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

- HAPA is a useful framework for understanding of the social-cognitive processes in CR.
- Education interventions in CR are effective in improving patients' knowledge.
- Knowledge is a significant construct leading to behavioral intention formation.

ObjectivesTo (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.MethodsCR 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.Results306 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.ConclusionsThe 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 implicationsEducational curricula should be designed to not only increase patients' knowledge, but also enhance intentions, self-efficacy, and action planning.