1. Background
In the past three decades, cardiovascular diseases (CVD) have been recognized as the leading cause of mortality worldwide, accounting for one-third of global deaths. In 2021, these diseases were responsible for approximately 20 million deaths. While the death rates from CVD have decreased in developed countries, they remain a major concern in low- and middle-income countries (1). With the increasing prevalence of CVD, the need for appropriate healthcare services to better manage these conditions has become a necessity. Cardiac patients require continuous care and access to the monitoring and education necessary for better disease management. In this regard, providing educational and supportive resources to assist patients in managing their daily lives and adhering to a healthy lifestyle is of particular importance (2).
Cardiac rehabilitation (CR) is considered one of the key strategies in managing CVD. Cardiac rehabilitation not only helps in reducing complications and issues arising from heart diseases but also enhances the quality of life and patient satisfaction. These programs may include exercise training, nutritional education, psychological counseling, and lifestyle modification plans, all of which contribute to improving the patient’s recovery (3). One important aspect of CR is structured educational programs (4). In the context of CR, needs assessment is important, and this information can aid in designing effective educational programs tailored to their specific circumstances and abilities. Educational programs that align with the needs and challenges of patients can assist them in better understanding their condition, managing symptoms, making lifestyle changes, and improving their overall quality of life.
2. Objectives
The aim of this study is to assess the educational needs of patients attending CR at Razi Hospital in Birjand and to compare these findings with the insights of healthcare providers, including physicians and nurses in the cardiology department.
3. Methods
The present study is a qualitative study conducted with the aim of assessing the educational needs of patients requiring CR in 2022. The research was carried out in two phases. Initially, qualitative techniques were used to identify needs using the fish bowl technique. Three sessions were held with the expert team. In the final meeting, 15 topics were selected as patients' educational needs with full agreement of the team members.
In the second phase, a checklist containing the 15 educational needs titles was designed and distributed to 70 cardiac patients and 17 healthcare providers, including cardiologists and nurses in the cardiology department, for prioritization. The validity of the checklist was reviewed by a panel of experts. A degree of importance index based on a five-point Likert scale was utilized for prioritizing the educational needs. Participants were asked to assign a score between 1 and 5 to each of the presented titles based on the importance and educational needs of the patients (where a score of 5 indicated the highest educational need and a score of 1 indicated the lowest). After collecting data, educational priorities were determined based on the average score of each topic.
4. Results
Patients assigned the highest scores to topics such as "the role of a healthy diet in the prevention and management of heart disease" and "the role of exercise and physical activety". In contrast, service providers placed more emphasis on topics like "awareness of warning clinical symptoms" and "risk factors for heart disease" (Table 1).
| Educational Topic | Patients | Service Providers |
|---|---|---|
| The role of a healthy diet in the prevention and management of heart disease | 3.79 ± 0.37 | 4.65 ± 0.56 |
| The role of exercise and physical activity in the prevention and management of heart disease | 3.63 ± 0.32 | 4.71 ± 0.32 |
| The role of controlling negative emotions in the prevention and treatment of heart disease | 3.49 ± 0.21 | 4.65 ± 0.31 |
| Risk factors for heart disease (hypertension, high cholesterol, diabetes, obesity, smoking, and tobacco) | 3.44 ± 0.22 | 4.88 ± 0.35 |
| Awareness of warning clinical symptoms (when to seek emergency care urgently) | 3.44 ± 0.34 | 4.94 ± 0.51 |
| Familiarity with the heart and its functions | 3.36 ± 0.31 | 2.88 ± 0.21 |
| Familiarity with types of heart diseases | 3.33 ± 0.31 | 2.76 ± 0.22 |
| How heart diseases are developed | 3.26 ± 0.21 | 3.53 ± 0.31 |
| Symptoms of heart diseases | 3.26 ± 0.21 | 4.59 ± 0.45 |
| The impact of heart disease on daily activities | 3.19 ± 0.22 | 4.24 ± 0.32 |
| Familiarity with pharmaceutical and non-pharmaceutical treatments for heart patients | 3.16 ± 0.19 | 4.00 ± 0.32 |
| Awareness of misconceptions about heart disease treatment | 3.10 ± 0.18 | 4.53 ± 0.42 |
| Familiarity with diagnostic methods for heart diseases | 2.86 ± 0.17 | 2.71 ± 0.21 |
| Familiarity with the CR process | 2.70 ± 0.18 | 4.82 ± 0.32 |
| The role of traditional medicine in the prevention and treatment of heart diseases | 2.63 ± 0.27 | 3.59 ± 0.28 |
Abbreviation: CR, cardiac rehabilitation.
a Values are expressed as mean ± SD.
b Priorities differ between patients and healthcare providers.
5. Discussion
The results of this study indicate significant differences in educational priorities between patients and healthcare providers. Patients emphasized lifestyle-related factors, such as a healthy diet, exercise, and the control of negative emotions, highlighting the importance of positive changes in these areas. In contrast, healthcare providers focused more on recognizing clinical symptoms and identifying disease risks. The difference in the perceived sensitivity and severity of each of the two groups is one of the reasons for the difference in the needs assessment results.
In the context of needs assessment and promoting self-care among patients requiring CR, identifying educational needs and providing accurate information is an essential necessity. Based on the priorities expressed by patients in this study, it is evident that many of them require information regarding proper nutrition and physical activity. From the perspective of our patients, access to adequate information regarding physical activities, dietary management, and stress management is of significant importance. After experiencing a heart attack, patients naturally face numerous stresses and concerns, with one of their main worries being their ability to start a regular physical activity program. They are eager to learn how to exercise safely and effectively to improve their heart health and prevent disease recurrence. Additionally, a healthy diet is considered a key factor in preventing disease recurrence, and patients are particularly keen on obtaining necessary information about healthy food choices and how to prepare them.
Increased awareness among healthcare providers about the importance of diagnostic signs and risk factors has been the reason for choosing these topics as educational priorities. Our findings are consistent with the results of Rashidi et al.'s study, which systematically reviewed the quality of life of heart patients following CR. Their study results indicate that patients experience significant positive changes in their quality of life after participating in CR programs. These changes include improvements in healthy habits, increased social interactions, and enhanced mental health. Patients particularly emphasized the importance of regular physical activity and proper nutrition, stating that these factors helped them feel better about themselves and increased their confidence in managing their health. Furthermore, interactions with peers in the rehabilitation environment provided a space for patients to share their experiences and benefit from each other's emotional support (5).
Soleimani et al. conducted a qualitative study to examine the perspectives of three groups (patients with chronic diseases, 11 healthcare providers, and 5 health policymakers) regarding self-management education for key cardiovascular risk factors, including diabetes, dyslipidemia, and hypertension. The findings reveal significant differences in the subthemes expressed by each stakeholder group, highlighting the importance of considering this diversity in the design of educational programs. Patients emphasized their need for clear, accessible information and interactive educational methods, underscoring the importance of a personalized approach to self-management education. These results align with our study, which focuses on the education of physical activity, dietary management, and stress management for patients with heart disease. Both studies emphasize patients' need for precise and contextually relevant information, suggesting that educational programs should be designed based on their actual needs and experiences. Considering patients' perspectives and needs allows for more impactful education, ultimately leading to improved health outcomes and quality of life (6).
A comprehensive and personalized approach to self-management education is essential to increase treatment outcomes and patient satisfaction in managing chronic diseases. The selection of samples from hospital patients and the subjective nature of individuals' responses are limitations of the study.
5.1. Conclusions
The results of the study show that educational needs differ from the perspectives of patients and healthcare providers. Patients emphasize the importance of lifestyle changes, such as a healthy diet, exercise, and emotional management, in managing their health. In contrast, members of the care team focus more on recognizing clinical symptoms and understanding risk factors, while acknowledging the significance of lifestyle interventions. Therefore, in addition to paying attention to the priorities expressed by patients, it is essential to design and implement necessary interventions to increase patients' perceived sensitivity to other educational topics.
