“I never thought it was my heart”: illness and health-seeking experiences of Saudi women with symptoms suggestive of acute coronary syndrome

Abstract

BACKGROUND: Coronary heart disease (CHD) is recognised as the leading cause of mortality and morbidity, affecting a considerable portion of men and women worldwide. CHD manifest clinically as Acute Coronary Syndrome (ACS), a spectrum of conditions that include STelevation MI, non-ST-elevation MI, and Angina Pectoris. Not recognising and responding to ACS symptoms promptly can significantly contribute to delays in diagnosis and treatment, which can exacerbate the potential for poor prognosis and the risk of mortality. While efforts in mitigating timely response within the healthcare system have been observed, delays in health-seeking persist, especially in women. This issue is understudied in the context of Saudi Arabia, where CHD is on the rise.

AIM: This PhD research aimed to explore the experiences of Saudi women with symptoms suggestive of ACS and their subsequent health-seeking behaviours in response to the perceived symptoms.

METHODS: Qualitative research design with in-depth, semi-structured interviews was carried out to explore women’s illness and health-seeking experiences within the context of Saudi Arabia. A total of twenty Saudi women hospitalised at King Abdulaziz University Hospital (KAUH) for an ACS event took part in this study. Data were gathered from September 2021 to March 2022 through individual interviews conducted in-person (n=17), online (n=2), and over the phone (n=1). The interviews took place 1-6 months after the women’s hospital discharge, during follow-up visits at the hospital’s cardiology outpatient clinic. All interviews were audiorecorded and transcribed verbatim. The textual data were then analysed using reflexive thematic analysis guided by Braun and Clarke (2022).

FINDINGS: Three key themes were constructed from the extensive accounts of the study participants: 1) Recognising the subtle change in health and interpreting symptoms, 2) Responses to perceived symptoms, and 3) Arriving at the final destination. The analysis indicates that, for the women interviewed, navigating illness in the circumstances of ACS cannot be separated from the contextual world where the acute event takes place. My research provides a nuanced understanding of how Saudi women navigate symptoms, assess biomedical and familial risks, manage their health issues, seek lay consultation, and ultimately attend the hospital in response to an acute cardiac event. The women’s experiences were understood by considering key theoretical elements of Chrisman’s (1977) health-seeking process combined with a gender lens.

CONCLUSION: My study contributes to the knowledge that Saudi women’s experiences in navigating their way to the hospital were complex and multifaceted. Alongside the severity of symptoms and worsening health conditions, gender roles and their accompanying social and familial responsibilities, as well as family dynamics, were essential in determining how the women engaged in health-seeking behaviours and decided to attend the hospital. By understanding the broader sociocultural conditions of Saudi women, this study provides valuable insights into women’s health-seeking trajectory, which may be different for women in other contexts. This nuanced understanding can inform healthcare providers working in community and hospital settings to be mindful of the importance of delivering socially sensitive, context-based healthcare to address women’s specific needs in Saudi Arabia and other similar cultural settings.