School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
Int J Nurs Stud. 2023 Dec;148:104564. doi: 10.1016/j.ijnurstu.2023.104564. Epub 2023 Jul 17.
Prolonged delays by patients in making care-seeking decisions remain a significant obstacle to the effective management of acute myocardial infarction.
This study aimed to compare the effects of a theory-based cognitive-narrative intervention with those of didactic education over a 24-month period on the participants' attitudes, beliefs, and knowledge regarding acute myocardial infarction, prehospital delay time, and the use of an ambulance. We also explored participants' engagement in the intervention.
This study adopted a sequential mixed-methods design comprising a multisite randomized controlled trial and a qualitative study.
Community-dwelling adult patients with a prior history of acute myocardial infarction in the past year were recruited from four hospitals in Hong Kong. They were randomly assigned to an 8-week theory-based cognitive-narrative intervention that involved a vivid experience of complex decision-making or didactic education. The Acute Coronary Syndrome Response Index questionnaire was administered at baseline (T0) and at 3- (T1), 12- (T2), and 24-month (T3) follow-up time points. Prehospital delay time and the use of an ambulance were evaluated for those participants who had recurrent acute myocardial infarction attacks during the study period.
A total of 608 participants were randomly assigned to the theory-based cognitive-narrative intervention group (n = 304) or the didactic education group (n = 304). The intervention group reported greater improvements than the control group in their attitudes (β = -1.053, p = 0.002) and beliefs (β = -0.686, p = 0.041) regarding acute myocardial infarction and care-seeking at T1. These effects were sustained at T2 [attitudes (β = -0.797, p = 0.018); beliefs (β = -0.692, p = 0.047)] and T3 [attitudes (β = -0.717, p = 0.024); beliefs (β = -0.701, p = 0.032)]. Sixty-three participants experienced another acute myocardial infarction event by T2. The median delay times for the intervention and control groups were 3.13 h (interquartile range (IQR: 1.15-6.48)) and 4.82 h (IQR: 2.23-9.02), respectively. The prehospital delay time was significantly reduced in the intervention group compared with the control group (β = -0.07, p = 0.011). The qualitative findings echoed the quantitative findings, as participants indicated that the intervention helped them to understand the variable nature of the disease presentation, which enabled them to recognize the symptoms more readily.
The novel cognitive-narrative intervention used in this study effectively improved the participants' attitudes and beliefs regarding acute myocardial infarction and reduced the prehospital delay time.
This study was registered with the International Clinical Trials Registry Platform of the World Health Organization (ChiCTR-IIC-17010576) on February 2, 2017; the first participant was recruited on January 11, 2018.
患者在做出就医决策方面的长时间拖延仍然是有效管理急性心肌梗死的一个重大障碍。
本研究旨在比较基于理论的认知-叙事干预与传统教育在 24 个月内对参与者对急性心肌梗死的态度、信念和知识、院前延迟时间以及使用救护车的影响。我们还探讨了参与者对干预的参与情况。
本研究采用了一种顺序混合方法设计，包括多地点随机对照试验和定性研究。
从香港的四家医院招募了过去一年有急性心肌梗死既往病史的社区居住成年患者。他们被随机分配到为期 8 周的基于理论的认知-叙事干预组，该干预组涉及复杂决策的生动体验，或传统教育组。在基线（T0）和 3 个月（T1）、12 个月（T2）和 24 个月（T3）随访时，使用急性冠状动脉综合征反应指数问卷进行评估。评估了在研究期间发生复发性急性心肌梗死的参与者的院前延迟时间和救护车使用情况。
共有 608 名参与者被随机分配到基于理论的认知-叙事干预组（n=304）或传统教育组（n=304）。与对照组相比，干预组在 T1 时对急性心肌梗死和就医的态度（β=-1.053，p=0.002）和信念（β=-0.686，p=0.041）有更大的改善。这些影响在 T2[态度（β=-0.797，p=0.018）；信念（β=-0.692，p=0.047）]和 T3[态度（β=-0.717，p=0.024）；信念（β=-0.701，p=0.032）]时仍持续存在。63 名参与者在 T2 时经历了另一次急性心肌梗死事件。干预组和对照组的中位延迟时间分别为 3.13 小时（四分位间距（IQR：1.15-6.48））和 4.82 小时（IQR：2.23-9.02）。与对照组相比，干预组的院前延迟时间明显缩短（β=-0.07，p=0.011）。定性研究结果与定量研究结果一致，因为参与者表示，干预帮助他们了解了疾病表现的多变性质，这使他们能够更迅速地识别症状。
本研究中使用的新型认知叙事干预有效地改善了参与者对急性心肌梗死的态度和信念，并缩短了院前延迟时间。
本研究于 2017 年 2 月 2 日在世界卫生组织国际临床试验注册平台（ChiCTR-IIC-17010576）注册；第一个参与者于 2018 年 1 月 11 日招募。
