Abstract 13428: Unveiling the Predictive Mechanisms of Care-seeking Delay in Patients With Acute Myocardial Infarction

Abstract

Introduction: Despite decades of research has been conducted to examine the phenomenon of care-seeking delay in patients with acute myocardial infarction (AMI), such delay remains the most significant limiting factor for effective disease management. Objectives: This study aimed to develop and test an integrative theoretical model to unveil the predictive mechanism for explaining the care-seeking behaviors of patients who experiencing an attack of AMI. Methods: Based on several major theories which explain the illness behaviors of patients with chronic diseases and the research evidence on the care-seeking behaviors of AMI patients, we hypothesized that AMI patients’ care-seeking decision was determined by two sequential perceptual-cognitive processes and the immediate context of symptom occurrence. A total of 301 patients with a recent AMI were recruited from the cardiac units of three regional hospitals in Hong Kong. Structural equation modeling was used to test the validity of the hypothesized model. Results: The results indicated the decision-making process of AMI patients was driven by two sequential perceptual-cognitive processes, by which a successful action relied on whether the patients could correctly attribute the symptoms to AMI. Such correct symptom attribution depended upon whether they were aware of their own susceptibility to this condition and had a good understanding about the nature of the disease manifestation. A perception of severe illness consequences and the associated negative emotional arousal motivated patients to seek care. The immediate context in which the symptoms occurred also played a role in influencing their decision making, with the favorable roles of lower level of perceived barriers to seek care and positive cues from others in advising care-seeking. This model explained 46% of the variance of care-seeking behaviors with a good data-model fit (χ2 = 38.48, df=30, p=0.72; RMSEA=0.03, NFI=0.96, NNFI=0.98 and CFI=0.99). Conclusions: The integrative theoretical model is valid to explain the care-seeking decisions in AMI patients. This model provides important insights to inform the development of innovative empowerment strategies to enhance appropriate care-seeking decisions and behaviors among AMI patients.