Paper
Friday, 21 July 2006
This presentation is part of : Critical Care Initiatives
Testing a Theory of Delay in Seeking Treatment for Acute Myocardial Infarction
Susan M. Fox-Wasylyshyn, RN, PhD and Maher M. El-Masri, RN, PhD. Faculty of Nursing, University of Windsor, Windsor, ON, Canada
Learning Objective #1: Identify predictors of delay in seeking care for symptoms of acute myocardial infarction
Learning Objective #2: Understand the process of delay in seeking care for symptoms of acute myocardial infarction within the context of a theoretical framework
Background:  Although much research has been conducted to investigate the phenomenon of delay in seeking treatment for symptoms of acute myocardial infarction (AMI), no studies examined this phenomenon within the context of a theory-testing approach.
Purpose: To test a theory of delay in seeking treatment for acute myocardial infarction
Methods: A retrospective, descriptive cross-sectional design was conducted on a convenience sample of 135 in-patients who had recently experienced out-of-hospital AMI. Two models adapted from Reynolds & Alonzo’s (2000) AMI Coping Model were tested. One model was tested on the full sample, while the other included the sub-sample of 73 patients who attributed their symptoms to the heart.  Participants completed an instrument eliciting information pertaining to history of AMI, congruence between symptoms experienced and pre-conceived ideas about the nature of AMI symptoms (symptom congruence), responses to symptoms, if and when symptoms were attributed to the heart, and the time taken seek medical care (decision delay).  Data were analysed using structural equation modeling.
Results: After trimming non-significant paths, goodness of fit indices (RMSEA, c2/df, GFI, AGFI, NFI, NNFI) of both models demonstrated excellent fit with the data. Independent predictors of decision delay were symptom congruence, attribution of symptoms to the heart, time elapsed until symptoms were attributed to the heart, and use of emotion-focused coping responses to symptoms. Although history of AMI had a direct positive relationship with decision delay, the total effect of AMI history was not significant. The first and second models explained 16.6% and 55.6% of the variance in decision delay, respectively.
Conclusions: The findings suggest that symptom congruence,  attribution of symptoms to the heart, and emotion-focused coping were independent predictors of AMI care-seeking delay. Despite a direct positive effect, the total effect of history of AMI on delay was not significant.

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