Women's descriptions of symptoms and delay reasons in seeking medical care at the time of a first myocardial infarction: A qualitative study

https://doi.org/10.1016/j.ijnurstu.2007.07.004Get rights and content

Abstract

Background

Coronary heart disease (CHD) is a major cause of mortality in women. Women have also been identified as late presenters in seeking medical care.

Aim

The aim of this study was to explore and describe women's symptoms and the reasons for delay in seeking medical care at the time of the first myocardial infarction (MI).

Methods

The study had an explorative and descriptive design based on content analysis approach. Nineteen women were interviewed at the hospital 2 or 3 days after hospitalisation.

Results

The result showed that the women had difficulties interpreting, understanding and linking the symptoms to CHD. They tried to handle the discomfort and even the chest pain, rather then ask for professional help. The women had problems with making the final decision.

Conclusion

Women need to be made aware of the clinical symptoms of CHD, in order to understand the consequences of delay in seeking medical care following an MI.

Section snippets

What is already known about the topic?

  • Coronary heart disease remains the number one killer of both women and men.

  • Women often experience atypical symptoms.

  • Women's perceptions of their low risk for myocardial infarction greatly influence their decision-making process.

What this paper adds

  • In spite of severe and evident clinical symptoms even from the chest pain, women do not see these as a potential risk for myocardial infarction.

  • Although intensive and unmanageable pain, women wait at home thinking pain will disappear.

  • Women have difficulties interpreting, understanding and linking the clinical symptoms to coronary heart disease.

  • Women need to be communicated the consequences of delay in seeking medical care following a myocardial infarction.

Design and method description

The study had an exploratory design based on content analysis to describe women's symptoms and their decision to delay seeking medical care. The content analysis method is especially suitable to analyse situations or documented processes (Burnard, 1991). Content analysis initially dealt with the objective, systematic and quantitative description of the manifest content of a text, but over time, the method has expanded to also include interpretation of latent content (Graneheim and Lundman, 2004

Ethical considerations

Verbal and written information about the study was given to each potential participant. Participation was voluntary and the participants were informed that they could withdraw at any time and that all data would be treated confidentially. Permission for the study was obtained from the Ethics Committee at Lund University, Sweden.

Describing pain

The women described the pain in many different ways. They described the pain as coming rather acute and sudden or that the symptoms did not appear typical for MI and overly painful. They experienced the pain as having a pressure over the chest. They also had pain in the left arm and in the scapula. They also described that they had pain in the back and how the pain moved from one part of the body to another and progressed. Although the pain was difficult to manage, they wanted to wait at home

Discussion

Trustworthiness is a central concept in content analysis and is best described using the terms credibility, dependability and transferability (Graneheim and Lundman, 2004). The trustworthiness of the data collection was satisfied in terms of a well-established cardiac nurse, who conducted all the interviews at a location chosen by the participants. The main author also transcribed the interviews soon after they were conducted, thereby reducing the risk of misunderstanding (Fridlund and

Conclusions and implications

This study points out important aspects on women in relation to an MI. The women had difficulties interpreting and understanding their symptoms and linking this to MI. They also had prodromal or atypical symptoms and they often tried to find explanations for this. They used different kinds of strategies for curing themselves such as taking medication or resting for a while. The women had problems with making the final decision to seek medical care when they wanted to have support and help from

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