Preparing Chinese patients with comorbid heart disease and diabetes for home management: A mixed methods study

Xian Liang Liu, Karen Willis, Chiung Jung Jo Wu, Paul Fulbrook, Yan Shi, Maree Johnson

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Objective To explore how health education received by patients with acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) influences patients' self-efficacy and self-management and changes in behaviour at, and following, hospital discharge. 

Design This study used a convergent mixed methods design. 

Participants Twenty-one participants with completed surveys and interviews at discharge and home follow-up were included in the analysis. 

Setting At a coronary care unit of a major hospital in Shanghai, China.

Results Most participants (n=17) did not perceive they had sufficient education or ability to manage both conditions. More concerning was that most participants (n=16) reported low self-efficacy in the management of ACS symptoms. Three major themes were identified: self-management of ACS and T2DM represents a complex interplay between individual self-efficacy, knowledge and skills, as individuals navigate shifting self-management priorities due to perceived condition severity; the social environment is integral to lifestyle and behaviour change and managing multiple health conditions requires body and mind systems' harmony. 

Conclusions The inpatient education received did not enhance participants' confidence to manage either condition on discharge. While an unhealthy lifestyle was embedded within social roles and norms, some social activities, such as square dancing, positively influenced health behaviour. Culturally appropriate education for Chinese people with diabetes and ACS should contain information on maintaining mind and body harmony. Family members should be involved in formal education.

Original languageEnglish
Article numbere029816
Pages (from-to)1-13
Number of pages13
JournalBMJ Open
Issue number9
Publication statusPublished - 17 Sep 2019
Externally publishedYes


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