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Title page for ETD etd-03252011-101722

Type of Document Dissertation
Author Waller, Cynthia Gregory
Author's Email Address cynthia.g.waller@vanderbilt.edu
URN etd-03252011-101722
Title Understanding the Relationship Between Gender, Previous Cardiac Event and prehospital Delay Behavior in Acute Myocardial Infarction
Degree PhD
Department Nursing Science
Advisory Committee
Advisor Name Title
Kenneth Wallston Committee Chair
  • gender
  • previous cardiac event
  • prehospital delay behavior
Date of Defense 2011-02-16
Availability unrestricted




Cynthia G. Waller

Dissertation under the direction of Professor Kenneth A. Wallston

Using Leventhal’s Self-Regulation model as a conceptual framework, the purpose of this dissertation was to examine the relationship between gender, a previous cardiac event, and their interaction on prehospital delay time and then, using the Modified Response to Symptom Questionnaire, to examine the relationships between gender, previous cardiac event, and their interaction with the patient’s behavioral, cognitive, and emotional coping responses to acute myocardial infarction (AMI) symptoms on prehospital delay time. A secondary data analysis of 780 patients with a confirmed diagnosis of an AMI from coronary care units and cardiac step-down units in academic medical centers and community hospitals in four different countries was conducted. Using a 2 x 2 factorial design, results demonstrated that gender, previous cardiac event, and their interaction did not directly have an impact on the log to the base 10 of prehospital delay time once age, years of education, and geographic location of the patient was statistically controlled for. Gender, a previous cardiac event, and their interaction did, however, affect symptom attribution to the heart, perceived severity of AMI symptoms, level of anxiety, perceived ability to control symptoms, and whether or not patients ignored and/or self-treated symptoms which, in turn, affected the amount of time it took for the patient to get to the hospital. Level of anxiety and perceived severity of symptoms were significantly correlated to one another and both coping responses significantly shortened prehospital delay time. Symptom attribution, symptom severity, ignored symptoms, accessed a healthcare provider, and level of anxiety accounted for 23% of the variance in prehospital delay time with ignoring AMI symptoms causing significantly longer and symptom attribution to the heart causing significantly shorter prehospital delay times. Symptom attribution to the heart serves as a differentiator of individuals who request medical assistance in a timely manner. Perceived severity of symptoms and the emotional response to signs and symptoms serve as important predictors of delay and can serve as cues for action. Nurses need to continually remind patients/families about the signs and symptoms of an AMI, the importance of not ignoring symptoms, and the value in accessing EMS in a timely manner.

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