Assessing patient education needs in cardiac rehabilitation: a commentary on the Information Needs in Cardiac Rehabilitation scale (short version) validation study

This editorial refers to ‘Psychometric validation of the short version of the Information Needs in Cardiac Rehabilitation scale through a first global assessment’, by G.L.d.M. Ghisi et al., https://doi.org/10.1093/eurjpc/zwae148. Cardiovascular diseases (CVDs) remain the most significant health challenge globally, leading as the primary cause of mortality and underscore the urgent need for effective preventive measures and rehabilitative strategies. The 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes emphasize the importance of structured patient education as part of cardiac rehabilitation (CR). These guidelines recommend that educational programmes should be integral to the management of patients, providing a foundational framework for developing and implementing effective educational interventions within CR programmes.1 Transitioning from guidelines to practice, Taylor et al.2 discuss the critical role of CR in managing heart failure, advocating for a holistic approach that includes substantial patient education. Their review argues for CR as an essential, albeit underutilized, pillar of heart failure management, highlighting the necessity of integrating comprehensive educational strategies to improve patient outcomes. Despite its proven benefits, the accessibility and effectiveness of CR programmes exhibit stark disparities across different regions and economic contexts. In high-income countries, CR programmes are comprehensive and often supported by healthcare systems, whereas in low-income regions, resources are scarce, and patients often lack basic services and education. The one-size-fits-all approach to patient education is inadequate because it fails to address the diverse cultural, economic, and educational backgrounds of patients. Health literacy disparities, unequal access to healthcare resources, and diverse cultural beliefs about health significantly influence the effectiveness of CR programmes. Tailoring educational interventions to consider local cultural contexts and healthcare infrastructures is essential for enhancing patient engagement and outcomes in CR.3 Addressing these challenges, Grace et al.4 propose adaptable models for delivering CR in resource-constrained environments. These models leverage local community health workers for education and support, utilize low-cost technologies like mobile phones for remote monitoring and education, and involve developing simple, visual educational materials understandable regardless of literacy level. Another example is the ‘learning and coping’ strategy as investigated by Pedersen et al.,5 which provides a compelling case for the need for tailored educational interventions. This approach significantly enhanced adherence to CR, underscoring the effectiveness of patient-centred educational frameworks in improving health outcomes. Uhm and Hwang6 explored how tailored autonomy enhancement education significantly improves self-management capabilities in cardiac patients, further emphasizing the impact of personalized education. Their findings suggest that customizing educational content to the patient’s specific risk factors and medical history can substantially influence their autonomy and engagement in their own care, marking a pivotal shift towards more personalized care in CR. The work of Yang et al.7 serves as a pivotal example of the necessity for cultural sensitivity in educational tools. Their study on adapting the Coronary Artery Disease Education Questionnaire—Short Version for the Chinese population underscores the importance of cultural relevance in educational interventions, demonstrating how tailored adjustments can significantly improve engagement and comprehension among diverse patient groups. The studies by de Melo Ghisi et al.8 and Imran et al.9 collectively underscore the significant role of technology in advancing CR by bridging geographical and logistical barriers and enhancing patient engagement. de Melo Ghisi et al.8 demonstrate the effectiveness of virtual and in-person education programmes in CR, illustrating how digital platforms can be customized to meet diverse educational needs without compromising the quality of education. Their findings suggest that both delivery methods significantly improve disease-related knowledge and encourage behavioural changes, highlighting that virtual platforms offer a viable solution for overcoming challenges like geographic isolation. Complementing this, Imran et al.9 explore the impact of mobile technology on patient engagement and adherence to CR programmes. Their use of mobile apps and online platforms for delivering interactive and personalized learning experiences showcases how technology can support continuous education and enable real-time monitoring and adjustments by healthcare providers. Together, these studies reveal how integrating sophisticated technologies into CR strategies not only enhances educational outreach but also improves overall programme adherence and patient outcomes, affirming the transformative potential of technology in cardiac care.9 The continuing rise in the global burden of CVD, especially pronounced in low- and middle-income countries, necessitates a more integrated approach to incorporating tailored educational strategies into CR programmes worldwide. Future research should focus on developing and validating educational tools and interventions that are culturally sensitive and scalable across various healthcare settings. Global collaboration is essential to share best practices and innovations in patient education that can be adapted to local needs. By enhancing the efficacy of educational strategies within CR programmes, we ensure that all patients, regardless of their geographic or economic circumstances, receive the comprehensive care necessary to improve their health outcomes. The recent validation of the Information Needs in Cardiac Rehabilitation scale short version (INCR-S) marks a significant advancement in CR. This study uniquely contributes to our understanding by offering a globally validated tool that accurately assesses the diverse information needs of cardiac patients across multiple regions. Unlike previous tools, the INCR-S has been adapted for linguistic and cultural relevance in various languages, enhancing its utility in international settings. This adaptation ensures that the tool can effectively capture the nuanced educational needs of patients in different cultural and economic contexts, a critical step forward given the varied backgrounds of CR participants worldwide. The findings from this study emphasize the importance of tailoring educational materials to individual patient needs, a practice that has been shown to enhance patient outcomes significantly. For example, the study reveals that knowledge sufficiency ratings vary widely by region and income level, with higher ratings in high-income regions. This suggests that regions with lower income may benefit from more targeted educational interventions to address specific gaps in knowledge and health literacy. Moreover, the study’s results, which show a high correlation between tailored education and improved knowledge sufficiency, align with existing literature that supports personalized patient education as a means to increase treatment adherence and overall health outcomes. In the study, some limitations are rightly acknowledged, including its potential lack of generalizability to regions not represented in the sample and the exclusion of widely spoken languages such as Spanish, Hindi, and Arabic. These limitations highlight the need for future studies to include a broader demographic to ensure comprehensive applicability and effectiveness. From a personal perspective, understanding and addressing the information needs of cardiac patients is not just a matter of improving individual health outcomes but is also crucial for the broader healthcare strategies aimed at reducing the global burden of CVDs. The INCR-S tool’s ability to provide targeted insights into patient needs allows healthcare providers to develop more effective educational strategies, which can lead to more sustainable health behaviours and better management of cardiac health, particularly in diverse populations. This work was supported in part by ChatGPT, which assisted in the preliminary article review, citation cross-referencing, and initial draft structuring. The author conducted subsequent revisions, ensured the accuracy of citations, and shaped the final argument and presentation. Responsibility for the final content rests solely with the author, who independently finalized the critical viewpoints and conclusions presented. This editorial was partially supported by ‘Ricerca Corrente’ funding from the Italian Ministry of Health to IRCCS Policlinico San Donato.