Delayed presentation to hospital for paediatric appendicitis in rural families is most frequently due to extended decision-making around the costs and benefits of accessing hospital-level care, according to a qualitative study. The study involved semi-structured interviews with the parents of 11 rural children presenting to hospital with acute appendicitis between June 2019 and January 2020. The mean distance travelled to hospital was 50.4 km, and the median duration of prehospital symptoms was 42 hours. Families more likely to ‘watch and wait’ were those with reduced financial or social resources. Travel, organising childcare and parental income loss were key considerations. Prompt access and engagement with healthcare was further discouraged by structural barriers including poor cultural safety, maldistribution of rural health services, and contradictory public health messages. Earlier presentation to hospital was evident for families who sought informal community-based health advice.
