Research to Reduce Time to Treatment for Heart Attack/Myocardial Infarction for Rural American Indians/Alaska Natives (AI/AN)
Attachment 8A
Interview Guide for Individuals
Form Approved
OMB No. 0920-xxxx
Exp. Date xx /xx/xxxx
Research to Reduce Time to Treatment for Heart Attack/Myocardial Infarction for Rural American Indians/Alaska Natives (AI/AN)
Interview Guide for Individuals
My name is ____________ and I am working with a program that is trying to better understand the issues surrounding patients who are experiencing a heart attack. We are trying to identify what can be done to reduce the time from heart attack to treatment for patients in our rural American Indian communities. This is important because we believe that early treatment can reduce the damage that is done to the heart from a heart attack, it increases the patient’s ability to recover. We need your ideas, opinions and experiences to help determine the best ways to educate others in the importance of seeking immediate treatment for the signs and symptoms of a heart attack. Your time and opinions are extremely valuable to this project.
Please fill out the following:
1. Age: _________ 2.Male: ________ 3.Female: _________ 4.Years of Ed.____
5. Race:
American Indian __ Tribe_________________
Alaska Native___ Tribe_________________
Black or African American___
Native Hawaiian or Other Pacific Islander___
White__
Ethnicity:
Hispanic or Latino___
Not Hispanic or Latino___
6. Profession:____________________
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, NE, MS D-74, Atlanta, GA 30333, ATTN:PRA (0920-xxxx
7. Have you ever had a heart attack (MI)? No_____ Yes _____ (if no go to # 8, if yes go to # 7a)
7a. If yes, how long ago? ___________
8. Do you think that you are at risk for having a heart attack? Yes ____ No ____
9. Please check all the following that you would expect to occur in someone having a heart attack. (Signs are things you see, symptoms are things that you feel)
_______ Arm pain _______ Faint
_______ Chest pain _______ Denial _______ Chest pressure _______ Dizziness _______ Stomach pain _______ Vomiting
_______ Rapid or irregular heart beat _______ Neck pain
_______ Numbness & tingling in the Arm _______ Cold skin
_______ Blurred vision _______ Heartburn
_______ Sudden sweating _______ Indigestion
_______ Back pain _______ Jaw pain
_______ Paralysis
_______ Feeling of doom
_______ Shortness of breath
_______ Pain that spreads to your shoulders, neck, back arms _______ Squeezing sensation or tightness in you chest
_______ Unexplained Weakness or light headedness
Other___________________________________________________________
10. If you have had a heart attack, please check all the signs and symptoms that you had shortly before or at the time of your heart attack. (Signs are things you see, symptoms are things that you feel)
_______ Arm pain _______ Faint
_______ Chest pain _______ Denial _______ Chest pressure _______ Dizziness _______ Stomach pain _______ Vomiting
_______ Rapid or irregular heart beat _______ Neck pain
_______ Numbness & tingling in the arm _______ Cold skin _______ Blurred vision _______ Heartburn _______ Sudden sweating _______ Indigestion
_______ Back pain _______ Jaw pain
_______ Paralysis
_______ Feeling of doom
_______ Shortness of breath
_______ Pain that spreads to your shoulders, neck, back arms _______ Squeezing sensation or tightness in you chest
_______ Unexplained Weakness or light headedness
Others ___________________________________________________________
11. If you had a history of chronic symptoms that were identified by a medical provider as not being related to your heart such as heartburn or gallstones, what change in your symptoms made you believe that it might be a heart attack?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
12. Do men and women have the same signs &/or symptoms of a heart attack?
(Signs are seen, symptoms are felt) Yes ___ No___ don’t know_____
13. Would/did you call for help if you thought you might be having a heart attack?
Yes__ No__
14. Whom would/did you call?
a. _______ A friend b. _______ An ambulance or 911
c. _______ A family member d. _______ A medical provider (Dr., FNP, PA)
e. Other ___________________________________________________________
15. If you called someone other than 9-1-1 or an ambulance, how long did it take you to get in to see a doctor or other health care provider (besides EMTs)? __________________
16. How soon after you thought you were having a heart attack would / did you call for help?
a._____ Right away b._____ Less than an hour c._____1 -2 hours d._____ 2-3 hours
e. _____3-4 hours f._____ more than 4 hours
g. Other ___________________________________________________________
17. Who is the one person who would most influence you in getting care? _____________
(for example – daughter, son, husband, doctor, neighbor, etc.)
18. What is the first action that you would/did take when you thought you were having a heart attack? (for example, take an aspirin, call 911, call a friend or a relative, etc.)
1._______________________________________________________
2._______________________________________________________
3._______________________________________________________
4._______________________________________________________
19. Do you believe that a heart attack is a medical emergency that requires immediate attention? Yes_____ No ______
20. What do you believe are the consequences of delaying treatment for a heart attack? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
21. Would you like more information or education about heart attack? Yes ____ No _____
22. What kind of information would you like? (prevention/treatment/signs and symptoms)
______________________________________________________________________
23. How would you like to get more information on heart attacks?
a._______ Books
b._______ Pamphlets
c._______ Doctors - nurses – nurse practitioners – PA’s
d._______ Community meetings
e._______ A private meeting with someone that can answer your questions
f._______ Television
g._______ VCR, CD or audio tape
h. _______ Radio
Other ____________________________________________________________
24. What are the risk factors that you can think of that you believe may lead to a heart attack?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
25. Check as many of the following that may prevent you from seeking help if you thought you were having a heart attack.
_______ No Insurance
_______ Too Busy / No time
_______ Child care
_______ Family disapproval
_______ No transportation
_______ Denial
_______ Pride
_______ Embarrassment if nothing was wrong
_______ Giving up control
_______ Losing work time
________Cost of medications
_______ Don’t want to bother others
_______ Discrimination
_______ Hassle at the hospital
_______ Lack of knowledge
_______ Don’t want to scare family
_______ Tried to manage symptoms
_______ Don’t want to be a burden to the family
_______ Lack of privacy
_______ Don’t trust doctors / hospitals
_______ Don’t know how to get help
_______ Don’t care about my health, I’m going to die someday anyway
_______ Having to wait for treatment at the hospital
_______ Light and sirens of the ambulance, police or fire trucks
_______ Receiving a bill for the ambulance ride
_______ Receiving a bill from the hospital
_______ Fear of finding out if you are having a heart attack
_______ You feel your questions are dumb
_______ You feel the doctor may think your questions are dumb
Others ____________________________________________________________
26. How many times in the past year have you been to a doctor? _____________
27. Do you typically see the same provider each time you go to the doctor? Yes ____No_____
28. Describe the person who you think is most likely to have a heart attack. ____________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________
29. Are there problems in your hospital or clinic that could interfere with a person’s ability to receive timely treatment? Yes______ No ________
If yes, what are they? ___________________________________________________________________________________
30. What specific treatments or capabilities are lacking at your clinic or hospital to deliver appropriate acute myocardial infarct (heart attack) care, if any?
31. Do you believe that there is appropriate treatment and expertise for heart attack available at your local clinic? Yes______ No_______
32. Is EMS (emergency medical service) available in your community? Yes______ No______
33. In the cases in which you are familiar with of an individual having a heart attack, was the emergency medical system (EMS) used? Yes_______ No________
If No, why not? __________________________________________________________
34. What can be done to increase the use of the EMS? ________________________________________________________________________________________________________________________________________________________________________
What distance does your EMS have to travel to reach your door? ___________________
36. How many close relatives in your family have had a heart attack? _____________________
(Probe: Do you believe that having a family history of heart attack increases your risk for a heart attack?) ________________________________________________________________________________________________________________________________________________________________________
37. Do you believe that diabetes contributes to your risk for heart disease? _________________
| File Type | application/msword |
| File Title | Attachment 8 |
| Author | jnb1 |
| Last Modified By | arp5 |
| File Modified | 2008-06-23 |
| File Created | 2008-06-19 |