Intervention Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: A randomized controlled trial Frances O’Brien a, *, Gabrielle McKee a , Mary Mooney a , Sharon O’Donnell a , Debra Moser b a School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland b College of Nursing, University of Kentucky, Lexington, USA 1. Introduction Acute coronary syndrome (ACS) is an umbrella term for a range of clinical symptoms associated with myocardial hypo-perfusion as a consequence of pathological mechanisms [1,2]. Patients with ACS are classified as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina [2]. The adverse effects of ACS include fatal arrhythmias, heart failure and cardiogenic shock [1,3,4]. Efficacy and speed are essential if maximum benefits are to be achieved from the therapeutic interventions that are available to patients [5]. The decision to seek care for ACS symptoms is contingent on the individual having the requisite knowledge, attitudes and beliefs about the condition [6]. The literature suggests that knowledge, attitudes and beliefs about ACS is substandard among individuals with a diagnosis of coronary heart disease [7,8], even among those who had recently experienced an ACS event [9]. While the ACS symptoms, chest pain, arm pain and shortness of breath are relatively well known [9–14], knowledge of other ACS symptoms is less evident [9–11,13,15]. Those with inadequate knowledge, attitudes or beliefs about ACS are more susceptible to protracted pre-hospital delay time and a worse prognosis than their speedy counterparts. To date, eight interventions aimed to improve knowledge, attitudes or beliefs about ACS [7,8,14,16–20]. A summary of these interventions is outlined in Table 1. Six of the eight interventions reported significant improvements in knowledge of ACS symptoms [7,8,14,16,18,19]. Of the three researchers who reported on attitudes and beliefs [7,8,18], one researcher [8] reported significant improvement in attitudes, while two researchers [8,18] reported significant improvements in beliefs, following their intervention. While previous interventions showed promis- ing results, none of these have been conducted in Europe. Patient Education and Counseling 96 (2014) 179–187 A R T I C L E I N F O Article history: Received 19 January 2014 Received in revised form 9 May 2014 Accepted 25 May 2014 Keywords: Knowledge attitudes and beliefs Randomized controlled trial Educational intervention Acute coronary syndrome Motivational interviewing A B S T R A C T Objective: To test the effectiveness of an individualized educational intervention on knowledge, attitudes and beliefs about acute coronary syndrome (ACS). Methods: This multi-site, randomized controlled trial was conducted on 1947 patients with a diagnosis of ACS. Both groups received usual in-hospital education. Participants randomized to the intervention group received a 40-min one to one individualized education session, delivered using motivational interviewing techniques. The intervention was reinforced 1 month and 6 months later. Knowledge, attitudes and beliefs were measured using the ACS Response Index. A total of 1136 patients (control, n = 551; intervention, n = 585) completed the questionnaire at baseline, 3 and 12 months. Data were analyzed using repeated measures analysis of variance. Ethical approval was obtained. Results: There was a significant effect of the intervention on mean knowledge (p < 0.001), attitude (p = 0.003) and belief (p < 0.001) scores at 3 and 12 months. Conclusion: Ensuring patients retain information post education has always been difficult to attain. This study demonstrated that patient education using motivational interviewing techniques and an individualized approach has the potential to alter knowledge, attitudes and beliefs about ACS among a high risk population. Practice implications: This relatively short, simple and effective educational intervention could be delivered by nurses in multiple settings. ß 2014 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier St, Dublin 2, Ireland. Tel.: +353 1 896 2692; fax: +353 1 6083001. E-mail address: obrienfr@tcd.ie (F. O’Brien). Contents lists available at ScienceDirect Patient Education and Counseling jo ur n al h o mep ag e: w ww .elsevier .co m /loc ate/p ated u co u http://dx.doi.org/10.1016/j.pec.2014.05.022 0738-3991/ß 2014 Elsevier Ireland Ltd. All rights reserved.