Time-to-Treatment for Myocardial Infarction: Barriers and Facilitators Perceived by American Indians in Three Regions.
Early recognition of acute myocardial infarction (MI), followed by prompt emergency care, improves patient outcomes. Among rural American Indian (AI) populations there are disparities in access to care for MI and processes of care, resulting in poor MI-related health outcomes compared to the general population. We sought to gain an understanding of barriers related to MI time-to-treatment delays using a qualitative approach. We conducted semi-structured interviews and focus groups with AI key informants and community members in three Indian Health Service regions. Major barriers to care included long travel distance to care and lack of supporting infrastructure; distrust of the health care system; low overall literacy and basic health literacy; priority of family care-giving; and lack of specialized medical facilities and specialists. Findings suggest that improved time-to-treatment facilitators include educating the local community about the causes and consequences of MI and culturally-sensitive health communication, as well as addressing the quality of local systems of care and the community's perception of these systems. Pursuing these strategies may improve quality of care and reduce MI-related morbidity and mortality in rural AI populations.
Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA. enesoff1@jhu.edu.
Elizabeth D
ED
Nesoff
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F-72, Atlanta, GA, 30341-3717, USA.
J Nell
JN
Brownstein
Indian Health Service, 1215 N. Beaver Street, Suite #201, Flagstaff, AZ, 86001, USA.
Mark
M
Veazie
Missouri Breaks Industries Research, HCR 64 Box 52, Timber Lake, SD, 57656, USA.
Marcia
M
O'Leary
Native American Cardiology and Medical Service Program, University of Arizona Medical Center, 1501 North, Campbell Ave., PO Box 245202, Tucson, AZ, 85724, USA.
Eric A
EA
Brody
D001130:Arizona; D003469:Culture; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D015146:Midwestern United States; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D036301:Qualitative Research; D058996:Quality Improvement; D012424:Rural Population; D061665:Time-to-Treatment
American Indians; Myocardial infarction; Qualitative research; Time-to-treatment delay