Formative research methods to understand patient and provider responses to heart attack symptoms

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavorial Medicine; Meyers Primary Care Institute

Publication Date


Document Type



Acute Coronary Syndrome; Myocardial Infarction; Community-Based Participatory Research


Health Services Research | Primary Care


Formative research is often required for program planning, and for reducing uncertainty about generalizability of program effects. This article describes and justifies methods of formative research conducted for the REACT study (Rapid Early Action for Coronary Treatment), a multi-center collaborative randomized community trial aimed at reducing patient delay in seeking care for acute myocardial infarction (AMI). Formative research cast light on the decision-making process of patient and community members in seeking help for AMI, as well as barriers and facilitators of this process. Investigators at all five REACT Field Centers participated in the formative research. The process consisted of: (1) developing a common theoretical framework for the study intervention; (2) conducting a literature review and qualitative research to identify and address gaps in knowledge; and (3) developing a common protocol for the REACT study that accommodated the diversity of the target communities in terms of services, resources, history, and ethnicity. Analysis employed triangulation, defined as an explicit search for heterogeneous data sources to reduce uncertainty about forces at work and opportunities for intervention across settings and populations. Because the collection and interpretation of data went in stages, staff of several REACT Field Centers had independent input to the overall synthesis, then shared and revised the results. Advantages and limitations of this approach are discussed.


Leviton LC, Finnegan JR, Zapka JG, Meischke H, Estrabrook B, Gilliland J, Linares A. Weitzman ER, Raczynski J, Sone E. Formative research methods to understand patient and provider responses to heart attack symptoms. Eval Program Plann 1999;22(4):385-397.

Journal/Book/Conference Title

Evaluation and Program Planning