Behavior determinants among cardiac rehabilitation patients receiving educational interventions: an application of the health action process approach

Patient Educ Couns. 2015 May;98(5):612-21. doi: 10.1016/j.pec.2015.01.006. Epub 2015 Jan 20.


Objectives: To (1) test the effect of a health action process approach (HAPA) theory-based education program in cardiac rehabilitation (CR) compared to traditional education on patient knowledge and HAPA constructs; and, (2) investigate the theoretical correlates of exercise behavior among CR patients receiving theory-based education.

Methods: CR patients were exposed to an existing or HAPA-based 6 month education curriculum in this quasi-experimental study. Participants completed a survey assessing exercise behavior, HAPA constructs, and knowledge pre and post-program.

Results: 306 patients consented to participate, of which 146 (47.7%) were exposed to the theory-based educational curriculum. There was a significant improvement in patients' overall knowledge pre- to post-CR, as well as in some HAPA constructs and exercise behavior, regardless of curriculum (p < 0.05). Path analysis revealed that knowledge was significantly related to intention formation, and intentions to engage in exercise were not directly related to behavior, which required action planning.

Conclusions: The theoretically-informed education curriculum was not associated with greater knowledge or exercise behavior as expected. Education in CR improves knowledge, and theoretical constructs related to exercise behavior.

Practice implications: Educational curricula should be designed to not only increase patients' knowledge, but also enhance intentions, self-efficacy, and action planning.

Keywords: Cardiac rehabilitation; Health behavior theory; Knowledge; Patient education; Physical exercise.

MeSH terms

  • Cardiac Rehabilitation*
  • Cardiovascular Diseases / psychology
  • Curriculum
  • Exercise Therapy / methods*
  • Female
  • Health Behavior
  • Health Promotion
  • Humans
  • Intention
  • Male
  • Middle Aged
  • Patient Compliance*
  • Patient Education as Topic / methods*
  • Self Efficacy
  • Surveys and Questionnaires