Review Article
Education interventions in Chinese cardiac patients on health behaviours, disease-related knowledge, and health outcomes: A systematic review and meta-analysis

https://doi.org/10.1016/j.pec.2020.12.001Get rights and content

Highlights

  • Education interventions for adult Chinese cardiac patients may be beneficial.

  • There is a need to improve reporting of education interventions.

  • Research is needed on education interventions in Chinese immigrant cardiac patients.

Abstract

Objective

This systematic review and meta-analysis aimed to summarize and synthesize the available evidence in adult Chinese cardiac patients to determine the effect of education interventions on health behaviours, disease-related knowledge, self-efficacy, depressive symptoms, anxiety symptoms, health-related quality of life, morbidity, and mortality.

Methods

Seven databases were searched from database inception until January 2020 for randomized controlled trials. Characteristics of education interventions were described and random-effects meta-analysis was performed where feasible.

Results

Overall, 18 randomized controlled trials were included in this systematic review and suggested that education interventions are effective in improving patients’ physical activity, dietary habits, medication behaviour, disease-related knowledge, and health-related quality of life. Meta-analysis of two studies demonstrated benefit on physical activity (standardized mean difference [SMD] 1.27, 95% confidence interval [CI] 1.06–1.48; participants = 422; I2 = 0%), dietary habits (SMD 0.76, 95%CI 0.44–1.08; participants = 422; I2 = 61%), and medication behaviour (mean difference [MD] 0.31, 95%CI 0.17–0.46; participants = 422; I2 = 28%).

Conclusion

This study supports the benefits of education interventions for adult Chinese cardiac patients on health behaviours, disease-related knowledge, and health-related quality of life. Future studies should characterize their education interventions in detail to facilitate reproducibility and comparison.

Practice implications

This study identified the need for studies on the outcome of alcohol consumption and in Chinese immigrant populations.

Introduction

Rapid urbanization and accompanying lifestyle changes in China have contributed to a significant increase in the burden of cardiovascular disease (CVD), which is now the leading cause of mortality and a significant contributor to morbidity and hospitalization [1]. Cardiac rehabilitation (CR) is an evidence-based and cost-effective model of secondary prevention designed to reduce the morbidity and mortality of CVD [2,3] through structured exercise training and patient education and counselling [4]. Despite these benefits, recent studies showed an insufficient number of CR programs globally to meet the needs of this population, including in China [5], where the concept of CR is relatively new [6].

Patient education involves provision of information from healthcare providers to patients to improve their health behaviours and outcomes. Educational interventions for cardiac patients have been associated with reduced healthcare costs [7], reduced morbidity [8], improved self-management behaviours [4], and increased quality of life [7], and are recommended as a core component of CR by several guidelines, including those from the United States and Britain [9,10].

Previous systematic reviews have investigated varying aspects of patient education in CVD by confining their scopes to a specific timing of education, type of education, or mode of delivery. For example, previous reviews focused on postoperative and discharge education [[11], [12], [13]], psychoeducation [14,15], technology-based delivery [16,17], and nurse-led clinic delivery [18]. Two systematic reviews (a recent Cochrane systematic review and meta-analysis [19] and a review by some of the current authors [4]) investigate educational interventions broadly with outcomes on multiple health behaviours. These reviews demonstrate that patient education in CVD has been well studied in European and North American populations. However, the reported studies were mostly in educated, Caucasian populations, and the ability to generalize findings to populations less represented in these studies is unclear, given the complexities and interactions of culture and traditional health beliefs and practices on the effectiveness of patient education programs, especially in older populations [[20], [21], [22]].

Education interventions for cardiac patients vary widely in design, content, delivery. With a lack of standardization of CR components and services in China, it is important to understand what education strategies work for Chinese patients to inform future development and integration of patient education in comprehensive CR programs. This systematic review and meta-analysis aims to summarize and synthesize the available evidence in adult Chinese cardiac patients to determine the effect of education interventions on health behaviours (physical activity, dietary habits, smoking status, alcohol consumption, and medication behaviour), disease-related knowledge, self-efficacy, depressive symptoms, anxiety symptoms, health-related quality of life, morbidity (adverse cardiovascular events, hospitalization), and mortality (total mortality, cardiovascular mortality).

Section snippets

Methods

This review was exempt from review by institutional research ethics boards. The protocol of this review was registered on PROSPERO (CRD42020172947) prior to commencement of data extraction. There were no changes in the methods used in this review from those outlined in the PROSPERO protocol.

Peer-reviewed randomized controlled trials (RCT) published in English or Chinese language of Chinese participants from mainland China, Macau, Hong Kong, and Taiwan, and Chinese immigrants in other countries

Results

The study selection process is illustrated in the flow diagram in Fig. 1. Initial searching and reference screening yielded 2809 results. Two authors independently screened the titles and abstracts. Then, 89 full text articles were obtained and assessed for eligibility by two authors independently, with an inter-reviewer agreement proportion of 95.5%. Overall, 18 studies [[28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45]] were included in

Discussion

This systematic review and meta-analysis summarized and synthesized the available literature on the effect of education interventions on health behaviours, disease-related knowledge, self-efficacy, depressive symptoms, anxiety symptoms, health-related quality of life, morbidity, and mortality in Chinese cardiac patients. Education interventions were described using the WIDER criteria. There were 18 included studies in the systematic review. Overall, these studies suggested that education

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

None.

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