Women's interpretation of cardiac symptoms at the time of their cardiac event: the effect of co-occurring illness.
BACKGROUND
Women tend to access medical help for a myocardial infarction later than men and are at a disproportionate risk of dying or of suffering disability as a consequence. Co-morbidity is associated with delay but little is known how this affects decision making.


OBJECTIVE
To examine the effect of co-occurring chronic illness or infections on women's interpretation of their symptoms and action at the time of their cardiac event.


METHODS
Semi-structured interviews with 44 women admitted to 3 district hospitals following a cardiac event. For the purposes of analysis they were divided into those who arrived at the hospital within 12 h of onset of symptoms (<12 hour group) and those who took more than 12 h (>12 hour group).


RESULTS
Women utilised their mental records of knowledge and experiences to make sense of their cardiac symptoms. The mental records of the <12 hour group contained knowledge of symptoms and previous experiences relevant to cardiac problems. Those of the >12 hour group contained knowledge and experience of recent and co-occurring chronic illnesses, this provided persuasive 'evidence' to suggest that their symptoms were normal or typical for their current state of health and resulted in delay.


CONCLUSIONS
Women's decision making and timely access to medical help at the time of a cardiac event is influenced by their repertoire of knowledge and experience. Interventions need to be designed to capture the process of symptom recognition and the influence of co-morbidity.
Ruston
Annmarie
A
Canterbury Christ Church University, Centre for Health and Social Care Research, North Holmes Road, Canterbury, Kent CT1 1QU, UK. ajr25@canterbury.ac.uk
Clayton
Julie
J
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D003657:Decision Making; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006767:Hospitals, District; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000523:psychology*; D015404:Nursing Methodology Research; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D036301:Qualitative Research; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014930:Women / Q000193:education / Q000523:psychology*