| ObjectiveTo investigate the status of decision delay in patients with acute coronary syndrome(ACS),analyze the relationship between cognitive factors,emotional factors,coping tendency,health literacy and decision delay based on self-regulatory model of illness behaviour,so as to enrich the related research of health literacy and decision delay,to reduce the incidence of decision delay in ACS patients.Methods293 ACS patients in emergency department and cardiology department of a third class a hospital in Jinan were selected by convenient sampling method from December 2018 to July 2019.The research tools included ACS patient information questionnaire,Chinese version of acute coronary syndrome response index,simple coping style questionnaire,hospital anxiety and depression scale and chronic disease patient health literacy scale.SPSS 25.0 was used for data analysis.Statistical methods included descriptive statistics,?2 test,independent sample t-test,two independent sample rank sum test,Logistic regression analysis etc.ResultsA total of 310 delayed decision-making questionnaires were issued in this study,305 of which were recovered,with a recovery rate of 98.39%.293 questionnaires were included in the study after the invalid questionnaires were eliminated,with an effective rate of 96.07%.1.Socio-demographic,diseases and environmental data of ACS patientsIn this study,the age of ACS patients ranged from 30 to 93 years,with an average age of 62.31±2.00 years.Among them,most of the patients were male(70.65%),most of them were retired from work(35.84%),most of them were educated in junior high school(32.08%),most of them were married(88.74%),most of them had a monthly income of 3001-5000 yuan(34.47%),and most of them were paid by medical insurance(62.80%).The first visit was the most frequent(65.53%),unstable angina pectoris was the most common type of disease(35.49%),chest compression,compression or chest pain symptoms were the most common(77.47%),nausea or vomiting were 71(24.23%),fatigue and weakness were 105(35.84%),sudden onset was 205(69.97%),symptoms continued at the time of onset was 53.58%.The nature of pain was press pain(29.01%),and the degree of pain was moderate pain(31.40%).At the time of onset,most of the patients were at home(80.55%),158(53.92%)at daytime,58.70%at rest,161(54.95%)at self medication and 218 people with family members(74.40%),but 69.97%of the families did not know about myocardial infarction.2.Status of decision delay in ACS patientsIn this study,the median time of ACS patients was 5.33h.Among all disease types,the median time of decision delay was the shortest in patients with st-segment elevation myocardial infarction(2.00h),and the longest in patients with unstable angina pectoris(8.50h).The incidence of decision delay was 74.40%in patients with ACS,the highest(77.88%)in patients with unstable angina pectoris.3.Single factor analysis of decision delay in patients with ACSUsing ?2 test,independent sample t test and two independent sample rank sum test to analyze the influence of demographic data,disease data,environmental data,health literacy,emotional factors,coping tendency,etc on decision delay of ACS patients in different groups.The results showed that education level,accompanying symptoms(nausea,vomiting and sweating),sudden onset,symptom duration,pain level,onset time,age,anxiety,depression,attitude,belief,coping tendency,information acquisition ability,communication and interaction ability and health literacy had significant difference on decision-making delay of ACS patients(P<0.05).4.Multiple factors analysis of decision delay in patients with ACSMultivariate analysis showed that there was a significant difference between the time of onset,the duration of symptoms,the degree of pain,belief,depression and the coping tendency in the delay of medical decision-making(P<0.05).Among them,night onset,intermittent symptoms,mild or moderate pain were risk factors for decision-making delay in patients,while high belief level,high depression level and positive coping tendency were protective factors to reduce the occurrence of decision-making delay in patients.Conclusion1.The median time of decision delay in ACS patients is 5.33 h,and the incidence of decision delay is 74.40%.The status of decision-making delay is not optimistic.2.Patients with nocturnal onset,intermittent symptoms during onset,and mild or moderate pain are prone to decision delay.When conducting health education for high-risk groups,it is necessary to emphasize the characteristics of ACS and disease.3.The higher the patients' belief of seeking medical aid immediately,and the less the possibility of decision delay.4.The patients' depression can affect the delay of medical decision-making.The higher the]evel of depression,the less likely it is to have decision delay.5.The higher the positive coping tendency of patients,the shorter the time of medical decision-making.In the future,we can increase the effective measures for patients to deal with ACS,so as to improve patients' bad coping and promote medical decision-making. |
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