Systematic review, meta-analysis and meta-regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease

Abstract

Aims and objectives: To assess the effectiveness of educational interventions and the relative effect of intervention duration on secondary prevention health behaviours in adults with coronary heart disease.

Background: Patient education can reduce disease progression and improve outcomes. However, there is a lack of knowledge of its efficacy and the relative impact of education duration on health behaviour change in this population.

Design: A systematic review and meta-analysis.

Methods: Seven electronic databases and grey literature were searched from Inception to July 2021. The review followed the PRISMA guidelines. This meta-analysis was analysed in Comprehensive Meta-Analysis version 3 software. Outcomes considered were disease knowledge and health behavioural outcomes. Data were pooled together with random-effects models using the inverse-variance method. The effect of education duration (<3 vs. ≥3 months) was examined by meta-regressions.

Results: In summary, 73 studies were included with a total of participants (n = 24,985) aged mean of 60.5 ± 5.7 years and mostly male (72.5%). Patient education improved all behaviours including disease knowledge at <6 and 6-12 months follow-up, the likelihood of quitting smoking at <6, and 6-12 months, medication adherence at <6 and 6-12 months; physical activity and exercise participation at <6 and 6-12 months and healthy dietary behaviours, at <6 and 6-12 months. Furthermore, education programmes with a longer duration (≥3 months) improved disease knowledge and physical activity more than shorter programmes.

Conclusion: Patient education for secondary prevention, in various delivery modes and intensities, improves multiple self-reported health behaviours in patients with coronary heart disease.

Relevance to clinical practice: This study assessed the effectiveness of secondary prevention education and demonstrated improvements in all outcomes in this population. Longer duration programmes were more effective in improving disease knowledge and physical activity in the long term. These findings can assist the cardiac programmes' design, particularly in ensuring sufficient intervention duration.

Keywords: coronary heart disease; exercise; health behaviour; knowledge; meta-analysis; nursing; patient education as topic; risk factors; secondary prevention; systematic review.