This application seeks three years of support to investigate how lay people's cognitive representations of coronary heart disease (CHD) contribute to delays in seeking medical are for symptoms of myocardial infarction (MI), with an emphasis on female victims. In a correlational study, 1,114 post-MI patients and approximately 777 support providers will be interviewed. Analyses will (1) identify gender differences in pre- hospital symptom perceptions, symptom attributions, self-care activities, treatment-seeking behaviors, and perceptions of CHD vulnerability and the implications of such gender differences in self-referral for acute MI; (2) examine the impact of social influence processes in the lay evaluation of cardiac symptoms, including gender differences in information- seeking, advice received from support providers, and pre-hospital interactions with individual possessing medical expertise; and (3) determine whether gender differences in the response to acute MI symptoms are manifested even after controlling for victim age, ethnicity, education, prior CHD knowledge and experience, socioeconomic status, medical status, living arrangements, social support network, and other individual differences. The proposed research will focus on differences in lay CHD cognitive representations that may account for intervention after the onset of cardiac-related symptoms. The proposed project will provide fundamental information to nurses and other health care providers about how the lay interpretation of cardiac symptoms is influenced by the victim's gender, age, and other factors. Finally, the knowledge gained from the proposed project is likely to represent a vital contribution in the development of programmatic nursing interventions targeted at the facilitation of self-referral behaviors and the provision of optimal health care to both women and men at risk of CHD.
