Thesis (Ph. D. (Nursing))--Chulalongkorn University, 2009

The purpose of this study was to examine the causal relationship among severity of symptom, cognitive and emotional representations, alternative coping strategies, appraisal symptom seriousness, and delay in seeking treatment among Thai Acute Myocardial Infarction (AMI) patients was based on Leventhal’s Self- Regulatory model of illness behavior. Stratified random sampling was employed to obtain the sample of 160 AMI patients who visited five hospitals in Bangkok metropolitan. Research instruments consisted of Personal Information Questionnaire, the Response to Symptom Questionnaire (RSQ) and the Coping with Heart Attack Symptom Scale (CHASS). Data were analyzed using descriptive statistics and structural equation modeling. The goodness of fit indices illustrated that delay to seek treatment model fit with the empirical data (χ2 =31.18, df = 27, χ2 /df =1.15, p = 0.26, GFI = 0.97, AGFI = 0.92, and RMSEA = 0.03), and explained 55% of the variance of delay to seek treatment. Alternative coping strategies was the most influential factor affecting delay to seek treatment through appraisal symptom seriousness by having negative indirect effects. In addition, symptom severity and appraisal symptom seriousness had a significant negative direct effect on delay to seek treatment. Cognitive illness representation had a significant negative indirect effect on delay to seek treatment through appraisal symptom seriousness. However, the emotional response to symptom was no significant to perform as directed effect on alternative coping strategies. The findings indicated the prominent components of nursing intervention focusing on reduce delay time to seek treatment by increase the likelihood and speed with which two modifiable variables appraisal of symptom seriousness and alternative were coping strategies that significance to decrease time to attribution and representation for AMI symptom. Nurses should consider about symptom severity, cognitive and emotional illness representation affecting delay to seek treatment in planning the intervention. This study highlighted important clinical, theoretical, and research implications