Patient Education in Cardiac Rehabilitation: The Role of Knowledge on Behavior Change and its Mediators

The purpose of this series of studies was to investigate the relationship between patient education and behavior change in CR and the role of knowledge on behavior change and its mediators in the context of the Health Action Process Approach (HAPA). The first study was a systematic review aimed to investigate the impact of education on patients' knowledge and health behavior change in cardiac patients. Findings from this review support the benefits of educational interventions in CAD, through increase in patients' knowledge and behavior change. The second study aimed to develop and psychometrically-validate a tool to assess information needs in CR patients. After a review by an expert panel, a pilot test, and a psychometric test in 203 CR patients, the tool - called INCR - demonstrated to have good reliability and validity. The INCR was completed by 306 CR patients and 28 CR providers in the third study. Results showed that CR patients desire information in many areas and that providers were highly cognizant of those needs. The forth study aimed to develop and psychometrically-validate the second version of the CADE-Q (Coronary Artery Disease Education Questionnaire), a tool to assess CR patients' knowledge. After a strict process, including a psychometric test in 307 CR patients, the CADE-Q II was considered valid and reliable. Finally, the fifth study investigated: (1) changes in knowledge and HAPA constructs among CR patients following participation in educational programs; and, (2) the theoretical correlates of exercise behavior change among CR patients receiving educational interventions. There was a significant improvement in patients' overall knowledge, some HAPA constructs, and exercise from pre- to post-CR regardless of curriculum. Path analysis revealed that knowledge was a significant motivational construct leading to intention formation, and intentions to engage in physical activity were not directly related to behavior, needing especially action planning, which was related to self-efficacy. Overall, results from all five studies were valuable in the area of patient education in CR and showed the importance of assessing patients' information needs and knowledge as well as to identify behavior determinants related to educational interventions.Ph.D