Electronic Thesis and Dissertation Repository


Doctor of Philosophy




Dr. Leora Swartzman and Dr. John Paul Minda



It is somewhat paradoxical that few patient education interventions actually consider the processes by which individuals best learn health-related information. The paucity of empirically validated teaching strategies impedes efforts to improve the delivery of care in cardiovascular rehabilitation and secondary prevention (CRSP) programs. The main goal of this dissertation was to examine whether explaining how illness pathophysiology, symptoms and health behaviour are interconnected (i.e., causal information) enhances the effectiveness of patient education materials.

This question was first addressed in a laboratory setting (Study 1) in which younger and older adults read about a fictitious disease under two conditions. Younger participants who read about how health behaviours were causally linked to illness pathophysiology and symptom reduction were better able to apply their knowledge than those who read this information in a non-integrated manner. However, this effect was not observed in the older sample. These findings were followed up in a cluster randomized controlled trial, in which causal information about connections among endothelial pathophysiology, cardiac risk factors, symptoms and health behaviours were integrated into a group education session at a Cardiac Rehabilitation and Secondary Prevention (CRSP) program. Results from Study 2 indicated that the addition of causal information was associated with deeper levels of knowledge about cardiovascular management and enhanced efficacy beliefs about the CRSP program. Study 3, which focused on participants’ behaviours, showed that the intervention did not impact patients’ likelihood to enroll into CRSP nor their physical activity levels four months into the program. The intervention group was marginally faster at completing prerequisites for program entry, but baseline characteristics, including anxiety and male gender, were stronger predictors of this behavior.

The present dissertation is the first to provide empirical support for the inclusion of causal information into patient education curricula. Findings indicate that patients’ depth of understanding warrants more attention in patient education contexts. Taken together, results from this dissertation serve as a stepping-stone towards enhancing provider-patient collaboration by demonstrating that patients have a better understanding when they are told why they are being asked to follow the cardiovascular management recommendations rather than simply being told what to do.