The impact of patient’s gender and cultural factors in prehospital delay in patients presenting with myocardial infarction in KSA

Abstract

Many factors have been implicated in patients’ decision to seek care in MI, but most research has a Western origin and it is possible that reasons for delay differ in Arab cultures. Our study aimed to explore the factors that contribute to pre-hospital delay among MI patients in Saudi Arabia. This study combined quantitative and qualitative methods using sequential explanatory design and received ethical approval. This cross sectional study comprised a consecutive sample of research participants (n = 311), who presented with a diagnosis of MI to 3 hospitals in Riyadh, from March 2011 to August 2011. Of these, 189 patients met the eligibility criteria and provided quantitative data. 18 patients were purposefully selected for semi-structured interviews that were taped and transcribed verbatim. There was a statistically significant difference between pre-hospital delay time (onset of symptoms to hospital arrival) and participants’ gender. For males the median delay was 5 h and for females it was 12.9 h (p = 0.002). A hierarchical multiple regression model determined female gender as the strongest predictor of total delay in this sample. Thematic content interview analysis produced a core theme-Lack of knowledge and Control and five subthemes, which will be presented with verbatim quotations. Total pre-hospital delay time reported here is longer than in studies in other settings and there are significant gender differences, particularly in transfer delay. Qualitative data indicate that cultural factors are implicated. Health promotion strategies for potential MI patients should consider offering culturally-specific, gender related messages.