Project Overview
Readmissions for acute myocardial infarction (AMI) are common, costly, and pose a substantial burden on healthcare resources, yet existing interventions have not consistently reduced readmission rates. Younger women with AMI (≤55 years) are more frequently readmitted over the first year after AMI than younger men, resulting in poorer outcomes. In concert with sex-related factors (i.e. biological factors), gender-related factors (e.g. psycho-socio-cultural factors) are associated with worse outcomes after a first AMI in young women. However, the role of sex and gender as determinants of AMI re-hospitalization in younger women is not fully elucidated. A major obstacle to effective intervention is that gender-related factors have not been routinely collected in existing cohort studies. Thus, risk models for post-AMI readmission have failed to incorporate variables associated with gender. In addition, there is a lack of understanding of causes of readmission from young women’s perspectives and how sex and gender-related variables affect this risk.
This project incorporates both sex- and gender-related factors in developing an individualized intervention using the WOOP (Wish, Outcome, Obstacle, and Plan) self-regulation strategy, to reduce the risk of readmission in young women within one year of discharge from AMI. WOOP helps people target goals and attain behavioral change. It has proven effective across ages and in various health contexts. This strategy may be particularly powerful in young women, as they have significant self-care responsibilities and psycho-socio-cultural stressors. WOOP promises to be an easy, affordable, and effective way to help young women self-regulate their behavior by explicating their individual wishes, outcomes, obstacles, and plans post-AMI. This approach is supported by prior research showing that promoting self-care leads to decreased readmissions.
Data Collection Overview
The overall goal of the study was to develop a WOOP behavioral self-regulation intervention to reduce the risk of readmission in young women (<55 years) within one year of discharge from AMI. The project was a planning study aimed at helping to inform a future clinical trial of WOOP’s implementation. The research involved an iterative process involving stakeholder reviews, education, training, evidence reviews, interviews, focus groups, and WOOP-adaptation. Regarding the qualitative interviews, we used a Stakeholder Advisory committee to develop interview guides for both participant (patient) and provider experiences. Stakeholders included a panel of experts in outcomes research, behavioural science, medical professionals, and community members (women with lived experience of AMI) who were representative of study population (listed as Project Members in the data project metadata field “Contributors”).
The following data were collected:
(1) Qualitative interviews with both patients and providers, to identify key barriers/motivators related to the experiences of young women who are readmitted within one year of hospitalization for AMI. Note: only patient interviews are being shared at this time in QDR.
(2) Focus groups with patients and providers, to elicit feedback on our interventional WOOP design from young women readmitted within one year of hospitalization for AMI. Note: focus group data are not being shared at this time.
While for category (1) we aimed to recruit about 25 patient participants, we completed 18 interviews before we started hearing the same themes from participants and reached saturation. The individual qualitative interviews with patients, de-identified transcripts from which are being shared in this deposit, lasted between 18-55 minutes each (average around 38 minutes). Since they were conducted between February 5th and August 4th, 2021, in context of the COVID-19 epidemic, the interviews were all conducted remotely via Zoom.
We audio-recorded the interviews (note: participants did not state their name or any identifying information during the interviews), which we then had professionally transcribed and de-identified by a HIPAA-compliant vendor. A unique code was assigned to each transcript. During the analysis stage, we used Dedoose to complete our coding. Data analysis was performed by several co-investigators with input from the larger stakeholder group with expertise in cardiology, women’s health, psychology and qualitative research (listed as Researchers in the data project metadata field “Contributors”).
Shared Data Organization
The data published in QDR consist of 18 de-identified patient narratives, intentionally condensed from the full transcripts of the qualitative interviews. This abstracted version of data presentation was approved by the researchers’ IRB.
The documentation files consist of the information sheet and script for verbal consent used in the study, the interview guide (semi-structured questionnaire), a data narrative and an administrative README file. |
