Multilingual video education for hospitalised patients with Myocardial Infarction (EDUCATE-MI): single-arm implementation study

Background International guidelines recommend that after a myocardial infarction (MI), patients receive education on key secondary prevention medications and lifestyle modifications, before hospital discharge. Multilingual videos may help deliver high-quality patient information to patients with diverse preferred languages and literacy levels, but little is known about the feasibility and impact on knowledge of this approach in the inpatient setting. To evaluate whether an educational video (available in English, Arabic, Hindi and Mandarin) provided to hospitalised patients post-MI can feasibly improve patient knowledge of MI.

This was an effectiveness-implementation hybrid quasi-experimental study. Recruitment took place between December 2023 to October 2024 in a tertiary hospital in Sydney, Australia. The intervention consisted of a 5-minute educational video on post-MI management, available in English, Arabic, Hindi and Mandarin. The primary outcome was change in patient knowledge of MI measured by comparing the mean number of correct responses before and immediately after the intervention using a two-sample t-test. Implementation was assessed by evaluating the acceptability and fidelity of the video. We performed thematic analysis on the notes taken of participants’ feedback for improving the video.

Of the 129 participants recruited, 20.2% (26/129) were female and the mean age was 59.4 years (Standard deviation [SD] 12.6). For 74.4% (96/129) of participants English was their preferred language, with Hindi the predominant preferred non-English language (13.2%, 17/129). The average number of correct responses out of 10 at baseline was 5.4 (SD 2.7) compared to 7.2 (SD 2.5) post-intervention (mean difference = 1.9; 95% CI 1.6, 2.2, p<0.001). The educational video was well-accepted, with 83.6% (107/128) of participants finding it easy to understand, 74.2% (95/128) finding it engaging, and 87.5% (112/128) considering it useful. Fidelity of the intervention was assessed as high, as core components (i.e. animations and educational content via audio and subtitles) were delivered as intended. Themes from participants’ feedback for improvement include content complexity and preference for conversational language and dialects.

A MI educational video delivered during inpatient hospital admission, available in multiple languages, may improve patient knowledge in the short term. Further scaled research is needed to evaluate the effectiveness and implementation of this intervention in other hospitals and settings, and to assess additional languages and strategies to support the health education needs of diverse populations. Competing Interest Statement The authors have declared no competing interest. Clinical Trial This is a one-arm quasi experimental study. The protocol is available on Open Science Framework (registered on 12 April 2024). The study was not registered. Funding Statement This work was funded by a Sydney Health Partners Implementation Science Pilot Grant 2021 (Grant Approval: Clinician created multimedia and multicultural cardiovascular m-Health education - EDUCATE_MI) Assoc Prof Liliana Laranjo is supported by a NHMRC Investigator Grant (2017642) and Sydney Horizon Fellowship Dr Mitchell Sarkies is supported by a NHMRC Investigator Grant (2007970) and Sydney Horizon Fellowship. Prof Clara Chow is supported by a NHMRC Investigator Grant (APP1195326). Dr Julie Ayre is supported by a NHMRC Investigator Grant (2017278). Dr Sul Ki Kim is supported by Postgraduate Research Scholarship in Stem Cells and Regenerative Medicine and Western Sydney Local Health District JMO Research Scholarship Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval (2021_ETH00983_v3) was obtained from Western Sydney Local Health District Human Research Ethics Committee. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes ↵* Aravinda Thiagalingam and Liliana Laranjo are co-senior authors Data Availability The datasets generated and/or analyzed during this study can be made available from the corresponding author on reasonable request. Abbreviations - CVD - Cardiovascular disease - MI - Myocardial infarction