BACKGROUND: Approximately 50% of Danish stroke patients did not arrive within the 4.5-hour revascularization window in 2018, and only 20% received acute revascularization therapy. Delay in seeking help was a major factor for missing the time window. This study explored patient-reported factors influencing the timing of a decision to seek help. METHODS: We performed a qualitative interview study to explore prehospital help-seeking behavior. Inclusion was guided by a purposive sampling of stroke and transient ischemic attack patients and, if necessary, bystanders. Semistructured explorative interviews with 8 patients and 2 bystanders were audio-recorded, transcribed verbatim, and analyzed via thematic analysis. RESULTS: Analysis yielded 3 main themes: (1) symptom interpretation, (2) barriers and enablers to response, and (3) participant suggested optimization of acute stroke response and awareness. DISCUSSION: Factors associated with prompt action to seek help were either a perception that the symptom indicated a serious illness or a strong emotional response. Patients with recurrent stroke failed to associate symptoms with a new stroke. Having a stroke in unfamiliar surroundings prompted delay in seeking help. Suggestions for optimization included targeted stroke campaigns. CONCLUSION: Response to stroke onset may be driven by perceptions of symptom severity and emotional response rather than the ability to correctly identify symptoms. Stroke education should include the information that new stroke symptoms may be different from the old ones because different parts of the brain may be affected.