The Effect of Education Provided to Patients Undergoing Planned Percutaneous Coronary Intervention on Self-Efficacy and Secondary Prevention

Technical Summary: The Effect of Education Provided to Patients Undergoing Planned Percutaneous Coronary Intervention on Self-Efficacy and Secondary Prevention

Problem Statement
Cardiovascular diseases (CVDs) remain the leading cause of global mortality, imposing a significant socioeconomic burden. Percutaneous coronary intervention (PCI) is a primary treatment for ischemic CVD; however, long-term clinical outcomes depend heavily on secondary prevention and patient self-management. Despite guidelines emphasizing the importance of patient self-efficacy and active participation in care, many patients lack the necessary knowledge and behavioral strategies to manage risk factors (e.g., diet, physical activity, smoking) effectively. While nurses play a critical role in patient education, there is a need for structured, theory-based educational interventions that move beyond routine clinical practice to foster sustainable behavioral change and improve self-efficacy in patients undergoing elective PCI.

Methodology
This study employed a single-blind, randomized controlled trial (RCT) with a pre-test–post-test control group design. The research was conducted at the Cardiology Institute of a public university in Istanbul, Turkey, between January and June 2022.

• Participants: The initial population consisted of 180 patients scheduled for elective PCI. Based on power analysis (80% power, 95% confidence interval), 120 patients were included in the final analysis, randomly assigned to an intervention group (n=60) or a control group (n=60). Eligibility criteria included age >18, literacy, cooperation, and the ability to communicate via telephone.
• Intervention: The intervention group received a comprehensive educational program grounded in Social Cognitive Learning Theory (Bandura), focusing on attention, retention, motivation, and behavior formation. The program consisted of:
  • Three face-to-face sessions:
    1. Pre-procedure: Disease overview and preparation (30 min).
    2. Discharge: Post-discharge care and precautions (20–30 min).
    3. Day 10 follow-up: Secondary prevention strategies (30 min).
  • Materials: Educational booklets, slide/video presentations, case studies, and QR codes linking to resources (BMI calculation, smoking cessation).
  • Follow-up: Weekly SMS text messages for 12 weeks containing secondary prevention recommendations and motivational content, plus telephone follow-up.
• Control Group: Received a standard one-page text form regarding the procedure, reflecting routine clinical practice.
• Data Collection: Data were collected at three time points: baseline (pre-training), Day 10 (post-training), and 3 months post-training. Instruments included:
  • A researcher-developed questionnaire (sociodemographics, medical history, clinical values).
  • A 10-item Knowledge Test (KR-20 reliability = 0.87).
  • The Chronic Disease Self-Efficacy Scale (33 items, 10 subdimensions; Cronbach's α = 0.97).
  • The Healthy Lifestyle Behaviors Scale-II (52 items, 6 subdimensions; Cronbach's α = 0.94–0.97).
  • Clinical measurements: Anthropometrics (weight, BMI, BP) and laboratory values (cholesterol, triglycerides, LDL, HDL, fasting glucose).
• Statistical Analysis: Data were analyzed using NCSS 2007 software. Comparisons utilized the Mann–Whitney U test, Wilcoxon signed-rank test, Student's t-test, and paired samples t-test, with significance set at p < 0.05.

Key Results
The study found statistically significant differences between the intervention and control groups across multiple domains at the 3-month follow-up:

1. Knowledge: Both groups showed increased knowledge scores post-training, but the intervention group demonstrated a significantly higher mean increase (58.50 ± 17.15) compared to the control group (13.50 ± 10.70) (p < 0.01).
2. Self-Efficacy: The intervention group showed significantly greater improvements in total self-efficacy scores and all 10 subdimensions (including regular exercise, disease management, communication with physicians, and coping with symptoms) compared to the control group (p = 0.001).
3. Healthy Lifestyle Behaviors: Significant improvements were observed in the intervention group across all six subscales of the Healthy Lifestyle Behaviors Scale-II (interpersonal relationships, nutrition, health responsibility, physical activity, stress management, spiritual development) and in total scores (p < 0.01).
4. Clinical Outcomes: The intervention group exhibited more favorable changes in total cholesterol, triglycerides, LDL, HDL, weight, and BMI compared to the control group (p < 0.01). No significant difference was found between groups regarding fasting glucose levels.
5. Blood Pressure: While both groups showed significant within-group reductions in blood pressure over time, there was no statistically significant difference between the intervention and control groups regarding blood pressure measurements at follow-up.

Significance and Claims
The authors conclude that patient education structured according to Social Cognitive Learning Theory, delivered across pre-, intra-, and post-procedural phases and reinforced with mobile-supported follow-up, positively influences self-efficacy and secondary prevention behaviors in patients undergoing elective PCI.

The paper claims that this approach:

• Effectively improves health outcomes by enhancing self-efficacy and promoting healthy lifestyle behaviors.
• Plays a critical role in secondary prevention for PCI patients, supporting the management of modifiable risk factors.
• Demonstrates that telephone and text message follow-ups have a positive effect on maintaining secondary prevention efforts.

The study recommends that patient education be institutionalized as part of standard care, beginning before the procedure, utilizing theory-based approaches, and integrating emerging technologies (such as QR codes and mobile messaging) to ensure continuous, holistic, and reinforced education. The authors assert that these findings provide evidence to guide future research and contribute to the literature on nursing interventions in cardiology.