Barriers to prehospital emergency response behaviors among first witnesses of stroke: A qualitative study guided by the COM-B model.

OBJECTIVES

Timely prehospital emergency response by first witnesses of stroke is critical for improving patient outcomes, yet the behavioral mechanisms underlying such responses remain poorly understood. Guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model, this study explored barriers influencing prehospital emergency response behaviors among first witnesses of stroke.

STUDY

DESIGN

Theory-informed qualitative descriptive study.

METHODS

Thirteen first witnesses of consecutive patients with acute stroke admitted to a tertiary hospital in eastern China were purposively recruited between May and August 2024. Semi-structured in-depth interviews were conducted. Data were analyzed using thematic analysis informed by Colaizzi's analytical procedures and interpreted using the COM-B framework.

RESULTS

Barriers were identified across the capability, opportunity, and motivation domains of the COM-B model. Capability-related barriers included impaired symptom recognition, limited emergency response skills, and inadequate preparedness. Opportunity-related barriers involved restricted access to emergency resources, limited social support, and misalignment between health information and public needs. Motivation-related barriers included emotional distress, fear of causing harm, ethical concerns, and distrust in emergency medical services. These interacting barriers contributed to delayed or constrained emergency responses.

CONCLUSIONS

Prehospital emergency response behaviors among first witnesses of stroke are shaped by interacting constraints across capability, opportunity, and motivation. These findings provide a theory-informed basis for developing targeted interventions and health system strategies to improve timely prehospital stroke care.