Abstract
Background The hypothesis tested was that one year of problem-based learning (PBL) improves patients’ self-efficacy, and empowerment to change self-care significantly compared to one year of standardised home-sent patient information after an event of coronary heart disease (CHD). Methods We randomly assigned 157 patients (78% male; age 68±8.5 years) with CHD verified by percutaneous coronary intervention (PCI) (70.1%) or coronary artery by-pass surgery (CABG) and CABG+PCI or myocardial infarction (29.9%) to either PBL (experimental group; n = 79) or home-sent patient information group (controls; n = 78). The PBL intervention consisted of a patient education in primary health care by trained district nurses who tutored groups of 6-9 patients on 13 occasions over one year. Controls received home- sent patient information on 11 occasions during the study year. Results At the one-year follow-up, the primary outcome, patient empowerment, did not significantly differ between the experimental group and controls. We found no significant differences between the groups regarding the secondary outcomes e.g. self-efficacy, although we found significant differences for body mass index (BMI) [-0.17 (SD 1.5) vs. 0.50 (SD 1.6), P=0.033 ], body weight [-0.83 (SD 4.45 vs. 1.14 kg (SD 4.85), P=0.026 ] and HDL cholesterol [0.1 (SD 0.7) vs. 0.0 mmol/L (SD 0.3), P=0.038 ] for the experimental group compared to controls. Conclusions The PBL and the home-sent patient information interventions had similar results regarding patient empowerment. However, PBL exhibited significant effects on weight loss, BMI, and HDL cholesterol levels, indicating that the PBL intervention positively affected risk factors compared to the home-sent patient information intervention. Trial registration : NCT01462799 (August 2019, date last accessed) Keywords: Problem-based learning, Coronary Heart Disease, Primary Health Care, Patient empowerment, Risk factors, Self-care