Translation and evaluation of a comprehensive educational program for cardiac rehabilitation patients in Latin America: A multi-national, longitudinal study

Objectives: To translate, cross-culturally adapt and validate a comprehensive evidence-and theoretically based CR education intervention in Latin America. Methods: First, best practices in translation and cross-cultural adaptation were applied through 6 steps. Then, the Spanish version was delivered to CR participants from programs in Colombia, Costa Rica and Peru for validation, such that the evaluation was pre-post, uncontrolled, pragmatic, observational, and prospective in design. Participants completed surveys assessing knowledge, health literacy, self-efficacy, and health behaviours. All outcomes were assessed pre-, and post-CR, as well as 6 months after CR completion. Results: After translation of the patient guide from English to Spanish, 5 of the 9 booklets were culturally adapted. Two-hundred and forty-nine patients consented to participate, of which 184 (74 %) completed post-CR, and 121 (48 %) completed final assessments. There was a significant improvement in disease related knowledge pre-to post-CR, as well as in health literacy, self-efficacy, and health behaviours (all p < 0.05). These gains were sustained 6 months post-program. With adjustment, CR attendance (i.e., exposure to the education) was associated with greater post-CR knowledge (ss = 0.026; p = 0.01). Conclusion: A patient education intervention for CR patients in Latin America has been validated, and wider implementation is warranted. Practice implications: Application of this first-ever validated CR education program for Spanish-speaking settings may result in secondary prevention. (c) 2020 Elsevier B.V. All rights reserved.

Automated summary

This study translated, cross-culturally adapted, and validated a comprehensive evidence-based cardiac rehabilitation education intervention in Latin America, demonstrating significant improvements in disease-related knowledge, health literacy, self-efficacy, and health behaviors pre- and post-CR, with sustained gains at 6 months post-program. Attendance at the cardiac rehabilitation program was associated with greater post-CR knowledge. The findings support wider implementation of the patient education intervention for Spanish-speaking populations in Latin America for secondary prevention.