Mass Media Campaigns’ Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign

Abstract

BackgroundThe aim of this study was to examine the awareness of a recent mass media campaign, and its influence on knowledge and prehospital times, in a cohort of acute coronary syndrome (ACS) patients admitted to an Australian hospital.Methods and ResultsWe conducted 199 semistructured interviews with consecutive ACS patients who were aged 35 to 75 years, competent to provide consent, and English speaking. Questions addressed the factors known to predict prehospital delay, awareness of the campaign, and whether it increased knowledge and influenced actions. Multivariable logistic regression was used to examine the association between campaign awareness and a 1-hour delay in deciding to seek medical attention (patient delay) and a 2-hour delay in presenting to hospital (prehospital delay). The median age was 62 years (IQR=53 to 68 years), and 68% (n=136) were male. Awareness of the campaign was reported by 127 (64%) patients, with most of these patients stating the campaign (1) increased their understanding of what is a heart attack (63%), (2) increased their awareness of the signs and symptoms of heart attack (68%), and (3) influenced their actions in response to symptoms (43%). After adjustment for other predictors, awareness of the campaign was significantly associated with patient delay time of ≤1 hour (adjusted odds ratio [AOR]=2.25, 95% CI: 1.03 to 4.91, P=0.04) and prehospital delay time ≤2 hours (AOR=3.11, 95% CI: 1.36 to 7.08, P=0.007).ConclusionsOur study showed reasonably high awareness of the warning signs campaign, which was significantly associated with shorter prehospital decision-making and faster presentation to hospital.

The barriers associated with emergency medical service use for acute coronary syndrome: the awareness and influence of an Australian public mass media campaign

“…As previously reported,13 323 patients with ACS were admitted and screened for the study. Of these, 109 were ineligible (age n=77, non–English speaking n=15, medically unstable n=8, inpatient event n=5, cognitive impairment n=3, and previously interviewed and readmitted n=1) and 214 were eligible, with 199 (93%) patients consenting and 15 declining to participate.…”

“…We conducted a prospective, single-centre survey of patients with ACS13 examining awareness of the campaign, EMS use and reason for choice of transport. This study was approved by the Monash University Human Ethics Research Committee (CF13/3743-2013001917) and the Alfred Hospital Human Ethics Committee (235/13).…”

“…The interview tool (see online supplementary appendix 1)13 included questions from the modified Response to Symptoms Questionnaire16 17 and specific questions about awareness of the campaign, mode of transport to hospital and rationale for not using EMS (open-ended question with multiple answers allowed).…”

“…This campaign ran periodically across the state of Victoria, Australia, between 2009 and 2012, with an intense campaign in the city of Melbourne for 4 months in 2013 13 14. We have previously reported an association between awareness of this campaign and shorter times in presenting to hospital in patients with ACS 13. A more recent report found an increase in the number of calls to EMS for chest pain during the period in which campaign activity took place; however, it is unknown if these users had ACS14 or if the campaign had an impact on the factors that prevent the use of EMS 14.…”

“…In 2009, to address these barriers and to improve awareness of symptoms and reduce prehospital delay in ACS, the Heart Foundation of Australia launched the ‘Warning Signs of Heart Attack’ strategy 13. The strategy included mass media and digital advertising campaigns with a primary focus on the lesser known warning signs of ACS and the importance of acting quickly by calling EMS, and a secondary focus on barriers of embarrassment and perceived seriousness.…”