title: The Process of Care-seeking for Myocardial Infarction Among Patients With Diabetes.
abstract: BACKGROUND
  People with diabetes have a higher risk for myocardial infarction (MI) than do people without diabetes. It is extremely important that patients with MI seek medical care as soon as possible after symptom onset because the shorter the time from symptom onset to treatment, the better the prognosis.
  
  
  OBJECTIVE
  The aim of this study was to explore how people with diabetes experience the onset of MI and how they decide to seek care.
  
  
  METHODS
  We interviewed 15 patients with diabetes, 7 men and 8 women, seeking care for MI. They were interviewed 1 to 5 days after their admission to hospital. Five of the participants had had a previous MI; 5 were being treated with insulin; 5, with a combination of insulin and oral antidiabetic agents; and 5, with oral agents only. Data were analyzed according to grounded theory.
  
  
  RESULTS
  The core category that emerged, "becoming ready to act," incorporated the related categories of perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Our results suggest that responses in each of the categories affect the care-seeking process and could be barriers or facilitators in timely care-seeking. Many participants did not see themselves as susceptible to MI and MI was not expressed as a complication of diabetes.
  
  
  CONCLUSIONS
  Patients with diabetes engaged in a complex care-seeking process, including several delaying barriers, when they experienced symptoms of an MI. Education for patients with diabetes should include discussions about their increased risk of MI, the range of individual variation in symptoms and onset of MI, and the best course of action when possible symptoms of MI occur.
authors.affiliation: Karin Hellström Ängerud, RN, MSc PhD Student, Department of Nursing, Umeå University, Umeå, Sweden. Christine Brulin, RNT, PhD Professor, Department of Nursing, Umeå University, Umeå, Sweden. Mats Eliasson, MD, PhD Professor, Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden. Ulf Näslund, MD, PhD Professor, Department of Public Health and Clinical Medicine, Cardiology, Heart Centre, Umeå University, Umeå, Sweden. Åsa Hörnsten, RN, PhD Associate Professor, Department of Nursing, Umeå University, Umeå, Sweden.
authors.forename: Karin Hellström
authors.initials: KH
authors.lastname: Ängerud
authors.forename: Christine
authors.initials: C
authors.lastname: Brulin
authors.forename: Mats
authors.initials: M
authors.lastname: Eliasson
authors.forename: Ulf
authors.initials: U
authors.lastname: Näslund
authors.forename: Åsa
authors.initials: Å
authors.lastname: Hörnsten
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003657:Decision Making; D058065:Diabetic Cardiomyopathies / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D012649:Self Concept; D063189:Symptom Assessment
chemical_list: D007004:Hypoglycemic Agents