Factors influencing pre-hospital decision-making among stroke survivors in the rural area of South Africa: an exploratory study.

Introduction: Stroke remains a leading cause of mortality and disability globally, with a disproportionate burden in low-and middle-income countries. While early intervention is the clinical gold standard, pre-hospital delays remain a significant barrier to effective treatment in rural South African contexts. This qualitative study explored the socio-cultural, cognitive, and structural factors influencing stroke survivors' decision-making pathways in rural South Africa. Methods: An exploratory qualitative design was employed. Ten stroke survivors were recruited from rural Limpopo Province using snowball sampling. Data were collected through semi-structured interviews and analysed using thematic analysis. Results: Three primary themes emerged as determinants of pre-hospital delay factors. Knowledge of stroke, severity of the symptoms, belief system and distance to medical health facilities. Discussion: Pre-hospital delay among rural South African stroke survivors is a complex interplay of knowledge, cultural causal attributions and systematic healthcare inequalities. Efforts to reduce pre-hospital delay must move beyond hospital-based education and enter the community's primary networks: the home, the church, and the traditional healer's office.