MI time to treatment in rural American Indian country: Qualitative insight into delays

Early recognition of a myocardial infarction (MI), followed by prompt cardiac emergency care, has a direct effect on patient outcomes. Data from the National MI Registry show that American Indians/Alaska Natives experience the greatest disparity in time to treatment following an MI. We sought to gain an understanding of the barriers related to these delays by obtaining information through semi-structured telephone interviews with key informants and community member focus groups. Information obtained from participants includes their beliefs, perceptions, and behaviors affecting these delays. Interviews and focus groups took place in three IHS tribal areas—the Tucson Service Unit, the Bemidji area and the Aberdeen area. Distrust of providers, health literacy issues, denial of MI and stoicism emerged as major themes. Distance to hospitals, lack of transportation for family members and patients, and difficulties of patients in obtaining return transportation home, a lack of ambulances and trained EMTs and medical specialists in rural areas are significant barriers. We will discuss system experiences and perceptions that might explain why this population delays seeking much needed care. Additionally, we will discuss other cultural and personal barriers among the native population, as well as potential solutions revealed by study participants. This project was developed through the Healthy People 2010 Heart Disease and Stroke Partnership, a consortium of several federal agencies and the American Heart Association. Planning and implementation of the project were guided by an advisory group made up of tribal and state representatives and members of the Partnership.