背景：认知障碍疾病（Cognitive impairment）患病率不断上升，已成为一项重要的公共卫生问题。轻度认知障碍（Mild cognitive impairment,MCI）和痴呆（Dementia）是认知障碍疾病发展的不同阶段，MCI被认为是痴呆的前驱期，具有向痴呆转化的高风险。在MCI阶段及时识别、诊断及干预，是维持认知功能甚至逆转至正常认知的重要途径。疾病的早识别和治疗有赖于个体积极主动的就医行为及良好的外部就医环境。目前，MCI患者就诊率低，提示存在就医延迟的问题。研究MCI患者就医延迟的原因，对促进认知障碍疾病的防控具有重要意义。

目的：本研究旨在描述区域内MCI患者就医延迟现状，并分析患者就医延迟的影响因素，以期补充关于MCI患者就医延迟现实情况及困境的实证数据，为区域内相关政策制定提供参考，引导患者科学及时就医。

方法：本研究基于安德森模型（Andersen’s behavioral model），使用问卷调查法和半结构式访谈法开展研究。采用便利抽样法从四川省泸州市某三甲医院门诊选取MCI患者实施问卷调查。采用目的抽样法，选取四川省泸州市内各级医疗机构医务工作者、就医延迟的MCI患者实施访谈。问卷数据导入SPSS27.0，采用卡方检验、非参数检验及二元Logistic回归分析进行统计分析。访谈资料经转录后导入Nvivo软件,采用主题分析法，以初始编码、提炼子主题、归纳主题为研究路径进行主题分析。

结果：研究发放并收回问卷208份，有效问卷201份，有效率96.63%。患者自我报告出现症状到医疗服务利用的时间在4天-5.8年之间，以3个月为界，将患者分为未延迟组和延迟组。延迟组患者165人，就医延迟率82.09%。患者延迟就医的平均时间为1.46年，中位时间1.18 (0.48，1.99)年。延迟时间在2年内的患者占比75.14%。单因素分析结果显示，延迟组和未延迟组患者在倾向特征下的性别、职业类型中存在统计学差异（P＜0.05）；在能力资源下的每月可支配收入，所在社区/乡镇开展认知障碍疾病宣传/知识讲座情况、居住地离确诊医疗机构的距离中存在统计学差异（P＜0.05）。多因素分析结果显示，职业、每月可支配收入、社区/乡镇开展认知障碍疾病宣传/知识讲座情况、居住地离确诊医疗机构的距离是患者就医延迟的独立影响因素。与单位在业人员相比，退休人员发生就医延迟的风险显著增加（OR=4.721, 95%CI:1.607-13.869, P=0.005）；与每月可支配收入小于3000元的患者相比，每月可支配收入在5000元以上的患者发生就医延迟风险显著降低（OR=0.247, 95%CI:0.073-0.832, P=0.024）；与社区/乡镇未开展相关知识宣传/疾病讲座的患者相比，开展过相关宣讲的社区/乡镇患者就医延迟风险显著降低（OR=0.171, 95%CI:0.044-0.662, P=0.011）；居住地到确诊医疗机构距离越远的患者，发生就医延迟的风险越高（OR=1.023, 95%CI:1.006-1.041, P=0.009）。研究共纳入访谈对象26名，其中医生16人，就医延迟的MCI患者10例。受访患者从出现症状到医疗服务利用的时间在10-33个月之间，确诊前的就医频次在0-4次之间，患者在医疗服务利用过程中存在就诊、确诊或治疗延迟的情况。通过对文本数据的主题分析，形成就医延迟影响因素的5个主题：疾病低认知、疾病弱感知、疾病应对偏差、自主就医能力欠缺、医疗服务供给不足。

结论及建议：安德森模型对本研究具有较好的指导价值。研究揭示了区域内MCI患者就医延迟现象普遍存在，延迟率处于国内慢性疾病就医延迟发生率的较高水平。MCI患者就医延迟存在于“患者就诊-疾病确诊-系统治疗”三个医疗服务利用的不同环节，呈现系统性特征。MCI患者就医延迟受环境因素及个人特征综合影响。建议加强健康教育，促进患者主动健康；加强相关医务人员认知障碍疾病诊疗能力培训；加强认知功能筛查，促进高风险人群的及时识别。

Background：The prevalence of cognitive impairment continues to rise, and it has grown into a major public health issue. Mild cognitive impairment (MCI) and Dementia represent different stages in the progression of cognitive disorders. MCI is considered a precursor stage to dementia with a high risk of progression. Early identification, diagnosis, and intervention in this stage are crucial for maintaining cognitive function or even reversing impairment. Timely identification and treatment of cognitive disorders rely heavily on the individual’s proactive healthcare-seeking behavior and a supportive external healthcare environment. Currently, the consultation rate among MCI patients is low, indicating problems of delay in seeking medical care. Therefore, a study on the current status and reasons for delay in seeking health care is of great significance for promoting the prevention and control of cognitive impairment diseases.

Objective：This study aims to describe the current status of delay in seeking health care among MCI patients within the surveyed region and analyze the influencing factors. It is expected to supplement the empirical data regarding the realities and dilemmas associated with delays in seeking health care with mild cognitive impairment, thereby providing references for the formulation of relevant policies in the region and guiding patients to seek medical care in a scientific and timely manner.

Methods：Based on Andersen’s behavioral model, this study used a combination of questionnaire surveys and semi-structured interviews. Patients with MCI were selected through convenience sampling from the outpatient clinic of a tertiary hospital in Luzhou, Sichuan Province, and were asked to complete questionnaires. Healthcare providers from different medical institutions and MCI patients experiencing delays in seeking treatment were recruited through purposive sampling for interviews. Questionnaire data were analyzed using SPSS 27.0, employing Chi-square tests, non-parametric tests, and binary logistic regression analysis. Interview transcripts were imported into Nvivo software, and thematic analysis was conducted following a three-step process: initial coding, refining sub-themes, and summarizing themes.

Results：A total of 208 questionnaires were distributed and collected, yielding 201 valid questionnaires (effective rate: 96.63%). The time from symptom onset to healthcare utilization ranged from 4 days to 5.8 years. Based on a threshold of 3 months, patients were categorized into delayed and non-delayed groups. There were 165 patients in the delayed group, yielding a delay rate of 82.09%. The average delay was 1.46 years, with a median delay of 1.18 (0.48, 1.99) years. Patients delayed by less than 2 years accounted for 75.14%. Univariate analysis revealed statistically significant differences (P<0.05) between delayed and non-delayed groups in terms of gender and occupational type under predisposing characteristics. Furthermore, significant differences (P<0.05) were observed in monthly disposable income, community or township provision of cognitive impairment-related educational activities, and distance from residence to diagnostic medical institutions under enabling resources. Multivariate analysis showed that occupation, monthly disposable income, cognitive impairment educational lectures in communities or towns, and distance to diagnostic medical institutions were independent influencing factors for delays in seeking health care. Compared to currently employed individuals, retirees had a significantly increased risk of delay (OR=4.721, 95%CI:1.607–13.869, P=0.005). Patients with a monthly disposable income above 5,000 yuan had a significantly lower risk of delay compared to those earning less than 3,000 yuan (OR=0.247, 95%CI:0.073–0.832, P=0.024). Those residing in communities or towns that provided educational lectures had significantly lower risks than those without such resources (OR=0.171, 95%CI:0.044–0.662, P= 0.011). Patients living farther away from diagnostic institutions had a significantly increased risk (OR=1.023, 95%CI:1.006–1.041, P=0.009). The study included 26 interviewees, comprising 16 medical practitioners and 10 MCI patients who experienced delays. Time from symptom onset to healthcare utilization ranged from 10 to 33 months, and the number of healthcare visits prior to diagnosis ranged from 0 to 4. Delays occurred across various stages of healthcare utilization, including initial consultation, diagnosis, and treatment. Thematic analysis identified five primary reasons for delays: low disease awareness, weak disease perception, incorrect coping strategies, limited autonomous healthcare-seeking capacity, and insufficient healthcare provision.

Conclusion and Suggestions：Andersen’s behavioral model provided effective guidance for this study. The study revealed a high prevalence of delayed healthcare-seeking behaviors among patients with MCI in the region, with a delay rate comparable to the upper range reported for chronic diseases in China. Delays were identified across different stages (initial consultation, diagnosis, and systematic treatment), reflecting a systematic characteristic. Delays were influenced by both environmental factors and individual characteristics. Recommendations include strengthening health education to enhance patient proactivity, providing targeted training to medical personnel on cognitive impairment diagnosis and treatment, and increasing cognitive function screening to enable timely identification of high-risk populations.