title: Treatment-seeking delay among women with acute myocardial infarction: decision trajectories and their predictors.
abstract: BACKGROUND
  Women's delay in seeking treatment for acute myocardial infarction symptoms results in higher rates of mortality and morbidity for women.
  
  
  OBJECTIVE
  To describe decision trajectories used by women when experiencing symptoms of acute myocardial infarction, and to identify predictors of the decision trajectory used by women with acute myocardial infarction.
  
  
  METHODS
  A cross-sectional, descriptive design was used. The nonprobability sample included 52 women hospitalized for acute myocardial infarction. To elicit descriptions of decision making, focused, semistructured interviews were used in this mixed-methods study. Predictors of decision trajectories were measured with standardized instruments among the same women. Narrative analysis was used to examine the stories from the qualitative data and to identify decision trajectory types. Discriminant analysis was used to predict trajectory type membership.
  
  
  RESULTS
  The median delay time was 4.25 hours. Most of the women used one of two trajectory types: knowing (defined as those women who knew almost immediately that they would seek help, n = 25) and managing (those women who managed an alternative hypothesis or minimized their symptoms, n = 23). Discriminant analysis correctly classified 71% (chi [4] = 11.2; n = 48; p =.02) of the cases into trajectory types on the basis of four predictor variables: social support, personal control, heart disease threat, and neuroticism.
  
  
  CONCLUSIONS
  Women's behaviors during the period between onset of acute myocardial infarction symptoms and treatment seeking can be categorized into a small number of patterns termed decision trajectories. A profile of sociostructural and intrapersonal factors with potential for predicting behavior in relation to future coronary events was developed.
authors.affiliation: Oregon Health & Science University School of Nursing, SN5N, 3455 SW Veterans Hospital Road, Portland, OR 97239-2941, USA. rosenfea@ohsu.edu
authors.forename: Anne G
authors.initials: AG
authors.lastname: Rosenfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D003717:Denial, Psychological; D016002:Discriminant Analysis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D008960:Models, Psychological; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D033262:Narration; D015205:Northwestern United States / Q000453:epidemiology; D015404:Nursing Methodology Research; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014930:Women / Q000193:education / Q000523:psychology*