The impact of patients’ gender and cultural factors in prehospital delay in patients presenting with myocardial infarction in Kingdom of Saudi Arabia (KSA)

Introduction: 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.
Method: 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.
Findings: 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
and for females it was 12.9 hours (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 sub-themes,
which will be presented with verbatim quotations.
Conclusion: 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.