Prev
Med 2000 Sep;31(3):205-13
Patient delay in seeking care for heart attack symptoms: findings from
focus groups conducted in five U.S. regions.
Finnegan JR Jr, Meischke H, Zapka JG, Leviton L, Meshack A, Benjamin-Garner
R, Estabrook B, Hall NJ, Schaeffer S, Smith C, Weitzman ER, Raczynski J,
Stone E.
University of Minnesota, Minneapolis, Minnesota 55455, USA.
BACKGROUND: Patient delay in seeking health care for
heart attack symptoms is a continuuing problem in the United States.
METHODS: Investigators conducted focus groups (N = 34;
207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative
evaluation to develop a multi-center randomized community trial (the REACT
Project). Target groups included adults with previous heart attacks, those
at higher risk for heart attack, and bystanders to heart attacks. There
were also subgroups reflecting gender and ethnicity (African-American,
Hispanic-American, White).
FINDINGS: Patients, bystanders, and those at higher risk
expected heart attack symptoms to present as often portrayed in the movies,
that is, as sharp, crushing chest pain rather than the more common onset
of initially ambiguous but gradually increasing discomfort. Patients and
those at higher risk also unrealistically judge their personal risk as
low, understand little about the benefits of rapid action, are generally
unaware of the benefits of using EMS/9-1-1 over alternative transport,
and appear to need the "permission" of health care providers
or family to act. Moreover, participants reported rarely discussing heart
attack symptoms and appropriate responses in advance with health care
providers, spouses, or family members. Women often described heart attack
as a "male problem," an important aspect of their underestimation
of personal risk. African-American participants were more likely to describe
negative feelings about EMS/9-1-1, particularly whether they would be
transported to their hospital of choice.
CONCLUSIONS: Interventions to reduce patient delay need
to address expectations about heart attack symptoms, educate about benefits
and appropriate actions, and provide legitimacy for taking specific health
care-seeking actions. In addition, strategy development must emphasize
the role of health care providers in legitimizing the need and importance
of taking rapid action in the first place. Copyright 2000 American Health
Foundation and Academic Press.
PMID: 10964634 [PubMed - indexed for MEDLINE]
