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Time-to-Treatment for Myocardial Infarction: Barriers and Facilitators Perceived by American Indians in Three Regions

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Abstract

Early recognition of acute myocardial infarction (MI), followed by prompt emergency care, improves patient outcomes. Among rural American Indian (AI) populations there are disparities in access to care for MI and processes of care, resulting in poor MI-related health outcomes compared to the general population. We sought to gain an understanding of barriers related to MI time-to-treatment delays using a qualitative approach. We conducted semi-structured interviews and focus groups with AI key informants and community members in three Indian Health Service regions. Major barriers to care included long travel distance to care and lack of supporting infrastructure; distrust of the health care system; low overall literacy and basic health literacy; priority of family care-giving; and lack of specialized medical facilities and specialists. Findings suggest that improved time-to-treatment facilitators include educating the local community about the causes and consequences of MI and culturally-sensitive health communication, as well as addressing the quality of local systems of care and the community’s perception of these systems. Pursuing these strategies may improve quality of care and reduce MI-related morbidity and mortality in rural AI populations.

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Acknowledgments

The authors thank the study participants, the study advisory group, Melissa O’Leary, Daniella Uslan, and Dr. James M. Galloway for their contributions to this paper.

Funding

This study was funded by The Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Indian Health Service.

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Authors and Affiliations

  1. Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA

    Elizabeth D. Nesoff

  2. Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F-72, Atlanta, GA, 30341-3717, USA

    J. Nell Brownstein

  3. Indian Health Service, 1215 N. Beaver Street, Suite #201, Flagstaff, AZ, 86001, USA

    Mark Veazie

  4. Missouri Breaks Industries Research, HCR 64 Box 52, Timber Lake, SD, 57656, USA

    Marcia O’Leary

  5. Native American Cardiology and Medical Service Program, University of Arizona Medical Center, 1501 North, Campbell Ave., PO Box 245202, Tucson, AZ, 85724, USA

    Eric A. Brody

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  1. Elizabeth D. Nesoff
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  2. J. Nell Brownstein
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  5. Eric A. Brody
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Correspondence to Elizabeth D. Nesoff.

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Nesoff, E.D., Brownstein, J.N., Veazie, M. et al. Time-to-Treatment for Myocardial Infarction: Barriers and Facilitators Perceived by American Indians in Three Regions. J Community Health 42, 129–138 (2017). https://doi.org/10.1007/s10900-016-0239-x

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  • DOI: https://doi.org/10.1007/s10900-016-0239-x

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