ReviewA systematic review of patient education in cardiac patients: Do they increase knowledge and promote health behavior change?
Introduction
Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide [1], and are a significant contributor to morbidity and health-related costs [2]. Coronary artery disease (CAD) – the most common type of CVDs – is considered a chronic condition and, therefore, requires a careful medical management with multiple recommendations for patients to achieve optimal secondary prevention [3], [4], [5]. As a consequence, patient education is a necessary first step to promote patient understanding of the recommended therapies and behavior changes, as well as to follow them [6], [7], [8], [9].
Patient education has been formally defined as “the process by which health professionals and others impart information to patients that will alter their health behaviors or improve their health status” [10]. Research is beginning to demonstrate a positive effect of cardiac patient education on behavior change, including 4 reviews [11], [12], [13], [14]. Of these, 3 demonstrated educational interventions produce a positive effect on behavior change. Although these reviews may be less subject to bias as they included only randomized controlled trials, they included a small number of trials and focus on outcomes, failing to describe the interventions in depth and aiming only to assess psycho-educational strategies. It is important to gain a clear picture of how these interventions are structured and how they impact not only behavior, but also knowledge. To our knowledge, such a synthesis has not been published previously.
Cardiac rehabilitation (CR) is a comprehensive risk reduction program, of which patient education is considered a core component [15]. Thus, American and Canadian Cardiovascular Societies include education as a quality indicator of CR [16], [17]. According to the Canadian Association of CR Guidelines [3], patient education should: be personalized; be led by a professional staff, with regular contact between staff and patients; be delivered in individual or group settings; discuss specific health goals; and seek to influence outcomes beliefs, to elicit positive emotions, to increase optimism about the possibility of change, and to heighten the salience of personal experience or other evidence supporting self-efficacy. However, the nature of education delivery is not fully specified, and the impact of the education has not been often considered.
The first objective of this systematic review was to investigate the impact of education on patients’ knowledge about health and disease. The second objective was to determine if educational interventions are related to health behavior change in CAD patients, namely smoking, physical activity, dietary habits, response to cardiac symptoms, and medication adherence, as well as psychosocial well-being. Finally, the third objective was to describe the nature of the educational interventions offered, as per the Workgroup for Intervention Development and Evaluation Research (WIDER) reporting guideline [18].
Section snippets
Search methods for identification of studies
Literature published from database inception until August 2012 was searched using the MEDLINE, PsycINFO, CINAHL, EMBASE and EBM computerized databases, in conjunction with a subject librarian. Search results were downloaded into bibliographic software. The search strategy incorporated 3 concepts: (1) condition, which was divided into cardiac and rehabilitation aspects (e.g. coronary disease, myocardial infarction, and rehabilitation); (2) education (e.g. health education or patient education);
Results
Initial searching yielded 6476 records, and 3 records were identified through the snowball hand-search. After the screen, 343 full-articles were assessed for eligibility. Overall, 42 articles were included in this systematic review. A flow diagram depicting the search results, reasons for exclusion, and study selection is presented in Fig. 1.
Discussion
This systematic review investigated the impact of education on patients’ knowledge and health behavior change in CAD patients and described the nature of educational interventions delivered. Overall results of this review suggest that educational interventions within cardiac care increase patients’ knowledge and facilitate behavior change. All studies assessing knowledge but one reported an increase in patients’ knowledge, in areas including appropriate responses to cardiac symptoms and
References (76)
- et al.
Degree and correlates of cardiac knowledge and awareness among cardiac impatiens
Patient Educ Couns
(2009) - et al.
A meta-analysis of controlled trials of cardiac patient education
Patient Educ Couns
(1992) - et al.
AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services
J Am Coll Cardiol
(2007) - et al.
Current methods of the US Preventive Services Task Force: a review of the process
Am J Prev Med
(2001) - et al.
A low-literacy medication education tool for safety-net hospital patients
Am J Prev Med
(2009) - et al.
Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases
Patient Educ Couns
(2012) - et al.
Nutrition education intervention increases total n − 3 fatty acid intakes in heart patients living in the Midwest
Nutr Res
(2007) - et al.
The effects of education and group discussion in the post myocardial infarction patient
J Psychosom Res
(1984) - et al.
Effects of an intervention on health behaviors of older coronary artery bypass (CAB) patients
Arch Gerontol Geriatr
(2008) - et al.
Guideline-based early rehabilitation after myocardial infarction: a pragmatic randomised controlled trial
J Psychosom Res
(2002)