Evaluate the effect of virtual nurse-guided discharge education app on disease knowledge and symptom response in patients following coronary events

Background: Pre-discharge patient education promotes better self-care and secondary prevention following acute coronary syndrome (ACS). Traditional methods do not adapt well to staff and patient time limitations and varied health literacy levels. Self-administered digital methods using engagement strategies may address these issues. 

Objectives: To evaluate whether a co-designed, self-administered, virtual nurse avatar-guided patient education app can improve ACS knowledge, beliefs, and medication adherence, and be acceptable for patients and nurses. 

Methods: A prospective pre-post-test study was used with patients recruited during hospitalisation for ACS and their associated nursing staff. Patients, alongside usual care, were provided with the education app on a tablet at discharge to use immediately and over the following month. Data were collected immediately following use and one-month post on heart disease knowledge, ACS symptom response attitudes and beliefs and medication adherence. User satisfaction data was collected from both patients and nurses. 

Results: Participants included nurses (n = 22) and patients (n = 22) who were diagnosed with ST-elevation myocardial infarction (STEMI) (73 %), aged mean 59.7 years and 40 % had not completed high school. 

Patients’ heart disease knowledge improved from pre to one-month post-use (15.7 vs 17.0; p < 0.001) and from immediately post to one-month post-use (16.3 vs 17.0; p = 0.003). Patients’ ACS symptom knowledge and response beliefs improved from pre- to immediate post-use (13.8 vs 15.5; p = 0.008; 23.8 vs 25.1; p = 0.038), and to one-month post-use (13.8 vs 17.0; p < 0.001; 23.8 vs 25.7; p = 0.025), and ACS symptom response attitudes improved from pre- to one-month post-use (15.8 vs 17.0; p = 0.036). 

Patients and nurses rated the app's presentation, content, usability, and usefulness highly; 86% of nurses thought the app would help with discharge education. 

Conclusion: A co-designed, self-administered, virtual nurse avatar-guided education app can improve heart disease knowledge, attitudes, and beliefs following ACS with high nurse and patient acceptability.