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Baxter, Susan K; Allmark, Peter (2013)
Publisher: Springer Nature
Journal: BMC Medical Research Methodology
Languages: English
Types: Article
Subjects: Epidemiology, Research Article, Cardiac delay, Chest pain, R5-920, Medicine (General), Systematic review, Theory-based review



Research suggests that there are a number of factors which can be associated with delay in a patient seeking professional help following chest pain, including demographic and social factors. These factors may have an adverse impact on the efficacy of interventions which to date have had limited success in improving patient action times. Theory-based methods of review are becoming increasingly recognised as important additions to conventional systematic review methods. They can be useful to gain additional insights into the characteristics of effective interventions by uncovering complex underlying mechanisms.


This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies exploring the issue of why people having a heart attack delay seeking professional medical help. The study used standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data relating to theoretical underpinnings.


Thirty six papers from the 53 in the original systematic review referred to a particular theoretical perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this model including different coping mechanisms, strategies of denial and varying models of treatment seeking. Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and referred to models of maintaining integrity, ways of knowing, and the influence of gender.


The review highlights the need to examine an individual’s subjective experience of and response to health threats, and confirms the gap between knowledge and changed behaviour. Interventions face key challenges if they are to influence patient perceptions regarding seriousness of symptoms; varying processes of coping; and obstacles created by patient perceptions of their role and responsibilities. A theoretical approach to review of these papers provides additional insight into the assumptions underpinning interventions, and illuminates factors which may impact on their efficacy. The method thus offers a useful supplement to conventional systematic review methods.

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    • 1. Finn JC, Bett JHN, Shilton TR, Cunningham C, Thompson PL: Patient delay in responding to symptoms of possible heart attack: can we reduce time to care? Med J Aus 2007, 187:293-298.
    • 2. Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K, et al: Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation 2006, 114:168-182.
    • 3. Luepker RV: Delay in acute myocardial infarction: why don't they come to the hospital more quickly and what can we do to reduce delay? Am Heart J 2005, 150:368-370.
    • 4. Allmark P, Todd A, Macintosh M, Gee M: Reducing the time-lag between onset of chest pain that could be due to a heart attack and seeking professional medical help. Sheffield: Sheffield Hallam University; 2011.
    • 5. Pawson R, Tilley N: Realistic Evaluation. London: Sage; 1997.
    • 6. Nilsen P: The how and why of community-based injury prevention: a conceptual and evaluation model. Safety Sci 2007, 45:501-521.
    • 7. Blamey A, Mackenzie M: Theories of change and realistic evaluation: peas in a pod or apples and oranges. Evaluation 2007, 13:439-455.
    • 8. Foss Hansen H: Choosing evaluation models: a discussion on evaluation design. Evaluation 2005, 11:447-462.
    • 9. Rossi P, Lipsey M, Freeman H: Evaluation - A Systematic Approach. Thousand Oaks CA: Sage; 2004.
    • 10. Katrak P, Bialocerkowski A, Massy-Westropp N, Kumar VS, Grimmer K: A systematic review of the content of critical appraisal tools. BMC Med Res Meth 2004, 4:22. doi:10.1186/1471-2288-4-22.
    • 11. Centre for Reviews and Dissemination: Systematic Reviews: CRD's Guidance for Undertaking Reviews in Health Care. University of York: Centre for Reviews and Dissemination York; 2009.
    • 12. Pawson R: Evidence-based policy: the promise of Realist Synthesis. Evaluation 2002, 8:340-358.
    • 13. Leventhal H, Leventhal E, Contrada R: Self-regulation, health and behaviour: a perceptual-cognitive approach. Psychol Health 1998, 13:717-733.
    • 14. Dracup K, McKinley S, Riegel B, Moser DK, Meischke H, Doering LV, et al: A randomized clinical trial to reduce patient prehospital delay to treatment in acute coronary syndrome. Circ Cardiovasc Qual Outcomes 2009, 2:524-532.
    • 15. McKinley S, Dracup K, Moser DK, Riegel B, Doering LV, Meischke H, et al: The effect of a short one-on-one nursing intervention on knowledge, attitudes and beliefs related to response to acute coronary syndrome in people with coronary heart disease: A randomized controlled trial. Int J Nurs Studies 2009, 46:1037-1046.
    • 16. Buckley T: The effect of education and counselling on knowledge, attitudes and beliefs about responses to acute myocardial infarction symptoms. Eur J Cardiovasc Nurs 2007, 6:105.
    • 17. Tullmann DF, Haugh KH, Dracup KA, Bourguignon C: A randomized controlled trial to reduce delay in older adults seeking help for symptoms of acute myocardial infarction. Res Nurs Health 2007, 30:485-497.
    • 18. Harralson TL: Factors influencing delay in seeking treatment for acute ischemic symptoms among lower income, urban women. Heart Lung 2007, 36:96-104.
    • 19. Herning M, Hansen PR, Bygbjerg B, Lindhardt T: Women's experiences and behaviour at onset of symptoms of ST segment elevation acute myocardial infarction. Eur J Cardiovasc Nurs 2010, doi:10.1016/j. ejcnurse.2010.10.002.
    • 20. Bunde J, Martin R: Depression and prehospital delay in the context of myocardial infarction. Psychosomat Med 2006, 68:51-57.
    • 21. Noureddine S, Adra M, Arevian M, Dumit NY, Puzantian H, Shehab D, et al: Delay in seeking health care for acute coronary syndromes in a Lebanese sample. JTranscultur Nurs 2006, 17:341-348.
    • 22. Noureddine S: Patterns of responses to cardiac events over time. J Cardiovasc Nurs 2009, 24:390-397.
    • 23. Diefenbach M, Levanthal H: The Common-Sense Model of Illness Representations: theoretical and practical considerations. J Soc Distress Homeless 1996, 5:11-38.
    • 24. Khan MS, Jafary FH, Faruqui AM, Rasool SI, Hatcher J, Chaturvedi N, et al: High prevalence of lack of knowledge of symptoms of acute myocardial infarction in Pakistan and its contribution to delayed presentation to the hospital. BMC Public Health 2007, 7:284. doi:10.1186/1471-2458-7-284.
    • 25. Dracup K: Acute coronary syndrome: what do patients know? Arch Intern Med 2008, 168:1049-1054.
    • 26. Løvlien M, Schei B, Hole T: Prehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction. Eur J Cardiovasc Nurs 2007, 6:308-313.
    • 27. Hwang SY: The influence of age on acute myocardial infarction symptoms and patient delay in seeking treatment. Progress Cardiovasc Nurs 2006, 21:20-27.
    • 28. Thuresson M: Thoughts, actions, and factors associated with prehospital delay in patients with acute coronary syndrome. Heart Lung 2007, 36:398.
    • 29. Lovlien M: Are there gender differences related to symptoms of acute myocardial infarction? A Norwegian perspective. Progress Cardiovasc Nurs 2006, 21:14-19.
    • 30. Fukuoka Y: Is severity of chest pain a cue for women and men to recognize acute myocardial infarction symptoms as cardiac in origin? Progress Cardiovasc Nurs 2007, 22:132-137.
    • 31. Perkins-Porras L, Whitehead DL, Strike PC, Steptoe A: Pre-hospital delay in patients with acute coronary syndrome: factors associated with patient decision time and home-to-hospital delay. Eur J Cardiovasc Nurs 2009, 8:26-33.
    • 32. Fox-Wasylyshyn S, El-Masri M, Artinian NT: Testing a model of delayed care-seeking for acute myocardial infarction. Clin Nurs Res 2010, 19:38-54.
    • 33. Higginson R: Women's help-seeking behaviour at the onset of myocardial infarction. Brit J Nurs 2008, 17:10-14.
    • 34. Albarran JW, Clarke BA, Crawford J: “It was not chest pain really, I can”t explain it!' An exploratory study on the nature of symptoms experienced by women during their myocardial infarction. J Clin Nurs 2007, 16:1292-1301.
    • 35. Khraim FM, Scherer YK, Dorn JM, Carey MG: Predictors of decision delay to seeking health care among Jordanians with acute myocardial infarction. J Nurs Scholarship 2009, 41:260-267.
    • 36. Vavouranakis I, Fanioudaki A, Lamprogiannakis E, Baltzakis I, Sidiropoulou K, Porfiri E, et al: Delays incurred during acute myocardial infarction: a comparative study of rural and urban populations in Greece. Rur Remote Health 2010, 10:1271.
    • 37. Henriksson C, Lindahl B, Larsson M: Patients' and relatives' thoughts and actions during and after symptom presentation for an acute myocardial infarction. Eur J Cardiovasc Nurs 2007, 6:280.
    • 38. Ruston A: Women's interpretation of cardiac symptoms at the time of their cardiac event: the effect of co-occurring illness. Eur J Cardiovasc Nurs 2007, 6:321-328.
    • 39. Locker D: Symptoms and Illness: the cognitive organisation of disorder. London: Tavistock Publications; 1981.
    • 40. Riegel B, Moser DK, McKinley S, Pelter M, Doering L, Meischke H, et al: Who Listens to Our Advice? Predicting who Responds to an Intervention Designed to Decrease Delay in Seeking Treatment for Acute Coronary Syndrome. Circulation 2008, 118:S825.
    • 41. Zegrean M, Fox-Wasylyshyn S, El-Masri M: Alternative coping strategies and decision delay in seeking care for acute myocardial infarction. J Cardiovasc Nurs 2009, 24:151-155.
    • 42. Morgans AE, Archer F, Allen FCL: Patient decision making in prehospital health emergencies: Determinants and predictors of patient delay. J Emerg Prim Health Care 2008, 6:1-9.
    • 43. Henriksson C: Patients' and relatives' thoughts and actions during and after symptom presentation for an acute myocardial infarction. Eur J Cardiovasc Nurs 2007, 6:280-286.
    • 44. Fox-Wasylyshyn SM: Comparison of coping responses to symptoms between first-time sufferers and those with a previous history of acute myocardial infarction. J Cardiovasc Nurs 2007, 22:145-151.
    • 45. Kaur R, Lopez V, Thompson DR: Factors influencing Hong Kong Chinese patients' decision-making in seeking early treatment for acute myocardial infarction. Res Nurs Health 2006, 29:636-646.
    • 46. Lazarus R, Folkman S: Stress, Appraisal, and Coping. New York: Springer; 1984.
    • 47. Reynolds N, Alonzo A: The acute myocardial infarction coping model: A midrange theory. In Handbook of Stress, Coping and Health: Implications for Nursing Research, theory and practice. Edited by Rice V. Thousand Oaks: Sage; 2000:411-423.
    • 48. Banks AD, Dracup K: Are there gender differences in the reasons why African Americans delay in seeking medical help for symptoms of an acute myocardial infarction? Ethnic Dis 2007, 17:221-227.
    • 49. Safer M, Tharps Q, Jackson T, Leventhal H: Determinants of three stages of delay in seeking care at a medical clinic. Med Care 1979, 17:11-29.
    • 50. Bunde J, Martin R: Depression and prehospital delay in the context of myocardial infarction. Psychosomat Med 2006, 68:51-57.
    • 51. Gallagher R, Marshall AP, Fisher MJ: Symptoms and treatment-seeking responses in women experiencing acute coronary syndrome for the first time. Heart Lung 2010, 39:477-484.
    • 52. Rosenfeld A, Lindauer A, Darney A: Understanding the treatment seeking delay in women with acute myocardial infarction: descriptions of decision-making patterns. Am J Crit Care 2005, 14:708-715.
    • 53. Sullivan MD, Ciechanowski PS, Russo JE, Soine LA, Jordan-Keith K, Ting HH, et al: Understanding why patients delay seeking care for acute coronary syndromes. Circ Cardiovasc Qual Outcomes 2009, 2:148-154.
    • 54. Turris SA: Maintaining integrity: women and treatment seeking for the symptoms of potential cardiac illness. Qual Health Res 2008, 18:1461-1476.
    • 55. Turris SA, Finamore S: Reducing delay for women seeking treatment in the emergency department for symptoms of potential cardiac illness. J Emerg Nurs 2008, 34:509-515.
    • 56. Turris SA: Women's Decisions to Seek Treatment for the Symptoms of Potential Cardiac Illness. J Nurs Scholarship 2009, 41:5-12.
    • 57. Carper B: Fundamental patterns of knowing in nursing. Adv Nurs Sci 1978, 1:13-23.
    • 58. Galdas P, Cheater F, Marshall P: What is the role of masculinity in white and South Asian men's decisions to seek medical help for cardiac chest pain? J Health Serv Res Po 2007, 12:223-229.
    • 59. Conner M: and Norman, P: Predicting Health Behaviour: Research and Practice with Social Cognition Models. 2nd edition. Maidenhead: Open University Press; 2005.
    • 60. Becker M, Maiman L: Socio-behavioural determinants of compliance with health and medical care recommendations. Med Care 1975, 23:539-555.
    • 61. Bandura A: Self-efficacy: towards a unifying theory of behavioural change. Psychol Rev 1977, 84:191-215.
    • 62. Munro S, Lewin S, Swart T, Volmink J: A review of health behaviour theories: how useful are these for developing intervention to promote long-term medication adherence for TB and HIV/Aids. BMC Public Health 2007, 7:104. doi:10.1186/1471.
    • 63. Stame N: Theory-based evaluation and types of complexity. Evaluation 2004, 10:58-76.
    • 64. Weiss C: Theory-based evaluation: past, present and future. New Dir Eval 1997, 76:41-55.
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