Health-seeking behavior of Korean women with myocardial infarcion

HEALTH-SEEKING BEHAVIOR OF KOREAN WOMEN WITH MYOCARDIAL INFARCTION

Purpose: This study was to generate a theory of HSB among Korean women with MI with regard to their experiences of MI at the time of symptom presentation, and the process of treatment seeking. Background: Coronary heart disease is the second leading cause of death among both men and women in Korea. Yet the mortality rate of heart disease among women aged over 65 is nearly twice that of their male counterpart. Although mortality rates for women are approximately 10 years behind those for men, women have no survival benefits. More women have poor clinical outcomes and prognosis than men. Studies have reported women’s non-specific symptoms lead them to be slow in seeking treatments, and relatively advanced age and accompanying comorbid diseases cause more serious hemodynamic status among women. However, there is scanty knowledge about the reason, apart from physiological and biological differences, for why women have longer symptom-to-door time. The health-seeking behavior (HSB) is influenced by multiple factors including socio-economic variables, social status of individuals, perceived quality of service, and social perspectives of gender. Social and cultural factors are central in identifying HSB among women. In spite of this, no study has been found in published literature on the social and cultural construction of myocardial infarction (MI) among Korean women, which affects MI care for this population. Methods: Grounded theory was adopted to explore the experiences of Korean women with MI at the time of symptom presentation to identify Korean women’s health-seeking process in getting optimal treatment. 18 women participated in 42 interviews using a theoretical sampling from two university hospitals. 42 open-ended interviews were tape-recorded and transcribed verbatim, and then constant comparative analysis was chosen to achieve saturation of theory. Results: The core phenomenon experienced by women, as articulated in their colloquial expression was “finding out what’s going on and relieving symptoms.” The process of HSB for seeking a treatment was a sequential and iterative cognitive. The concepts of HSB of Korean women with MI were “experiencing symptoms,” “attributing symptoms,” “evaluating situation,” “managing symptoms,” “consulting others about symptoms,” “getting an optimal treatment,”  “maintaining optimal health.” Women performed a series of actions through the process from the time of symptoms onset to getting an optimal treatment and maintaining optimal health. For some women, the process was repeated if symptoms evolved and relapse occurred. Inner iteration loops happened among some women as women consult symptoms to others. Women got alarmed at unusual and evolving symptoms, which started from mild and non-specific symptoms ahead of MI. Attributing of symptoms was made based on previous experiences and evaluating of situations directed next step how to relieve symptoms and identify the causes.  After an optimal intervention, women paid attention to strategies for maintaining optimal health as an ongoing process. Implications: The study was socially and physiologically contexted, therefore empirical testing in clinical setting needs to be done for future studies.