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Original research article
Reducing delay in patients with acute coronary syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions
  1. Barbara Farquharson1,
  2. Purva Abhyankar2,
  3. Karen Smith3,
  4. Stephan U Dombrowski4,
  5. Shaun Treweek5,
  6. Nadine Dougall1,
  7. Brian Williams1 and
  8. Marie Johnston6
  1. 1 School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
  2. 2 School of Health Sciences, University of Stirling, Stirling, UK
  3. 3 NHS Tayside School of Nursing & Midwifery, University of Dundee, Dundee, UK
  4. 4 Faculty of Kinesiology, University of New Brunswick, New Brunswick, Canada
  5. 5 Health Sciences Research Unit, University of Aberdeen, Aberdeen, UK
  6. 6 Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Barbara Farquharson; b.farquharson{at}


Background Time to treatment in many conditions, particularly acute coronary syndrome, is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay.

Objective To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical.

Methods The data sources were Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Study eligibility criteria include intervention evaluations (randomised controlled trials, controlled clinical trials and cohort studies) involving adults (aged >18 years) and including an outcome measure of patient delay up to August 2016. Study appraisal and synthesis methods include screening potential studies using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies.

Results From 39 studies (200 538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified, plus 5 additional techniques, with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, three of four studies that included two or more BCTs, in addition to the two most commonly used additional techniques, reported a significant reduction in delay.

Conclusions Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions, although in relation to patient delay particularly additional use of BCTs might be helpful.

Trial registration number CRD42014013106.

  • acute coronary syndrome
  • delay: behaviour change
  • psychology
  • education

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  • Funding This work was supported by the Chief Scientist Office, Scotland (grant number CZH/4/1025).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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