pre-hospital delay in myocardial infarction reveal its key determinants. Healthcare providers should develop targeted interventions tailored to patients' cognition, culture, and family situations to enhance intervention effectiveness. PATIENT OR PUBLIC CONTRIBUTION: Patients and family members contributed to the data collected.