Cardiovascular disease is the leading cause of death for women in the United States. While major advances in the treatment of acute myocardial infarction (AMI) and in emergency transportation have occurred in the last two decades, little progress has been made in reducing delay time in help seeking by patients. This is especially true for women with AMI who have been shown to delay longer than men. Reducing decision delay is important because most deaths due to AMI occur within the first hours after AMI and the effectiveness of reperfusion therapies is greatest in the first hours after onset of symptoms. However, little is known about how to decrease decision delay in women. Phase 1 is a descriptive study with three aims: (1) to describe decision trajectories used by women when experiencing symptoms of AMI; (2) to identify predictors of the decision trajectory used by women with AMI; and (3) to develop AMI decision scenarios based on women's decision trajectories in response to AMI. A sample of 50 women with AMI will be interviewed to describe their decision trajectories and to complete measures of the predictor variables of age, ethnicity, socioeconomic status, health care access, social support, personal control, perceived heart disease threat, and negative affect. Narrative analysis techniques will be used to describe commonly used decision trajectories. Discriminant function analysis will be used to assess prediction of membership in the decision trajectory groups from the set of predictor variables. These findings will be used to develop a Profile of Predictors for use in Phase 2 and to develop AMI decision scenarios for use in a Rehearse Your Response intervention. The purpose of Phase 2 is to pilot test the intervention with women at risk for AMI (aim 4). Using an experimental 2X3 repeated measures design, 20 women with AMI will be randomly assigned to receive the Rehearse Your Response intervention or general dietary information. The choice of AMI decision scenario to be used in the intervention is based on the woman's responses on the Profile of Predictors. It is expected that this intervention will both enhance women's self-efficacy for following a """"""""fast track"""""""" to medical care when symptoms of AMI occur and decrease decision delay. The long-term goals of this study are to develop research-based knowledge of decision delay in women with AMI and to develop interventions tailored to the decision trajectories used by women with AMI.
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