PhD in Nursing Science Program

Cynthia G. Waller

Understanding the Relationship Between Gender, Previous Cardiac Event and Pre-hospital Delay Behavior in Acute Myocardial Infarction


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 and the 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 from academic medical centers and community hospitals in four different countries was conducted. Results demonstrated that gender, previous cardiac event, and their interaction did not directly have an impact on prehospital delay time once age, education level, and geographical location of the patient was statistically controlled for, but they did affect symptom attributions to the heart, perceptions of AMI symptom severity, level of anxiety, and whether or not patients ignored the symptoms and/or accessed a healthcare provider. In turn, these five coping responses accounted for 23% of the variance in prehospital delay time with ignoring AMI symptoms causing significantly longer prehospital delay times.