title: Reducing patient delay with symptoms of acute coronary syndrome: a research protocol for a systematic review of previous interventions to investigate which behaviour change techniques are associated with effective interventions.
abstract: Delay to presentation with symptoms of acute coronary syndrome (ACS) is common meaning many fail to achieve optimal benefit from treatments. Interventions have had variable success in reducing delay. Evidence suggests inclusion of behaviour change techniques (BCTs) may improve effectiveness of interventions but this has not yet been systematically evaluated. Data from other time-critical conditions may be relevant.
  
  
  
  A systematic review will be undertaken to identify which BCTs are associated with effective interventions to reduce patient delay (or prompt rapid help-seeking) among people with time-critical conditions (eg, chest pain, ACS, lumps, stroke, cancer and meningitis). A systematic search of a wide range of databases (including Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo) and grey literature will be undertaken to identify all relevant intervention studies (randomised controlled trials, controlled clinical trials and cohort studies). Two independent reviewers will screen abstracts to identify relevant studies, apply inclusion criteria to full papers, assess methodological quality and extract data.
  
  
  
  Change in patient decision time BCTs reported in each of the included studies will be categorised and presented according to the latest reliable taxonomy. Results of included studies will be synthesised, exploring relationships between inclusion of each BCT and effectiveness of the overall intervention. Where possible, means and SDs for differences in delay time will be calculated and combined within meta-analyses to derive a standardised mean difference and 95% CI. Analysis of (1) all time-critical and (2) ACS-only interventions will be undertaken.
  
  
  
  No ethical issues are anticipated. Results will be submitted for publication in a relevant peer-reviewed journal.
authors.affiliation: Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Farquharson
authors.affiliation: School of Psychology, University of Stirling , Stirling , UK.
authors.forename: Stephan
authors.initials: S
authors.lastname: Dombrowski
authors.affiliation: Nursing, Midwifery and Allied Health Professionals Research Unit , Glasgow Caledonian University , Glasgow , UK.
authors.forename: Alex
authors.initials: A
authors.lastname: Pollock
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen , Aberdeen , UK.
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.affiliation: Health Services Research Unit , University of Aberdeen , Aberdeen , UK.
authors.forename: Shaun
authors.initials: S
authors.lastname: Treweek
authors.affiliation: Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
authors.affiliation: School of Nursing and Midwifery, University of Dundee , Dundee , UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Dougall
authors.affiliation: Health Informatics Centre, University of Dundee , Dundee , UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Jones
authors.affiliation: Cardiology Department , NHS Tayside , Dundee , UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Pringle
keywords: Quality of Care and Outcomes