Applying the Three Delays Model to understand emergency care seeking and delivery in rural Bangladesh: A qualitative study

Bansari Shah, Nandita Krishnan, Stephen R. Kodish, Gayane Yenokyan, Kaniz Fatema, Kazi Burhan Uddin, A. K.M.Fazlur Rahman, Junaid Razzak

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Objectives The Three Delays Model has been commonly used to understand and prevent maternal mortality but has not been systematically applied to emergency medical conditions more generally. The objective of this study was to identify delays in emergency medical care seeking and delivery in rural Bangladesh and factors contributing to these delays by using the Three Delays Model as a framework. Design A qualitative approach was used. Data were collected through focus group discussions and in-depth interviews using semistructured guides. Two analysts jointly developed a codebook iteratively and conducted a thematic analysis to triangulate results. Setting Six unions in Raiganj subdistrict of Bangladesh. Participants Eight focus group discussions with community members (n=59) and eight in-depth interviews with healthcare providers. Results Delays in the decision to seek care and timely receipt of care on reaching a health facility were most prominent. The main factors influencing care-seeking decisions included ability to recognise symptoms and decision-making power. Staff and resource shortages and lack of training contributed to delays in receiving care. Delay in reaching care was not perceived as a salient barrier. Both community members and healthcare providers expressed interest in receiving training to improve management of emergency conditions. Conclusions The Three Delays Model is a practical framework that can be useful for understanding barriers to emergency care and developing more tailored interventions. In rural Bangladesh, training community members and healthcare providers to recognise symptoms and manage acute conditions can reduce delays in care seeking and receiving adequate care at health facilities.

Original languageEnglish
Article numbere042690
JournalBMJ Open
Issue number12
Publication statusPublished - 23 Dec 2020
Externally publishedYes


  • accident & emergency medicine
  • public health
  • qualitative research


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