Effects of a Health-Education Mobile App on Stroke-Related Knowledge and Health-Related Quality of Life in Patients with Stroke: A Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Chia-Yun Lin ◽  
Hsiu-Nien Shen ◽  
Szu-Chi Huang ◽  
Tsung-Fu Wu ◽  
Wen-Hsuan Hou

BACKGROUND Education regarding risk factors for stroke can prevent stroke recurrence and improve health-related quality of life (HRQOL) in patients with stroke. However, health-education mobile apps addressing risk factors for recurrent stroke are required. OBJECTIVE To develop a health-education mobile app related to stroke and examine its effectiveness on stroke-related knowledge and HRQOL in patients with stroke. METHODS In this single-blind randomized controlled trial, we recruited 76 stroke patients without cognitive impairment from stroke wards of 4 teaching hospitals and randomly assigned them to either complete the health-education app intervention (intervention group; n = 38) or undergo usual care by using a stroke-related health-education manual (control group; n = 38). The app was administered for a maximum of 30 days. The improvement in patients’ stroke knowledge (primary outcome) and HRQOL (secondary outcome) was assessed using the stroke-knowledge questionnaire and European Quality of Life–Five Dimensions (EQ-5D) questionnaire, respectively. RESULTS Total 63 patients were assessed in posttest (intervention group, n = 30; control group, n=33). In posttest, compared with the intervention group, the control group had nonsignificantly lower scores on the stroke-knowledge questionnaire (28.00 ± 5.46 vs 29.04 ± 5.27; Cohen’s d = 0.194; P = .43) and EQ-5D index (0.46 ± 0.41 vs 0.62 ± 0.29; Cohen’s d = 0.451; P = .07), but nonsignificantly higher scores on the EQ-5D visual analog scale (VAS; 65.00 ± 18.37 vs 62.30 ± 18.77; Cohen’s d = −0.145; P = .57). In the intervention group, posttest scores on the stroke-knowledge questionnaire were significantly higher than pretest scores (29.07 ± 5.27 vs 26.23 ± 6.65, P = .002); however, no significant differences were noted in the EQ-5D index (0.62 ± 0.29 vs 0.55 ± 0.29, P = .11) or VAS scores (62.30 ± 18.77 vs 59.67 ± 20.17, P = .45). In the subgroup analysis of the intervention group, patients aged ≤55 years demonstrated a higher percent improvement in stroke knowledge than did those aged >55 years (89% vs 58%; P = .08). CONCLUSIONS A short intervention period, weak patient involvement strategy, lack of reminders and animations may be the reasons hampered improvement between intervention and control groups. Although the improvements in stroke knowledge and HRQOL were nonsignificant in our between-group comparison, our subgroups analysis indicated that the use of our app led to greater stroke-knowledge improvement in younger patients with stroke (aged ≤55 years). Therefore, we suggest clinical professionals should incorporate our app into stroke care to improve the stroke knowledge and HRQOL of their patients with stroke. CLINICALTRIAL NCT02591511

2021 ◽  
Author(s):  
Mohammad Habibur Rahman Sarker ◽  
Michiko Moriyama ◽  
Harun Ur Rashid ◽  
Md Moshiur Rahman ◽  
Mohammod Jobayer Chisti ◽  
...  

BACKGROUND Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. OBJECTIVE The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. METHODS A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. RESULTS Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. CONCLUSIONS It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. CLINICALTRIAL ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/30191


10.2196/30191 ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. e30191
Author(s):  
Mohammad Habibur Rahman Sarker ◽  
Michiko Moriyama ◽  
Harun Ur Rashid ◽  
Md Moshiur Rahman ◽  
Mohammod Jobayer Chisti ◽  
...  

Background Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. Conclusions It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID) DERR1-10.2196/30191


Author(s):  
PJ Shiji ◽  
Neetha Kamath ◽  
Supriya Hegde

Introduction: Alcoholism is a major problem in developing countries like India. Alcoholism affects not only the individual but also his family and the society. Spouses of alcoholics are among those who suffer the maximum consequences of alcoholism and its effects. Aim: To find the effect of health promotional strategies (Yoga and Health education) on Quality of Life (QOL) of the spouse of alcoholics. Materials and Methods: Quasi experimental pre-test post-test control design was adopted. A total of 330 men were administered the Alcohol Use Disorders Identification Test (AUDIT) tool to screen for alcoholics through house to house survey, of which 279 men who scored in the range of 8-15 AUDIT score were considered as alcoholics. Their spouses were selected as study participants (who met the sampling criteria) and subjects were randomly allocated to intervention group (132) and control group (147) through simple randomised sampling. The data was gathered by using WHOQOL-BREF tool to assess the QOL; initially pre-test QOL was assessed, followed by individual health education (45 minutes) and yoga (15 minutes) once a week for 3 consecutive weeks and post-test was done during fourth week for intervention (127) and control groups (142). There were five dropouts in post-test from each group due to health problems, migration and no cooperation from the family for the intervention. Independent t-test was performed by using SPSS version 18.0 to determine effectiveness of health promotion strategies on QOL scores between the intervention and control group and chi-square test was used to find the association between post-intervention QOL scores and selected demographic variable at p<0.05 level of significance. Results: QOL scores in all four domains in the intervention group showed that there was an increase before and after the interventions. On comparing the mean differences between QOL scores post-test in intervention and control group, calculated t-value was (34.04) and the difference was highly statistically significant at p<0.001** showing that health promotional strategies were effective in improving QOL among spouse of alcoholics. There was a significant association between post-test intervention QOL scores of subjects and selected variables such as primary decision maker (p=0.002*) of the family and history of domestic violence (p=0.030*). Conclusion: The study findings suggest that adopting health promotional strategies such as yoga can help the spouses of alcoholics to improve their QOL.


QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A M Ibrahim ◽  
A E Shoman ◽  
G E Mady ◽  
A M Hassan ◽  
D H Mohamed

Abstract Background Patients with renal failure had poorer quality of life than patients with other chronic diseases such as heart failure, diabetes mellitus and even cancer which makes them more susceptible to withdraw dialysis treatment. Objectives The study was conducted to implement a health education program for patients with end stage renal disease on hemodialysis and their caregivers at Ain Shams University Hospital and measure its effect on their quality of life. Methods A controlled interventional study was carried out on three phases. A sample of 56 patients on chronic regular hemodialysis and their caregivers (HD) were selected from the two hemodialysis units at Ain Shams university hospital and data were collected at the beginning and after six months of the health education program. Results The intervention group of the patients after the intervention reported significant better quality of life scores than the control group in all the domains except in work status, quality of social interaction, sexual function, social support and patient satisfaction and there were statistically significant increases in the intervention group of the caregivers than the control group in social function, emotional well-being, role emotional and mental component summary scores. Conclusion The health education and individualized nutritional program had a positive effect on many components of quality of life of the hemodialysis patients and their caregivers


2020 ◽  
Author(s):  
Roberto Collado-Borrell ◽  
Vicente Escudero-Vilaplana ◽  
Almudena Ribed ◽  
Cristina Gonzalez-Anleo ◽  
Maite Martin-Conde ◽  
...  

BACKGROUND Oral antineoplastic agents (OAAs) have revolutionized cancer management. However, they have been reported with adverse side effects and drug-drug interactions. Moreover, patient adherence to OAA treatment is critical. Mobile apps can enable remote and real-time pharmacotherapeutic monitoring of patients, while also promoting patient autonomy in their health care. OBJECTIVE The primary objective was to analyze the effect of using a mobile app for the follow-up of patients with oncohematological malignancies undergoing treatment with OAAs on their health outcomes. The secondary objectives were to analyze the role of the app in communication with health care professionals and patient satisfaction with the app. METHODS We performed a comparative, quasi-experimental study based on a prepost intervention with 101 patients (control group, n=51, traditional pharmacotherapeutic follow-up vs intervention group, n=50, follow-up through e-OncoSalud, a custom-designed app that promotes follow-up at home and the safety of patients receiving OAAs). The effect of this app on drug safety, adherence to treatment, and quality of life was evaluated. RESULTS With regard to drug safety, 73% (37/51) of the patients in the control group and 70% (35/50) of the patients in the intervention group (<i>P</i>=.01) presented with drug-related problems. The probability of detecting an insufficiently treated health problem in the intervention group was significantly higher than that in the control group (<i>P</i>=.04). The proportion of patients who presented with side effects in the intervention group was significantly lower than that in the control group (<i>P</i>&gt;.99). In the control group, 49% (25/51) of the patients consumed some health resources during the first 6 months of treatment compared with 36% (18/50) of the patients in the intervention group (<i>P</i>=.76). Adherence to treatment was 97.6% (SD 7.9) in the intervention group, which was significantly higher than that in the control group (92.9% [SD 10.0]; <i>P</i>=.02). The EuroQol-5D in the intervention group yielded a mean (SD) index of 0.875 (0.156), which was significantly higher than that in the control group (0.741 [0.177]; <i>P</i>&lt;.001). Approximately 60% (29/50) of the patients used the messaging module to communicate with pharmacists. The most frequent types of messages were acknowledgments (77/283, 27.2%), doubts about contraindications and interactions with OAAs (70/283, 24.7%), and consultations for adverse reactions to treatment (39/283, 13.8%). The satisfaction with the app survey conducted in the intervention group yielded an overall mean (SD) score of 9.1 (0.4) out of 10. CONCLUSIONS Use of e-OncoSalud for the real-time follow-up of patients receiving OAAs facilitated the optimization of some health outcomes. The intervention group had significantly higher health-related quality of life and adherence to treatment than the control group. Further, the probability of the intervention group presenting with side effects was significantly lower than that of the control group.


10.2196/14967 ◽  
2019 ◽  
Vol 21 (9) ◽  
pp. e14967 ◽  
Author(s):  
Robert J Tait ◽  
Raquel Paz Castro ◽  
Jessica Jane Louise Kirkman ◽  
Jamie Christopher Moore ◽  
Michael P Schaub

Background Alcohol use is prevalent in many societies and has major adverse impacts on health, but the availability of effective interventions limits treatment options for those who want assistance in changing their patterns of alcohol use. Objective This study evaluated the new Daybreak program, which is accessible via mobile app and desktop and was developed by Hello Sunday Morning to support high-risk drinking individuals looking to change their relationship with alcohol. In particular, we compared the effect of adding online coaching via real-time chat messages (intervention group) to an otherwise self-guided program (control group). Methods We designed the intervention as a randomized control trial, but as some people (n=48; 11.9%) in the control group were able to use the online coaching, the main analysis comprised all participants. We collected online surveys at one-month and three-months follow-up. The primary outcome was change in alcohol risk (measured with the alcohol use disorders identification test–consumption [AUDIT–C] score), but other outcomes included the number of standard drinks per week, alcohol-related days out of role, psychological distress (Kessler-10), and quality of life (EUROHIS-QOL). Markers of engagement with the program included posts to the site and comments on the posts of others. The primary analysis used Weighted Generalized Estimating Equations. Results We recruited 398 people to the intervention group (50.2%) and 395 people to the control group (49.8%). Most were female (71%) and the mean age was 40.1 years. Most participants were classified as probably dependent (550, 69%) on the AUDIT–10, with 243 (31%) classified with hazardous or harmful consumption. We followed up with 334 (42.1%) participants at one month and 293 (36.9%) at three months. By three months there were significant improvements in AUDIT–C scores (down from mean 9.1 [SD 1.9] to 5.8 [SD 3.1]), alcohol consumed per week (down from mean 37.1 [SD 28.3] to mean 17.5 [SD 18.9]), days out of role (down from mean 1.6 [SD 3.6] to 0.5 [SD 1.6]), quality of life (up from 3.2 [SD 0.7] to 3.6 [SD 0.7]) and reduced distress (down from 24.8 [SD 7.0] to 19.0 [SD 6.6]). Accessing online coaching was not associated with improved outcomes, but engagement with the program (eg, posts and comments on the posts of others) were significantly associated with improvements (eg, in AUDIT–C, alcohol use and EUROHIS-QOL). Reduced alcohol use was found for both probably dependent (estimated marginal mean of 40.8 to 20.1 drinks) and hazardous or harmful alcohol users (estimated marginal mean of 22.9 to 11.9 drinks). Conclusions Clinically significant reductions in alcohol use were found, as well as reduced alcohol risk (AUDIT–C) and days out of role. Importantly, improved alcohol-related outcomes were found for both hazardous or harmful and probably dependent drinkers. Since October 2016, Daybreak has reached more than 50,000 participants. Therefore, there is the potential for the program to have an impact on alcohol-related problems at a population health level, importantly including an effect on probably dependent drinkers. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110 International Registered Report Identifier (IRRID) RR2-10.2196/9982


1970 ◽  
Vol 4 (2) ◽  
Author(s):  
Yanita Trisetiyaningsih ◽  
Elsi Dwi Hapsari ◽  
Shofwal Widad

Perubahan fisik dan psikologis yang terjadi pada masa klimakterium akan mempengaruhi kualitas hidup perempuan. Untuk itu diperlukan proses adaptasi terhadap berbagai masalah dan perubahan selama masa klimakterium sehingga akan meningkatkan kualitas hidup perempuan klimakterik. Kurangnya pengetahuan dan akses informasi merupakan tantangan besar yang dihadapi oleh wanita menopause. Salah satu upaya yang bisa dilakukan untuk meningkatkan pengetahuan adalah melalui pemberian pendidikan kesehatan. Penelitian ini bertujuan untuk mengetahui pengaruh pendidikan kesehatan tentang menopause terhadap perubahan kualitas hidup perempuan klimakterik. Penelitian ini merupakan penelitian quasy experimentdengan rancangan pretest and posttest nonequivalent control group design. Penelitian dilakukan di Dusun Gamping Kidul Ambarketawang bulan Desember 2013-April 2014. Jumlah populasi sebanyak 271 orang. Sampel terdiri dari 44 orang kelompok intervensi dan 44 orang kelompok kontrol. Kelompok intervensi diberikan pendidikan kesehatan sebanyak 4 kali ceramah dan diskusi kelompok kecil, serta 1 kali praktik relaksasi dan senam yoga. Kelompok kontrol diberikan booklet tentang perubahan masa menopause, tanda dan gejala, nutrisi masa menopause, dan penatalaksanaan menopause. Instrumen yang digunakan adalah WHOQOL-BREF. Analisis yang digunakan adalah uji Paired t-test, Independent Samples t-Testdengan α 0.05.Nilai rata-rata kualitas hidup pretest pada kelompok intervensi sebesar 51,9 dan posttest sebesar 66,5. Hasil uji paired t-test menunjukkan ada perbedaan skor kualitas hidup sebelum dan sesudah diberikan pendidikan kesehatan pada kelompok intervensi (t =14,436, p=0,001). Namun tidak bermakna pada kelompok kontrol (t=1,059, p= 0,0295) dengan perubahan skor kualitas. Berdasarkan hasil penelitian dapat disimpulkan bahwa program pendidikan kesehatan tentang menopause dapat meningkatkan kualitas hidup perempuan selama periode klimakterium.Kata kunci: Klimakterium, kualitas hidup, menopause, pendidikan kesehatan.Influence of Health Education about Menopause towards the Quality of Life Changes in Climacteric Women AbstractPhysical and psychological changes that happen at the climacterium period would influence the quality of life in climacteric women. Therefore, the adaptation process is needed to overcome problems and changes during this period so that the quality of life of climacteric women could be increased. Lack of knowledge and access to information are major challenger that were faced by menopause women. One of efforts that can be done to improve their knowledge is through health education. This study aimed to identify the influence of health education about menopause towards the quality of live changes in climacteric women. The study used quasi experiment design with pretest and posttest nonequivalent control group. The location of this study was in Gamping Kidul Ambarketawang Village in December 2013 to April 2014. The total population is 271 people. Sample consisted of 44 people in the intervention group and 44 people in the control group. The intervention group received 4 times health education and small group discussion, as well as once relaxation and Yoga. Participants in control group received a booklet about menopause, signs and symptoms, nutrition during menopause period, and management of menopause. The quality of life was measured using WHOQOL-BREF. Analysis used paired t-test, independent samples t-test with α = 0.05. The mean scores of quality of life for intervention group were 51.0 (pretest) and 66.5 (posttest). The paired t-test showed that there was a significant difference of quality of life score before and after health education in the intervention group (t =14,436, p=0,001). However, there was no significant difference of quality of life in the control group (t=1,059, p= 0,0295). Based on this results, it can be concluded that health education program about menopause can increase quality of life of climacteric women. Keywords: Climacterium, health education, menopause quality of life.


Author(s):  
Yi-No Kang ◽  
Hsiu-Nien Shen ◽  
Chia-Yun Lin ◽  
Glyn Elwyn ◽  
Szu-Chi Huang ◽  
...  

Abstract Background Developing a stroke health-education mobile app (SHEMA) and examining its effectiveness on improvement of knowledge of stroke risk factors and health-related quality of life (HRQOL) in patients with stroke. Methods We recruited 76 stroke patients and randomly assigned them to either the SHEMA intervention (n = 38) or usual care where a stroke health-education booklet was provided (n = 38). Knowledge of stroke risk factors and HRQOL were assessed using the stroke-knowledge questionnaire and European Quality of Life–Five Dimensions (EQ-5D) questionnaire, respectively. Results Sixty-three patients completed a post-test survey (the SHEMA intervention, n = 30; traditional stroke health-education, n = 33). Our trial found that patients’ mean knowledge score of stroke risk factors was improved after the SHEMA intervention (Mean difference = 2.83; t = 3.44; p = .002), and patients’ knowledge was also improved in the after traditional stroke health-education (Mean difference = 2.79; t = 3.68; p = .001). However, patients after the SHEMA intervention did not have significantly higher changes of the stroke knowledge or HRQOL than those after traditional stroke health-education. Conclusions Both the SHEMA intervention and traditional stroke health-education can improve patients’ knowledge of stroke risk factors, but the SHEMA was not superior to traditional stroke health-education. Trial registration NCT02591511 Verification Date 2015-10-01.


2013 ◽  
Vol 2 ◽  
pp. 14
Author(s):  
Wenfang Fei

<p><strong>Objective:</strong> The study discussed the influence of comprehensive nursing intervention on the negative emotion and quality of life of patients with pulmonary tuberculosis. <strong>Method:</strong> 118 patients with pulmonary tuberculosis were collected in our department, who were randomly allocated to the two groups. In the intervention group (59 cases), in addition to conventional nursing, the patients also received the comprehensive nursing intervention based on health education, psychological guidance, cognitive-behavioral change and encouragement of social support. The control group (59 cases) received conventional nursing. The differences of negative emotion and quality of life between two groups were analyzed by the negative emotion subscale and quality of life scale (WHONQOL-BREF) in the Positive and Negative Affect Scale (PANAS). <strong>Results:</strong> The quality of life in the intervention group was significantly higher than the control group after intervention, and the negative emotion was significant lower than the control group. <strong>Conclusion: </strong>The comprehensive nursing intervention, based on health education, psychological guidance and encouragement of social support, could significantly reduce the negative emotion of patients with pulmonary tuberculosis, improved the quality of life.</p>


2019 ◽  
Vol 5 (6) ◽  
pp. 218-224
Author(s):  
Aan Nuraeni ◽  
Ristina Mirwanti ◽  
Anastasia Anna

Background: Coronary Heart Disease (CHD) has a high recurrence in Indonesia. This condition may occur as a result of the failure of compliance with post-acute management following a heart attack by CHD patients. One of the causes is the lack of effective health education.Objective: The aim of this study was to identify the feasibility of the workbook in improving patients’ self-efficacy (SE) and quality of life (QoL).Methods: This research used a quasi-experimental with pretest-posttest control design. A pretest was done to the patients who were treated in the cardiac intensive unit, and a posttest was carried out at the end of the first and second month after the pretest. The population was all post-acute CHD patients who were admitted to the cardiac intensive unit in one of the referral hospitals in West Java, Indonesia. A purposive sampling was used and obtained 39 respondents who were divided into control and intervention groups. The intervention group was given a health education using a workbook, and the control group was given a direct health education. Self-efficacy was measured using a questionnaire developed by the authors, with high validity and reliability. A SF-12 instrument was used for measuring the quality of life.  Data were analyzed using a descriptive quantitative analysis such as mean, Mann Whitney test, and Independent t-test. To estimate the effects of the intervention to QoL and SE, Kruskal Wallis test and One-way ANOVA were used.Results: The results showed that there was an increase in SE and QoL in both groups, either in the posttest 1 or posttest 2. The comparison of QoL in the pretest, posttest I and II obtained p=.452, .741, and .826, while SE between and within groups obtained p = .732, .220, and .009, respectively.Conclusions: Health education using the workbook was significantly more effective to increase SE than QoL of the CHD patients.


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