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Testing a Model to Reveal the Predictive Mechanism of Care-Seeking Decisions Among Patients With Acute Myocardial Infarction

Li, Polly W.C. PhD; Yu, Doris S.F. PhD

Journal of Cardiovascular Nursing: July/August 2017 - Volume 32 - Issue 4 - p 393–400
doi: 10.1097/JCN.0000000000000355
ARTICLES: Symptoms

Background: Extensive research has been conducted to examine the factors affecting care-seeking decisions in patients with acute myocardial infarction (AMI). Such a decision-making process is multifactorial, and its underlying mechanism is yet to be determined.

Objectives: Our aim was to test a theoretically integrated model to identify the mechanisms underlying patients’ care-seeking decisions in the context of AMI.

Methods: On the basis of both empirical and theoretical evidence, we proposed that patients’ care-seeking decisions are driven by 2 sequential perceptual-cognitive processes concerned with illness labeling and interpretation, as well as the contextual influences of perceived barriers to care seeking and cues from others. A sample of 301 patients was recruited to test this model using structural equation modeling.

Results: The model testing revealed good fit with the data (χ2 = 38.48, df = 30, P = .72; root-mean-square error of approximation = 0.03, normed fit index = 0.96, nonnormed fit index = 0.98, and comparative fit index = 0.99) and explained 46% of the variance in AMI care-seeking delay. Successful action relied on whether patients could correctly attribute the symptom experience to AMI, were aware of their own susceptibility to the condition, and had a good understanding of how the disease manifested itself. Lowering perceived barriers and positive cues from others in advising care seeking played favorable roles to promote care-seeking behaviors.

Conclusions: This integrative theoretical model is shown to be valid in explaining care-seeking delay among AMI patients and can guide the development of interventions to promote appropriate care-seeking behaviors among high-risk individuals.

Polly W.C. Li, PhD Professional consultant, The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.

Doris S.F. Yu, PhD Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.

The authors have no funding or conflicts of interest to disclose.

Correspondence Polly W.C. Li, PhD, The Nethersole School of Nursing, The Chinese University of Hong Kong, 6/F, Esther Lee Building, Shatin, N.T., Hong Kong (

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