A Systematic Integrative Review of the Interventions Aimed at Improving Knowledge, Attitudes, and Beliefs Among Patients with Acute Coronary Syndrome

Main Article Content

Jintana Tongpeth
Natkritta Chaowararak


This Systematic Integrative Review is aimed to identify in the scientific literature on educational interventions used by health care providers or other professionals to increase knowledge, attitudes or beliefs about Acute Coronary Syndrome (ACS) among patients with ACS. The review performed in the CINAHL, MEDLINE, PubMed, Scopus, Cochrane and EMBASE databases between 2004 and 2019 of articles published in the English language. This review followed a systematic integrative review methodology.

The review results indicated that six randomised controlled trials, one pilot randomised controlled trials, two pre-test/ post-test studies , and one single group quasi- experimental study met the eligibility criteria. Thus ten studies total were included in the review. The results of this review suggested that attitudes and beliefs may be harder to improve than knowledge. Among the studies that measured ACS knowledge, nine studies reported statistically significant positive effects of the study interventions on ACS knowledge. This review contributes to a deeper understanding of how to improve ACS knowledge by examining the types and effectiveness of the interventions in the selected studies on three domains of outcomes measures including knowledge, attitudes, and beliefs. This review also investigated the intervention delivery modes that were used to improve knowledge, attitudes, and beliefs in ACS patients.

 This review explored the evidence on interventions for improving knowledge, attitudes, and beliefs about ACS management. This review examined evidence to inform further development of educational interventions, as well as the interventions’ outcome assessments. Based on this review, beyond formal ACS management, ongoing support is essential for the maintenance of knowledge among people with ACS. There is much variation in interventions across the selected studies. We also found a lack of integrated innovative technology in ACS patients’ education, particularly how patient education can be incorporated into current models of care delivery to improve clinical effectiveness.

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How to Cite
Tongpeth J, Chaowararak N. A Systematic Integrative Review of the Interventions Aimed at Improving Knowledge, Attitudes, and Beliefs Among Patients with Acute Coronary Syndrome. J Public Hlth Dev [Internet]. 2020 Jul. 28 [cited 2024 Apr. 16];18(2):89-101. Available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/240996
Review articles
Author Biographies

Jintana Tongpeth, Prachomklao College of Nursing Phetchaburi Province Thailand , Phetchaburi, Thailand

Prachomklao College of Nursing Phetchaburi Province Thailand , Phetchaburi, Thailand

Natkritta Chaowararak, Phetchaburi Provincial Public Health Office Phetchaburi, Thailand

Phetchaburi Provincial Public Health Office Phetchaburi, Thailand


Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo, R Floyd J, Fornage M, Gillespie C & Isasi C 2017.Heart disease and stroke statistics—2017 update: A report from the American Heart Association. Circulation.2017; 135 (10): e146–603.

Basu JBMAM & Sharma, SMDFF. Early recognition vital in acute coronary syndrome.Practitioner.2016; 260(1797):19–23.

Neubeck L & Maiorana A. Time to get help? Acute myocardial infarction and delay in calling an ambulance. Heart, Lung and Circulation.2015; 24(1):1–3.

Coventry LL, Schalkwyk JW, Thompson PL, Hawkins SA & Hegney DG. Myocardial infarction, patient decision delay and help‐seeking behaviour: A thematic analysis.Journal of Clinical Nursing.2017; 26(13–14):1993–2005.

Chau PH, Moe G, Lee SY, Woo J, Leung AY, Chow C-M, Kong C, Lo WT, Yuen MH & Zerwic J.Low level of knowledge of heart attack symptoms and inappropriate anticipated treatment-seeking behaviour among older Chinese: A cross-sectional survey.Journal of Epidemiology & Community Health.2018;72(7);645-52.

Duber HC, McNellan CR, Wollum A, Phillips B, Allen K, Brown JC, Bryant M, Guptam RB, Li YC, Majumdar P, Roth GA, Thomson B, Wilson S, Woldeab A, Zhou, MG & Ng M. Public knowledge of cardiovascular disease and response to acute cardiac events in three cities in China and India. Heart.2018; 104(1): 67–72.

Cytryn KN, Yoskowitz NA, Cimino JJ & Patel VL.Lay public’s knowledge and decisions in response to symptoms of acute myocardial infarction. Advances in Health Sciences Education.2009;14(1):43–59.

Sorita A, Ahmed A, Starr SR, Thompson KM, Reed DA, Prokop L, Shah ND, Murad MH & Ting HH.Off-hour presentation and outcomes in patients with acute myocardial infarction: Systematic review and meta-analysis. British Medical Journal.2014; 348: f7393.

Poomsrikaew O, Ryan CJ & Zerwic JJ. Knowledge of heart attack symptoms and risk factors among native Thais: A street‐intercept survey method. International Journal of Nursing Practice.2010;16(5):492–8.

Swanoski MT, Lutfiyya MN, Amaro ML, Akers MF & Huot KL. Knowledge of heart attack and stroke symptomology: A cross-sectional comparison of rural and non-rural US adults. BMC Public Health.2012;12(1): 283.

Makam RP, Erskine N, Yarzebski J, Lessard D, Lau J, Allison J, Gore JM, Gurwitz J, McManus DD & Goldberg RJ. Decade long trends (2001–2011) in duration of pre‐ hospital delay among elderly patients hospitalized for an acute myocardial infarction, Journal of the American Heart Association.2016; 5(4): e002664.

AlHabib KF, Sulaiman K, Al Suwaidi J, Almahmeed W, Alsheikh-Ali AA, Amin H, Al Jarallah M, Alfaleh HF, Panduranga P & Hersi A. Patient and system-related delays of emergency medical services use in acute ST-elevation myocardial infarction: Results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps). PloS One.2016;11(1):e0147385.

Whittemore R & Knafl K.The integrative review: Updated methodology. Journal of Advanced Nursing.2005;52(5):546–53.

Goff DC, Mitchell P, Finnegan J, Pandey D, Bittner V, Feldman H, Meischke H, Goldberg RJ, Luepker RV & Raczynski JM. Knowledge of heart attack symptoms in 20 US communities:Results from the Rapid Early Action for Coronary Treatment Community Trial. Preventive Medicine.2004: 38(1): 85–93.

Meischke H, Diehr P, Rowe S, Cagle A & Eisenberg M. Evaluation of a public education program delivered by firefighters on early recognition of a heart attack. Evaluation & the Health Professions.2004; 27(1):3−21.

Buckley T, McKinley S, Gallagher R, Dracup K, Moser D & Aitken. The effect of education and counselling on knowledge, attitudes and beliefs about responses to acute myocardial infarction symptoms. European Journal of Cardiovascular Nursing.2007;6(2):105–11.

Tullmann DF, Haugh KH, Dracup,KA & Bourguignon,C. A randomized controlled trial to reduce delay in older adults seeking help for symptoms of acute myocardial infarction. Research in Nursing & Health.2007; 30(5):485–97.

Bell M, Lommel T, Fischer JG, Lee JS, Reddy S & Johnson MA. Improved recognition of heart attack and stroke symptoms after a community-based intervention for older adults, Georgia, 2006–2007.Preventing Chronic Disease.2009; 6(2): A41–A54.

McKinley S, Dracup K, Moser DK, Riegel B, Doering LV, Meischke H, Aitken, LM, Buckley T, Marshall A & Pelter M. The effect of a short one-on-one nursing intervention on knowledge, attitudes and beliefs related to response to acute coronary syndrome in people with coronary heart disease: A randomized controlled trial’, International Journal of Nursing Studies.2009;46(8):1037–46.

DeVon HA, Rankin SH, Paul SM & Ochs AL. The Know & Go! program improves knowledge for patients with coronary heart disease in pilot testing. Heart & Lung: The Journal of Acute and Critical Care.2010; 39(6):S23–33.

Gallagher R, Roach K, Belshaw J, Kirkness A, Sadler L & Warrington D.A pre- test post-test study of a brief educational intervention demonstrates improved knowledge of potential acute myocardial infarction symptoms and appropriate responses in cardiac rehabilitation patients. Australian Critical Care.2013; 26(2): 49–54.

O’Brien F, McKee G, Mooney M, O’Donnell S & Moser D. Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial. Patient Education and Counseling.2014; 96(2):179–87.

Singh D, Sukhbeer K, Ahmad A, Rahmat N & Hmwe NTT. Nurse‐led intervention on knowledge, attitude and beliefs towards acute coronary syndrome. Nursing in Critical Care.2016 (online Wiley Online Library).

Critical Appraisal Skills Programme. Randomised controlled trial checklist, Critical Appraisal Skills Programme, Oxford.2018 <https://casp-uk.net/wp- content/uploads/2018/01/CASP-Randomised-Controlled-Trial-Checklist.pdf>.

Joanna Briggs Institute.Critical appraisal tools for use in JBI systematic reviews, checklist for quasi-experimental studies (non-randomized experimental studies).2017. <http://joannabriggs.org/assets/docs/critical-appraisal-tools/JBI_Quasi- Experimental_Appraisal_Tool2017.pdf>.

Polit DF. Clinical significance in nursing research: A discussion and descriptive analysis. International Journal of Nursing Studies.2017; 73:17–23.

Riegel B, McKinley S, Moser DK, Meischke H, Doering L & Dracup K. Psychometric evaluation of the acute coronary syndrome (ACS) response index. Research in Nursing & Health.2007: 30(6); 584–94.

Ahmed MM, El Degwy HM, Ali MI & Hegazy NH.The effect of educational intervention on knowledge, attitude and glycemic control in patients with type 2 diabetes mellitus.International Journal of Community Medicine and Public Health.2017;2(3):302–7.

Littleton-Kearney M.Pragmatic clinical trials at the National Institute of Nursing Research.Nursing Outlook, (online PubMed).2018

Yeh M-Y, Wu S-C & Tung T-H. The relation between patient education, patient empowerment and patient satisfaction: A cross-sectional-comparison study. Applied Nursing Research.2018; 39:11–7.

Lu M, Tang J, Wu J, Yang J & Yu J. Discharge planning for acute coronary syndrome patients in a tertiary hospital: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports.2015;13(7):318–34.

Or CK, Tao D & Wang H. The effectiveness of the use of consumer health information technology in patients with heart failure: A meta-analysis and narrative review of randomized controlled trials. Journal of Telemedicine and Telecare.2017; 23(1):155–66.

Tawalbeh LI & Ahmad MM.The effect of cardiac education on knowledge and adherence to healthy lifestyle. Clinical Nursing Research.2014;23(3):245–58.

Farshidi H, Rahimi S, Abdi A, Salehi S & Madani A. Factors associated with pre- hospital delay in patients with acute myocardial infarction. Iranian Red Crescent Medical Journal.2013; 15(4):312–6.

Bray JE, Straney L, Barger B & Finn J. Effect of public awareness campaigns on calls to ambulance across Australia’.Stroke.2015;46(5):1377–80.

Mooney M, O’Brien F, McKee G, O’Donnell S & Moser D. Ambulance use in acute coronary syndrome in Ireland: A cross-sectional study. European Journal of Cardiovascular Nursing.2016;15(5):345–54.

Anderson JL & Morrow DA. Acute myocardial infarction. New England Journal of Medicine.2017;376(21):2053−64.

Carr HJ, McDermott A, Tadbiri H, Uebbing A-M & Londrigan M. The effectiveness of computer‐based learning in hospitalized adults with heart failure on knowledge, re‐ admission, self‐care, quality of life, and patient satisfaction: A systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports.2013;11(8):129– 45.

Heapy AA, Higgins DM, Cervone D, Wandner L, Fenton BT & Kerns RD.A systematic review of technology-assisted self-management interventions for chronic pain. Journal of Medical Systems.2015; 40(2):43–57.