REACT theory-based intervention to reduce treatment-seeking delay for acute myocardial infarction

Coronary heart disease (CHD) remains the leading cause of mortality in the U.S. Innovations in reperfusion therapies can potentially reduce CHD morbid ity and mortality associated with acute myocardial infarction (AMI) when tr eatment is initiated within the first few hours of symptom onset. However, delay in seeking treatment for AMI is unacceptably lengthy, resulting in mo st patients being ineligible for reperfusion therapies. The Rapid Early Act ion for Coronary Treatment (REACT) Trial is a four-year, 20-community, rand omized trial tc, design and test the effectiveness of a multi-component int ervention to reduce patient delay fbr hospital care-seeking for AMI symptom s. This manuscript describes the development and content of the theoretical ly-based REACT intervention and summarizes: (1) the research literature use d to inform the intervention; (2) the behavioral theories used to guide the development, implementation, and evaluation of the intervention; (3) the f ormative research undertaken to understand better decision-making processes as well as barriers and facilitators to seeking medical care as perceived by AMI patients, their families, and medical professionals; (4) the interve ntion design issues that were addressed; (5) the synthesis of data sources in developing the core message content; (6) the conceptualization for deter mining the intervention target audiences and associated intervention compon ents and strategies, their integration with guiding theoretical approaches and implementation theories for the study, and a description of major inter vention materials developed to implement the intervention; and (7) the focu s of the outcome, impact, and process measurement based on the intervention components and theories on which they were developed. (C) 1999 American Jo urnal of Preventive Medicine.