Myocardial infarction, patient decision delay and help‐seeking behaviour: a thematic analysis

Coventry, Linda L.; Schalkwyk, Welma Van; Thompson, Peter L.; Hawkins, Scott A; Hegney, Desley

doi:10.1111/jocn.13607

Cited by 30 publications

(38 citation statements)

References 44 publications

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“…For example, in our study we report that some used the ED because it was convenient, and this perception is likely to be further exacerbated when primary care services are hard to access in a timely way. Lack of clarity around what 'urgent' means to service users may also lead to delays in help-seeking 218 and we suggest that some groups (e.g. older people) may wait longer to access care.…”

Section: Model Of Urgent Care Help-seekingmentioning

confidence: 93%

Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

Turnbull

McKenna

Prichard

et al. 2019

Health Serv Deliv Res

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BackgroundPolicy has been focused on reducing unnecessary emergency department attendances by providing more responsive urgent care services and guiding patients to ‘the right place’. The variety of services has created a complex urgent care landscape for people to access and navigate.ObjectivesTo describe how the public, providers and policy-makers define and make sense of urgent care; to explain how sense-making influences patients’ strategies and choices; to analyse patient ‘work’ in understanding, navigating and choosing urgent care; to explain urgent care utilisation; and to identify potentially modifiable factors in decision-making.DesignMixed-methods sequential design.SettingFour counties in southern England coterminous with a NHS 111 provider area.MethodsA literature review of policy and research combined with citizens’ panels and serial qualitative interviews. Four citizens’ panels were conducted with the public, health-care professionals, commissioners and managers (n = 41). Three populations were sampled for interview: people aged ≥ 75 years, people aged 18–26 years and East European people. In total, 134 interviews were conducted. Analyses were integrated to develop a conceptual model of urgent care help-seeking.FindingsThe literature review identified some consensus between policy and provider perspectives regarding the physiological factors that feature in conceptualisations of urgent care. However, the terms ‘urgent’ and ‘emergency’ lack specificity or consistency in meaning. Boundaries between urgent and emergency care are ill-defined. We constructed a typology that distinguishes three types of work that take place at both the individual and social network levels in relation to urgent care sense-making and help-seeking.Illness workinvolves interpretation and decision-making about the meaning, severity and management of physical symptoms and psychological states, and the assessment and management of possible risks. Help-seeking was guided bymoral work: the legitimation and sanctioning done by service users.Navigation workconcerned choosing and accessing services and relied on prior knowledge of what was available, accessible and acceptable. From these empirical data, we developed a model of urgent care sense-making and help-seeking behaviour that emphasises that work informs the interaction between what we think and feel about illness and the need to seek care (sense-making) and action – the decisions we take and how we use urgent care (help-seeking).LimitationsThe sample population of our three groups may not have adequately reflected a diverse range of views and experiences. The study enabled us to capture people’s views and self-reported service use rather than their actual behaviour.ConclusionsMuch of the policy surrounding urgent and emergency care is predicated on the notion that ‘urgent’ sits neatly between emergency and routine; however, service users in particular struggle to distinguish urgent from emergency or routine care. Rather than focusing on individual sense-making, future work should attend to social and temporal contexts that have an impact on help-seeking (e.g. why people find it more difficult to manage pain at night), and how different social networks shape service use.Future workA whole-systems approach considering integration across a wider network of partners is key to understanding the complex relationships between demand for and access to urgent care.Study registrationThis study is registered as UKCRN 32207.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Model Of Urgent Care Help-seekingmentioning

confidence: 93%

Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

Turnbull

McKenna

Prichard

et al. 2019

Health Serv Deliv Res

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“…Here, attribution of symptoms to a cardiac cause has been found to be crucial [6][7][8][9][10]. In order to enable the patients to attribute the symptoms to the heart, knowledge of the symptoms of an AMI and the ability to recognize them seems to be beneficial [11][12][13]. However, to our knowledge, no review has attempted to summarize the findings on these factors systematically and give an overview of the world-wide knowledge levels of the AMI symptoms.…”

Section: Introductionmentioning

confidence: 99%

Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review

Birnbach

Höpner

Mikolajczyk

2020

BMC Cardiovasc Disord

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Background Since the knowledge of the symptoms of acute myocardial infarction (AMI) may reduce the decision time for patients to seek help in case of an AMI, we aimed to summarize evidence on the knowledge of the AMI symptoms and the symptom attribution in case of an acute coronary syndrome (ACS). Methods Therefore, we systematically searched the databases PubMed, CINAHL, Embase, and Cochrane Library for relevant studies published between January 1, 2008 and 2019 (last search August 1, 2019). Results A total of 86 studies were included, with a composite sample size of 354,497 participants. The weighted mean of the knowledge scores for the symptoms of AMI of 14,420 participants from the general population, was 42.1% (when maximum score was considered 100%) and 69.5% for 7642 cardiac patients. There was a substantially better level of knowledge for six symptoms (‘chest pain or discomfort’, ‘shortness of breath’, ‘pain or discomfort in arms or shoulders’, ‘feeling weak, lightheaded, or faint’, ‘pain or discomfort in the jaw, neck, or back’, and ‘sweating’) (49.8–88.5%) compared to the four less obvious/atypical symptoms ‘stomach or abdominal discomfort’, ‘nausea or vomiting’, ‘headache’, and ‘feeling of anxiety’ (8.7–36.7%). Only 45.1% of 14,843 patients, who experienced ACS, have correctly attributed their symptoms to a cardiac cause. Conclusion In conclusion, we found a moderate to good knowledge of “classic” and insufficient knowledge of less obvious symptoms of AMI. This might suggest that increasing knowledge about less obvious symptoms of AMI could be beneficial. It appears also important to address cardiac attribution of symptoms.

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“…The specificity of women's experience with AMI lasts throughout the disease course. Women's symptoms have often been defined ‘atypical’ : this might explain why AMI is not readily recognised by female patients and their families and seldom even by doctors , resulting in delayed access to care . The lack of recognition of the event often persists over time, as women frequently play down the impact of the infarction .…”

Section: Introductionmentioning

confidence: 99%

Quality of life, coping strategies, social support and self‐efficacy in women after acute myocardial infarction: a mixed methods approach

Fuochi

Foà

2017

Scandinavian Caring Sciences

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Background Quality of life, coping strategies, social support and self‐efficacy are important psychosocial variables strongly affecting the experience of acute myocardial infarction (AMI) in women. Aims To gain a more in‐depth understanding of how coping strategies, self‐efficacy, quality of life and social support shape women's adjustment to AMI. Design Mixed methods study. Quantitative data were collected through a standardised questionnaire on coping strategies, self‐efficacy, quality of life and social support. Qualitative data stemmed from 57 semistructured interviews conducted with post‐AMI female patients on related topics. Methods Quantitative data were analysed with unpaired two‐sample t‐tests on the means, comparing women who experienced AMI (N = 77) with a control group of women who did not have AMI (N = 173), and pairwise correlations on the AMI sample. Qualitative data were grouped into coding families and analysed through thematic content analysis. Qualitative and quantitative results were then integrated, for different age groups. Results Quantitative results indicated statistically significant differences between women who experienced AMI and the control group: the former showed lower self‐perceived health, perceived social support and social support coping, but greater self‐efficacy, use of acceptance, avoidance and religious coping. Pairwise correlations showed that avoidance coping strategy was negatively correlated with quality of life, while the opposite was true for problem‐oriented coping, perceived social support and self‐efficacy. Qualitative results extended and confirmed quantitative results, except for coping strategies: avoidance coping seemed more present than reported in the standardised measures. Conclusion Mixed methods provide understanding of the importance of social support, self‐efficacy and less avoidant coping strategies to women's adjustment to AMI. Relevance to clinical practice Women need support from health professionals with knowledge of these topics, to facilitate their adaptation to AMI.

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Myocardial infarction, patient decision delay and help‐seeking behaviour: a thematic analysis

Abstract: This study highlights the need to educate both the patient and the wider public, not only to seek prompt care but to also to call the emergency ambulance to arrange transport to the emergency department.

Cited by 30 publications

References 44 publications

Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

Sense-making strategies and help-seeking behaviours associated with urgent care services: a mixed-methods study

Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review

Quality of life, coping strategies, social support and self‐efficacy in women after acute myocardial infarction: a mixed methods approach

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