A phenomenologic study was conducted to explore, from the perspective of women with known coronary artery disease (CAD), the appraisal of the coronary artery symptom episode and whether certain factors influence seeking professional help. The specific aims addressed were: to examine the processes by which women appraise their CAD symptoms; to explore whether there are differences between expectations of cardiac symptoms and the actual symptom experiences; to examine what barriers affect the help-seeking response; and to discover whether there are significant differences among the appraisal processes of women who seek help promptly, those who delay, and those who fail to seek help for their cardiac symptoms.

Fourteen informants participated in the study who were purposively selected based on their personal knowledge of the cardiac symptom experience. From each taped interview, significant themes were extracted using the technique described by Colaizzi (1978). Key statements emerging from analysis were used to create two Q-sorting tasks. Analysis from this study revealed that the help seeking response was a complex, multidimensional process, complicated by confusion and competing issues. Confusion resulted from the features of the symptoms, an age/illness distinction, expectations, and preconceived beliefs. The competing issues included role conflicts, degree of support from significant others, and attitudes toward and accessibility to the health care system. The appraisal process was wrought with ambiguity as symptoms differed with informants' expectations. This diagnostic confusion required the informants to continually reappraise the symptoms to direct further action. Individuals either self-managed their symptoms, continued to be driven by the circular confusion, or recognized certain features of their symptoms indicating a need to seek professional help. Informants sought help as symptoms worsened; if symptoms were tolerable, competing issues helped or hindered the decision making process.

Findings indicate that the role of family and the reciprocal relationships established when individuals manage chronic heart conditions within a support system need to be a research focus. Strategies need to be developed that focus on empowering women to clarify perceptions about the symptom experience in order to make prompt, accurate decisions about the need for professional help.