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Reasons for Delay in Seeking Medical Help Among the African American Population with Symptoms of Myocardial Infarction

出版	University of California, San Francisco, 2005
URL	http://books.google.com.hk/books?id=2UTiLipzUfAC&hl=&source=gbs_api

註釋Prompt treatment decreases myocardial damage and is a critical determinant of mortality in an acute myocardial infarction (AMI). Patients who receive reperfusion therapy (i.e., thrombolysis and coronary artery angioplasty) within the first hour of symptom onset receive the most benefit; however many patients are excluded from therapy because of excessive delay. African Americans delay substantially longer than other ethnic groups, missing the opportunity for effective treatment. The purpose of this dissertation was to examine the factors associated with prolonged prehospital delay time, and to examine the extent to which perceived racism influences prehospital delay time in African Americans with AMI. In two descriptive studies, 12 African American women were interviewed using the qualitative method, interpretive phenomenology and 61 African Americans were interviewed using established questionnaires. In the qualitative study, women's interpretation of and response to symptoms were informed by experiences of marginalization and their self-understanding as people who were strong and endured life hardships. When hospitalized, some women experienced trivialization of their complaints by clinicians and a focus on technological procedures over respectfully attending to their concerns, providing further disincentives to seeking care. Three major themes emerged: (a) misrecognition/discounting of symptoms, (b) enduring, and (c) influence of faith. The median prehospital delay time of the second sample was 4.3 hours. The number one reason for prehospital delay given by both genders was waiting to see if symptoms would go away. Median delay time for insured patients was longer compared to uninsured (4.5 vs. 0.5 hours). Single patients had longer delay times compared to married patients (5.3 vs. 2.5 median hours), and patients with diabetes delayed longer than non-diabetics (7.3 hours vs. 3.5 median hours). Educational counseling for patients and health care providers must emphasize the most common response of African Americans to cardiac symptoms in the course of an AMI, and target interventions that focus on the importance of prompt response in seeking medical care with the intent to decrease the high mortality rates in this population.