Date of this Version
Patient Education and Counseling
Prolonged prehospital delay in persons experiencing acute coronary syndrome (ACS) remains a problem. Understanding which patients respond best to particular interventions designed to decrease delay time would provide mechanistic insights into the process by which interventions work.
In the PROMOTION trial, 3522 at-risk patients were enrolled from 5 sites in the United States (56.4%), Australia and New Zealand; 490 (N = 272 intervention, N = 218 control) had an acute event within 2 years. Focusing on these 490, we (1) identified predictors of a rapid response to symptoms, (2) identified intervention group subjects with a change in these predictors over 3 months of follow-up, and (3) compared intervention group participants with and without the favorable response pattern. Hypothesized predictors of rapid response were increased perceived control and decreased anxiety. Knowledge, attitudes, and beliefs were hypothesized to differ between responders and non-responders.
Contrary to hypothesis, responders had low anxiety and low perceived control. Only 73 (26.8%) subjects showed this pattern 3 months following the intervention. No differences in ACS knowledge, attitudes, or beliefs were found.
The results of this study challenge existing beliefs.
New intervention approaches that focus on a realistic decrease in anxiety and perceived control are needed.
NOTICE: This is the author’s version of a work that was accepted for publication in Patient Education and Counseling. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms, may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Patient Education and Counseling, 2011, 85, e33-e38. doi: 10.1016/j.pec.2011.01.016.
acute coronary syndrome, treatment seeking delay, denial, common sense model, responder analysis
Riegel, B., Elmi, A., Moser, D. K., McKinley, S., Meischke, H., Doering, L. V., Davidson, P., Pelter, M., Baker, H., & Dracup, K. (2011). Who Listens to Our Advice? A Secondary Analysis of Data From a Clinical Trial Testing an Intervention Designed to Decrease Delay in Seeking Treatment for Acute Coronary Syndrome. Patient Education and Counseling, 85 (2), e33-e38. http://dx.doi.org/10.1016/j.pec.2011.01.016
Date Posted: 01 June 2016
This document has been peer reviewed.