Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Mary Barger, PhD, MPH, CNM, FACNM, Chairperson; Ruth A. Bush, PhD, MPH, FAMIA, Committee Member; Brenda Boone, PhD, RN, CRN, Committee Member


Help-Seeking; Stroke; Delayed Care; Symptom Management Theory; Individual Determinants


Background: Acute thrombolytic therapy for ischemic stroke must be administered within 4.5 hours of stroke symptom onset. Despite its proven efficacy fewer than 12% of those suffering acute ischemic stroke receive this treatment. The most common reason for low utilization is late medical help-seeking. Though the relationship among predictor variables and time to medical help-seeking have been explored in previous studies, it stills remains uncertain which predictors are most influential. The aim of this study was to identify factors associated with time to medical help-seeking for patients who experienced symptoms of stroke within a U.S. Southern California-Mexico border region. This study used Andersen and Newman’s Individual Determinants of Health Service Utilization, a component of the Framework for Viewing Health Services Utilization, set within the context of Symptom Management Theory as its theoretical underpinnings. Methods: A retrospective cohort study using Get With The Guidelines® Stroke and electronic health records of patients from a single health care organization with a discharge diagnosis of ischemic stroke between October 2018 and December 2019 was conducted. Data included ischemic stroke cases admitted to a hospital through one of four hospital emergency departments. A hierarchical linear regression analysis was performed to see what variables indicated a statistically significant association with delayed medical help-seeking. Results: Of the total cases (N = 1052) discharged from the hospital with stroke, average age of 72 years and 25% Hispanic, 59% were considered delayed medical help-seekers. Regression analysis found a statistically significant association with late medical help-seeking and arriving by private vehicle (aOR 3.05, 95% CI, 2.27, 4.10), not having a prior history of stroke or TIA (aOR 1.50, CI 95%, 1.14, 1.97), and being female (aOR 1.45, 95% CI, 1.12, 1.89). However, only 10% of variance in delayed medical help-seeking could be explained. Conclusions: A majority of patients presenting to the hospital emergency department for symptoms of stroke were delayed medical help-seekers (> 4 hours from symptom onset). These patients arrived too late for first-line treatment with intravenous thrombolytics. It is necessary to identify those at risk for delayed medical help-seeking in order to decrease stroke mortality and long-term disabilities.

Document Type

Dissertation: Open Access



Included in

Other Nursing Commons