title: The turning point: from self-regulative illness behaviour to care-seeking in patients with an acute myocardial infarction.
abstract: OBJECTIVE
  To describe the care-seeking process from interpretation of an initial symptom to the decision to seek medical care in patients with an acute myocardial infarction.
  
  
  BACKGROUND
  Patients afflicted by symptoms of an acute myocardial infarction delay in seeking care far exceeding the desired time limits. This results in avoidable loss of life. There is thus a need to understand these patients' initial discomfort, appraisal and behaviour to design interventions that could reduce delay in care-seeking.
  
  
  METHODS
  Focus group discussions with patients who had had a recent acute myocardial infarction.
  
  
  METHODS
  The analysis of the transcribed text was inspired by the self-regulatory model of illness behaviour.
  
  
  RESULTS
  Patients with acute myocardial infarction describe problems to identify the exact time of onset of often vague symptoms. Their experiences of symptoms did not match their expectations. These patients exhibit self-regulatory illness behaviour that seems to cause a considerable delay in care-seeking.
  
  
  CONCLUSIONS
  We found indications of a pertinent shift in appraisal and coping-strategy when a patient changes from self-regulative illness behaviour to seeking care - the turning point. This shift seems to be affected by several partly contradictory influences and it takes a considerable time for a person to reach this stage. All aspects of the patients' self-regulative illness behaviour have to be considered if we want patients to seek medical care more rapidly.
  
  
  CONCLUSIONS
  Our findings are important to consider in future design of public health and rehabilitation strategies to save patient lives. To identify the turning point is a profitable way to deepen the understanding of patient behaviour during the initial phase of an acute myocardial infarction.
authors.affiliation: Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, SE-182 88 Stockholm, Sweden. carolin.nymark@ds.se
authors.forename: Carolin
authors.initials: C
authors.lastname: Nymark
authors.forename: Anne-Cathrine
authors.initials: AC
authors.lastname: Mattiasson
authors.forename: Peter
authors.initials: P
authors.lastname: Henriksson
authors.forename: Anna
authors.initials: A
authors.lastname: Kiessling
mesh_terms: D000223:Adaptation, Psychological; D017144:Focus Groups; D006801:Humans; D055809:Illness Behavior; D009203:Myocardial Infarction / Q000523:psychology* / Q000628:therapy; D010342:Patient Acceptance of Health Care