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Understanding and Informing Community Emergency Cardiovascular Disease Preparedness during the COVID-19 Pandemic:
Maria Cielito Robles1, Casey L Corches1, Morgan Bradford1
1University of Michigan, Department of Neurology, Stroke Program, Ann Arbor, MI, USA.
Insights
During the COVID-19 pandemic, community members feared seeking emergency care for stroke and acute myocardial infarction due to virus transmission concerns and reduced control over seeking care. Addressing these barriers is key to reducing delays.
Area of Science:
- Public Health
- Health Behavior Theory
- Cardiovascular Disease Epidemiology
Background:
- Time-sensitive treatments for acute stroke and acute myocardial infarction (AMI) were impacted during the COVID-19 pandemic.
- Early data indicated decreased patient presentation and increased pre-hospital delay for these emergencies.
- Understanding community perceptions is crucial for improving cardiovascular disease preparedness during health crises.
Purpose of the Study:
- To investigate community members' perceptions of seeking emergency care for acute stroke and AMI during the COVID-19 pandemic.
- To identify barriers and facilitators influencing timely access to cardiovascular emergency services.
- To inform the development of targeted public health strategies to mitigate pandemic-related delays.
Main Methods:
- A rapid assessment approach using semi-structured interviews was employed.
- The Theory of Planned Behavior guided the development of interview guides and data collection.
- Direct content analysis was performed on interview data, comparing responses for AMI and stroke.
Main Results:
- Fifteen interviews were conducted, with 80% of participants being Black Americans.
- Key concerns included fear of coronavirus transmission, hospital capacity, and quality of care.
- Socioeconomic factors like employment and childcare affected participants' perceived control over seeking emergent care.
Conclusions:
- The COVID-19 pandemic significantly impacted community members' attitudes and perceived behavioral control regarding seeking emergency cardiovascular care.
- Community-informed, theory-based public health messaging addressing identified barriers can potentially reduce pre-hospital delay.
- Addressing pandemic-related fears and perceived barriers is essential for maintaining timely access to critical stroke and AMI treatments.
Introduction:
Acute stroke and acute myocardial infarction (AMI) treatments are time sensitive. Early data revealed a decrease in presentation and an increase in pre-hospital delay for acute stroke and AMI during the coronavirus disease 2019 (COVID-19) pandemic. Thus, we set out to understand community members' perception of seeking acute stroke and AMI care during the COVID-19 pandemic to inform strategies to increase cardiovascular disease preparedness during the pandemic.
Methods:
Given the urgency of the clinical and public health situation, through a community-based participatory research partnership, we utilized a rapid assessment approach. We developed an interview guide and data collection form guided by the Theory of Planned Behavior (TPB). Semi-structured interviews were recorded and conducted via phone and data was collected on structured collection forms and real time transcription. Direct content analysis was conducted guided by the TPB model and responses for AMI and stroke were compared.
Results:
We performed 15 semi-structured interviews. Eighty percent of participants were Black Americans; median age was 50; 73% were women. Participants reported concerns about coronavirus transmission in the ambulance and at the hospital, hospital capacity and ability to triage, and quality of care. Change in employment and childcare also impacted participants reported control over seeking emergent cardiovascular care. Based on these findings, our community and academic team co-created online materials to address the community-identified barriers, which has reached over 8,600 users and engaged almost 600 users.
Conclusions:
We found that community members' attitudes and perceived behavioral control to seek emergent cardiovascular care were impacted by the COVID-19 pandemic. Community-informed, health behavior theory-based public health messaging that address these constructs may decrease prehospital delay.
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