Diagnostic delay among newly diagnosed pulmonary hypertension patients: A narrative study based on the social-ecological system theory Running title: Diagnostic delay in pulmonary hypertension: a narrative study
Year: 2026
Type: preprint
Abstract: Background Pulmonary hypertension is a progressive pulmonary vascular disease with a poor prognosis. Its early symptoms lack specificity, leading to widespread diagnostic delays.¹ Most patients are already in the moderate-to-severe stage at the time of diagnosis. Existing research has primarily focused on pathophysiological mechanisms and pharmacological treatment, while there is insufficient understanding of the socio-ecological barriers that contribute to diagnostic delays. Methods This study conducted a qualitative narrative inquiry within a socio-ecological framework. Using purposive sampling, 16 patients with newly diagnosed pulmonary hypertension were selected from a tertiary hospital in Guizhou. Through semi-structured narrative interviews, the study explored in depth their complete journey from symptom onset to diagnosis. Data were analyzed using three-dimensional narrative analysis combined with thematic coding, and mapped to the micro, meso, and macro system levels. The rigor of the study was ensured through triangulation, member validation, and independent coding by two researchers. This study was reported in accordance with the COREQ checklist. Results The median diagnostic delay was 6 months (range: 1 month–40 years). At diagnosis, 93.75% of patients presented with WHO functional class III–IV, and 87.5% were classified as having moderate-to-severe pulmonary hypertension. Notably, patients with lower education levels and from rural areas experienced more pronounced diagnostic delays.Three thematic levels emerged. At the micro level, patients exhibited gaps in disease knowledge and symptom misattribution (to aging or common colds), leading to passive healthcare-seeking behavior driven by economic concerns. At the meso level, fragmented referral pathways, poor clinician-patient communication, and lagging family support were identified as key barriers. At the macro level, systematic deficiencies in public pulmonary hypertension education and structural inadequacies in primary care diagnostic resources were pervasive. Conclusions Diagnostic delay in pulmonary hypertension represents not simply a deficit in patient awareness, but a systemic failure operating across multiple socio-ecological levels, which directly contributes to the presentation of advanced right heart failure at the time of diagnosis. There is an urgent need to implement multi-tiered intervention strategies: raising awareness among the public and primary care providers, optimizing resource allocation, and establishing standardized screening protocols. This study provides qualitative evidence for designing targeted interventions to shorten the diagnostic window and prevent irreversible pulmonary vascular damage. Trial registration: Not applicable. This study does not report results of a clinical trial involving human participants.
Source: Research Square
Authors: Mi Cui, Wenqing Yang
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Guizhou Medical University
OpenAlex ID: W7225338741