Cultural factors increase pre-hospital delay in myocardial infarction for Saudi women

Many factors have been implicated in patients’ decisions 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 prehospital delay among MI patients in Saudi Arabia. This cross sectional study comprised a convenience sample of research participants (n=311), who presented with a diagnosis of MI to three hospitals in Riyadh from March 2011 to June 2011. Of these, 189 patients met the eligibility criteria. 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 hours (M=5.78, SD=1.736) and for females it was 12.9 hours [M=6.79, SD=1.851; t (187) =-3.097, p=.002]. This was despite similar intervals between the genders for symptom onset to decision to seek care (male= 2.5 hours, female =3 hours). In addition, only 12% of females versus 88% of male participants arrived at hospital in the first hour of symptom onset. The median transfer time for all participants was 45 minutes, (0.5hrs for men and 2.5 hours for women). The gender differences in pre-hospital delay in Saudi are likely to be influenced by cultural factors, since the majority of females (97%), in this study cannot drive and it is culturally prohibited for them to go to hospital without a male relative escorting them. Only, 11% of patients from both genders travelled to the hospital by ambulance. Moreover, symptom onset most commonly occurred at home for both males (65%) and females (78%) and the most popular response (41%) was to try a self-help remedy. Two factor ANOVA demonstrated that females delay significantly more than males when they are non-Saudi, have no dyspnea and when they are outside their home at symptom onset (p < 0.05), perhaps due to language and cultural barriers. This the first study conducted with MI patients in Saudi within the restrictions of an Arab culture. Overall the total pre-hospital delay time reported here is longer than in studies in other settings and there are significant gender differences. We postulate that cultural factors are implicated. Health promotion strategies for potential MI patients should consider offering culturally- specific, gender related messages.