The Impact of Telenursing in Elderlies with Myocardial Infarction Based on a Self- care Program: A Randomized Clinical Trial

The Impact of Telenursing in Elderlies with Myocardial Infarction Based on a Self- care Program: A Randomized Clinical Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Telenursing in Elderlies with Myocardial Infarction Based on a Self- care Program: A Randomized Clinical Trial Arian Mobasheri, Parand Pourghane, Fereshteh Besharati, Saman Maroufizadeh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6029063/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Self-care and medication adherence are key factors in the management of patients with myocardial infarction (MI), but many patients face challenges in this field and need new care approaches. This study, based on a self-care program, aimed to determine the effect of telenursing on self-efficacy and adherence to medication in Elderlies with MI. Methods This study was a randomized clinical trial. Sixty-two Elderly with MI were randomly assigned to the intervention or control group. The intervention group received an in-person session (30-60 minutes), telephone follow-up (8 calls in a month), and educational text messages, and the control group received routine care only. The research tools were a cognitive test of the Abbreviated Mental Test (AMT), and questionnaires used before and four weeks after the intervention. Data were analyzed using paired t-test and ANCOVA by IBM SPSS Statistics version 26. Results : At the posttest measurement, results of the ANCOVA showed a significantly higher self-efficacy scores for the intervention group compared to the control group after adjusting for the pretest scores (F (1, 52) =67.31, P<0.001, η 2 P =0.564). The similar result was obtained for medication adherence (F (1, 52) =77.39, P<0.001, η 2 P =0.598). The effect sizes, calculated using partial eta squared, were 0.564 and 0.598, which are considered to be large. Conclusion Telenursing based on a self-care program significantly increases self-efficacy and medication adherence in elderly with MI, and it is recommended that telenursing programs be expanded in healthcare systems to promote self-care and medication adherence. Clinical Trial Registration : https://irct.behdasht.gov.ir/user/trial/76806/view. IrCTR registry, IRCT20240416061511N1/ Registration Date: 2024-05-23 Telenursing Self Care Self Efficacy Medication Adherence Myocardial Infarction Telemedicine Figures Figure 1 Figure 2 Figure 3 Background Myocardial infarction (MI) is one of the most common and severe cardiovascular diseases, which is known as the leading cause of death and disability worldwide [ 1 ]. In addition to physical consequences, this disease has profound psychological and social effects on patients and severely reduces their quality of life [ 2 ]. In Iran, with rapid changes in the population structure and lifestyle, the prevalence of cardiovascular diseases, including MI, has increased significantly, and this increase and, as a result, the limitations of access to specialized nursing services, has revealed the need to use new solutions such as telenursing [ 3 ]. This approach can have a significant effect on the management of patients by reducing costs and increasing access to health care. Therefore, this situation reveals the need for continuous and effective management of affected patients [ 4 ]. One key factor in the successful management of chronic diseases, including MIs, is self-care. Self-care includes patients' behaviors and actions to maintain their health and improve their condition [ 5 ]. This process is important in preventing disease complications, reducing frequent hospitalizations, and improving quality of life. However, self-care is only effective if the patient has a high level of self-efficacy, meaning that the individual trusts their ability to manage the disease [ 6 ]. Self-efficacy refers to a person's belief in his ability to perform the necessary behaviors to achieve specific goals. This concept plays a fundamental role in managing chronic diseases because the patient's confidence in his ability to deal with the challenges related to the disease is the basis for starting and continuing positive self-care behaviors [ 7 ]. Research has shown that patients with chronic diseases, including cardiovascular diseases, have a high level of self-efficacy and are more likely to show healthy behaviors, medication Adherence, and effective disease management [ 8 , 9 ]. Medication adherence is also important as a part of the treatment plan for MI patients. Non-adherence to drug therapy can lead to worsening of symptoms, serious complications, and even death [ 10 ]. However, many patients have difficulty adhering to medication due to various reasons, including lack of awareness, psychological problems, or limitations in access to care services [ 11 ]. Telenursing, which includes providing nursing services through communication technologies, is considered a new solution to improve self-efficacy and patient adherence to treatment. By providing the possibility of continuous communication between patients and nurses and receiving the necessary training, telenursing can strengthen the sense of self-efficacy and promote self-care behaviors [ 12 ]. This method is especially efficient in managing chronic diseases such as MI and brings benefits such as reducing costs, easy access, and improving clinical results [ 13 ]. Although telenursing has been used in many countries to manage chronic diseases, there is still insufficient evidence worldwide about the effectiveness of this method specifically for elderly people with heart attacks. [ 14 , 15 ]. Therefore, the present study was designed to fill this gap by investigating telenursing's effect on self-efficacy and medication adherence in Elderlies with MI based on a self-care program. Materials and methods Ethical approval and Study design This article results from a master's thesis in Geriatric Nursing from Guilan University of Medical Sciences, with clinical trial code IRCT20240416061511N1 and ethical code IR.GUMS.REC.1403.032. All ethical considerations were considered, including maintaining confidentiality, voluntary participation in the study, patient confidentiality, unconditional freedom of the patient to withdraw from the study at any stage, etc. Informed consent was obtained to use their data for research purposes. Type of Study This study was a randomized clinical trial with two parallel groups (intervention and control) and an allocation ratio of 1:1, conducted in 2024 in Rasht, Iran. Participants and study environment The research population included elderly patients with MI hospitalized in the CCU and PCCU of Dr. Heshmat Hospital in Rasht. The inclusion criteria included not having speech and hearing problems, not suffering from psychological diseases, having a landline and cell phone to establish telenursing, willingness to participate in the study, suffering from MI, and having a diagnosis of the disease by a cardiologist. Exclusion criteria included the death of the patient, unwillingness to continue participating, and simultaneous participation in other studies. Random assignment method The allocation of participants to intervention and control groups was done using block randomization (block sizes of 4 and 6). The allocation list was prepared using the Sealed Envelope Ltd online tool. Allocation concealment was done using opaque and numbered envelopes. Sample size The sample size calculation was done for detecting a difference between the means of two independent samples. With an effect size of 0.8 (Cohen’s d) for CSEQ and MMAS-8 total scores, a power of 0.8, and an alpha value of 0.05, 26 subjects would be required in each group. Assuming a potential drop-out rate of 15%, 31 subjects were needed in each group. Intervention The intervention group received a self-care training program that included the following: In-person training session: Each individual will be trained separately about heart anatomy, MI pathophysiology, and essential self-care measures at the hospital. This meeting was held for 30 to 60 minutes. Telephone follow-up: Our team made phone calls twice weekly for one month after discharge (8 calls total). Each call lasted 10 to 20 minutes. Messaging follow-up: During one month, 55 educational text messages were sent to the Elderly of this group to strengthen their learning. In the control group, there was no intervention, and they only received routine care, including drug recommendations and scheduling for their next doctor's appointments. Data collection method To conduct the present study, after obtaining permission from the vice president of research, the hospital managers, and the officials of the CCU PCCU of Dr. Heshmat Hospital, the medical records of all patients were reviewed based on the inclusion criteria to determine the eligible patients to participate in the study. Verbal and written consent to participate in the study was obtained from all selected patients who met the inclusion criteria (Additional file 1.ICF). Then, the Abbreviated Mental Test (AMT) was taken from cases that met the inclusion criteria. The patients were examined in terms of mental and cognitive health, and the ones with an AMT score of 7 or higher were included in the study. The AMT cognitive questionnaire is an abbreviated cognitive test suitable for screening cognitive disorders in the elderly. This questionnaire has 10 items, and the elderly in question must be able to score 7 to 10. A score lower than seven on this test means the presence of cognitive disorders. The items include age, time of day, year, name of residence, identification of two companions or employees, date of birth, year of the Islamic Revolution, name of the leader of the time, ability to count backward from 20 to 1, and repetition of an address (Additional file 2). Bakhtiari et al. confirmed this test's validity and reliability with a Cronbach's alpha coefficient of 0.76 [ 16 ]. Then, demographic information was taken from the selected patients to determine their demographic information and history of diseases. The demographic questionnaire consists of personal information and information related to the disease. The personal information section included age, gender, place of residence, marital status, level of education, insurance status, employment status, and monthly income. The information related to the disease included questions about the history of other diseases, the duration of the disease, and the duration of treatment. After that, patients were evaluated using Sullivan's Cardiac Self-Efficacy Questionnaire, and patients with insufficient self-efficacy (patients who scored between 0 and 22) were included in the study. The cardiac self-efficacy questionnaire was designed and developed by Sullivan et al. in 1998 to measure cardiac self-efficacy [ 17 ]. This questionnaire consists of 16 questions, the answers scored on a Likert scale from zero (not at all sure) to four (completely sure). In this questionnaire, the total score is between 0–64, and higher scores indicate better self-efficacy. The range of scores of the questionnaire is as follows: scores of 0 to 22 are considered low self-efficacy (insufficient), scores of 23 to 32 are considered moderate self-efficacy, and scores of 33 to 64 are considered high self-efficacy. The validity and reliability of this questionnaire were confirmed by Shamsizadeh et al., and its reliability was assessed as desirable with a Cronbach's alpha coefficient of 0.80 [ 18 ]. Then, the study employed a validated questionnaire adapted from the Morisky Medication Adherence Scale (MMAS-8) to the patients and completed it on their behalf. This questionnaire was designed by Morisky et al. (2008) and was created to measure adherence to medication treatment in patients with hypertension [ 19 ]. The MMAS questionnaire consists of seven two-choice questions (with yes and no answers) and one Likert-type question. Its total score range is between 0 and 8. The higher the score, the higher the medication adherence of the individuals. In questions 1 to 7, yes answers were given a score of 0, and no answers a score of 1. Question 5 was scored in reverse order, and in question 8, the answer "never" was given a score of 0, sometimes a score of 0.25, usually a score of 0.5, usually a score of 0.75, and always a score of 1. The validity and reliability of this questionnaire were confirmed in the study by Yadollahi et al., and its reliability was reported to be 71% using Cronbach's alpha method [ 20 ]. Also, in the study by Yang et al., its reliability was calculated to be 72% using Cronbach's alpha test [ 21 ]. This study translated the questionnaire into Persian using a forward-backward translation approach. Two specialists in medical translation and experienced translators of the questionnaire were translated. The translated versions were compared to ensure the questions accurately reflected the intended meanings and concepts. The most appropriate translations were chosen to create a final Persian version of the instrument. To verify that the Persian translation aligned closely with the original text and retained accurate sentence structures, two additional translators fluent in English, who had not seen the original questionnaire, reviewed the initial translation. Two metrics were employed to assess the quantitative content validity. the Content Validity Ratio (CVR) and the Item Content Validity Index (CVI). Initially, the questionnaire was distributed to 12 experts to evaluate the CVR. They rated each item on a three-point Likert scale, indicating whether it was "useful" or "not necessary." The CVR was computed using the formula: (ne - (N/2)) / (N/2), where N represents the total number of specialists and ne counts those who deemed the item "necessary." Each expert also evaluated the content validity index (CVI) for each question, providing their ratings. To assess the questionnaire's stability over time (test-retest), the intra-class correlation coefficient (ICC) was calculated at a 95% confidence interval. For this assessment, a group of 30 patients completed the tool on two occasions, two weeks apart. A score above 0.75 indicates optimal stability. Additionally, the internal consistency of the questionnaire items was determined to be 0.81 using Cronbach’s alpha. Then, the cases were divided into two groups: an intervention and a: control group. In the control group, no intervention was applied. They received routine care that included instructions on taking medications, guidance on activity types, drug recommendations, and scheduling for their next doctor's appointments. For the intervention group, in addition to routine training, a 30–60 minute face-to-face session was held at the hospital covering the anatomy and physiology of the heart in simple terms, the pathophysiology of M), and the necessary care and actions for patients to avoid complications. Patients' questions were also answered. After discharge, telephone follow-up for one month was conducted twice a week (8 calls per month) based on the needs of each patient for 10 to 20 minutes. Then, 55 educational text messages were sent to patients in this group over one month to reinforce learning. The educational content of the face-to-face sessions and telephone calls was compiled from reputable and relevant books and articles [ 22 , 23 ]. The content included topics such as anatomy and physiology of the heart, definition of MI, signs, and symptoms of MI, diagnostic tests for MI, self-care training for MI patients including diet, blood pressure control, blood lipid control, diabetes control, smoking cessation, stress control, adherence to medication regimen, and physical activity. The validity of the educational content was assessed by several nursing professors of the research team, faculty members, and a cardiologist consultant. After receiving their comments, the necessary amendments were made. The patients were provided a phone number to answer their questions. The subjects were informed about the study's purpose and the information's confidentiality. Four weeks after the last contact in the intervention group, patients in both groups completed the questionnaires again. Statistical analysis In this study, categorical variables were expressed as frequency (percentage) and continuous variables as mean (standard deviation (SD)). We conducted paired t tests to assess changes in CSEQ and MMAS-8 total scores between pre- and post-test measurement by groups. Additionally, ANCOVA was used to compare the groups at posttest after controlling for pretest scores. The effect size was reported in partial eta squared (η 2 p ) for ANCOVA and Cohen’s d for paired t test; η 2 p values of 0.01–0.06, 0.06–0.14, and > 0.14 and Cohen’s d values of 0.2–0.5, 0.5–0.8, and > 0.8 were considered as small, medium, and large effect size, respectively. Data analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA), and graphs were depicted using GraphPad Prism, Version 8.0.1 (GraphPad Prism Software Inc., San Diego, CA, USA). A P < 0.05 was considered statistically significant. Results Patients characteristics Figure 1 shows the flow of participants through the trial. A total of 120 patients with MI were screened and 62 elderly underwent randomization. The first patients underwent randomization on 2024 05, 28 and the last on 2024, 11, 23. Of these, posttest data were available for 55 patients to be included in the intention-to-treat analysis (control: 29 patients, and intervention: 26 patients). The demographic and clinical characteristics of the patients are shown in Table 1. The mean age of the patients was 71.6 (SD=9.1) years and the mean of the disease duration was 6.9 (SD=6.1) years. Of the patients, 60.0% were female, 49.1% were married, 9.1% had university education, 45.5% were resident in rural area and 81.8% had chronic disease. Demographics and clinical characteristics were well balanced between control and intervention groups. Table 1. Personal and clinical characteristics of the patients studied in the control and intervention. Total (n=55) Control Group (n = 29) Intervention Group (n=26) n (%) n (%) n (%) Gender Male 22 (40.0%) 12 (41.4%) 10 (38.5%) Female 33 (60.0%) 17 (58.6%) 16 (61.5%) Marital Status Married 27 (49.1%) 15 (51.7%) 12 (46.2%) Single 3 (5.5%) 1 (3.5%) 2 (7.7%) Widowed 20 (36.3%) 11 (38.0%) 9 (34.6%) Divorced 5 (9.1%) 2 (6.8%) 3 (11.5%) Education Illiterate 26 (47.3%) 15 (51.7%) 11 (42.3%) Below Diploma 13 (23.6%) 6 (20.7%) 7 (26.9%) Diploma 11 (20.0%) 6 (20.7%) 5 (19.2%) University 5 (9.1%) 2 (6.9%) 3 (11.5%) Occupation Employee 1 (1.8%) 0 (0.0%) 1 (3.8%) Self-Employed 22 (40.0%) 13 (44.9%) 9 (34.6%) Retired 15 (27.3%) 7 (24.1%) 8 (30.8%) Unemployed 17 (30.9%) 9 (31.0%) 8 (30.8%) Residence Urban 30 (54.5%) 15 (51.7%) 15 (57.7%) Rural 25 (45.5%) 14 (48.3%) 11 (42.3%) Smoking History Yes 21 (38.2%) 12 (41.4%) 9 (34.6%) No 34 (61.8%) 17 (58.6%) 17 (65.4%) Chronic Disease Yes 45 (81.8%) 25 (86.2%) 20 (76.9%) No 10 (18.2%) 4 (13.8%) 6 (23.1%) Mean (SD) Mean (SD) Mean (SD) Age (y) 71.6 (9.1) 70.6 (8.3) 72.7 (10.0) Disease duration (y) 6.9 (6.1) 7.0 (6.2) 6.9 (6.2) Abbreviation. SD: Standard Deviation. Comparison between pretest and posttest scores CSEQ total score As presented in Table 2, in the intervention group, the mean of CSEQ total score in the posttest measurement significantly increased by 12.38 (95% CI: 9.57 to 15.20) points compared to the pretest measurement (t (25) =9.06, P<0.001, Cohen’s d=1.776), while in the control group, the mean of CSEQ total score significantly decreased by 2.31 (4.35, 95% CI: 0.27) points (t (28) =-2.32, P=0.028, Cohen’s d=0.431). MMAS-8 total score In the intervention group, the mean of MMAS-8 total score in the posttest measurement increased significantly by 1.81 (95% CI: 1.32 to 2.30) points compared to the pre-test measurement (t (25) =7.60, P<0.001, Cohen’s d=1.489), while in the control group, the mean of MMAS-8 total scores decreased significantly by 0.69 (95% CI: 0.35 to 1.03) points (t(28)=-4.12, P<0.001, Cohen’s d=0.765) (Table 2). Table 2. Within-group analyses of the of the CSEQ and MMAS-8 total scores in patients with MI by control and intervention groups. Pretest Posttest Mean of differences (95% CI) t P Cohen’s d CSEQ total score Control 18.00 (8.59) 15.69 (9.36) -2.31 (-4.35 to -0.27) -2.32 0.028 0.431 Intervention 23.00 (10.00) 35.38 (14.85) 12.38 (9.57 to 15.20) 9.06 <0.001 1.776 MMAS-8 total score Control 3.91 (1.04) 3.22 (1.25) -0.69 (-1.03 to -0.35) -4.12 <0.001 0.765 Intervention 3.79 (1.24) 5.60 (1.47) 1.81 (1.32 to 2.30) 7.60 0.8 were considered as small, medium, and large effect size, respectively. P-value is based on paired t test Comparison between control and intervention groups CSEQ total score At the posttest measurement, results of the ANCOVA showed a significantly higher CSEQ total scores for the patients in the intervention group compared to the patients in the control group after adjusting for the pretest scores (F (1, 52) =67.31, P<0.001, η 2 P =0.564). The effect size, calculated using partial eta squared, was 0.564, which is considered to be large (Table 3). MMAS-8 total score After adjusting for pretest scores, patients in the intervention group scored, on average, 2.47 (95% CI: 1.91 to 3.04) points higher on the MMAS-8 total score than patients in the control group at the posttest assessment (F (1, 52) =77.39, P<0.001, η 2 P =0.598). The effect size was 0.598, which is considered to be large (Table 3). Table 3. Evaluating the effect of telenursing on cardiac self-efficacy and medication adherence in patients with MI. Control Intervention Adjusted mean difference (95% CI) a F (1, 52) P η 2 p CSEQ total score Pretest 18.00 (8.59) 23.00 (10.00) Posttest 15.69 (9.36) 35.38 (14.85) 13.94 (10.53 to 17.35) 67.31 <0.001 0.564 MMAS-8 total score Pretest 3.91 (1.04) 3.79 (1.24) Posttest 3.22 (1.25) 5.60 (1.47) 2.47 (1.91 to 3.04) 77.39 <0.001 0.598 Abbreviation. CI: Confidence Interval; CSEQ: Cardiac Self-Efficacy Questionnaire; MMAS-8: 8-item Morisky Medication Adherence Scale. Data are mean (SD), unless otherwise specified. a Adjusted for pretest scores. η 2 p values of 0.01-0.06, 0.06-0.14, and >0.14 were considered as small, medium, and large effect size, respectively. Discussion This study was conducted to determine the effect of telenursing based on a self-care program on self-efficacy and adherence to medication in Elderlies with MI. The findings of the present study regarding the comparison of the mean self-efficacy scores before and after the intervention between the intervention and control groups showed that the self-efficacy score in the intervention group was significantly higher than the control group and showed that telephone follow-up and education had a significant effect on the self-care of patients in the test group. In line with this finding, the findings of the study by Keshavarz et al. [24], Gohari et al. [25], and Yuan et al. (2024) (26) showed that training in methods such as face-to-face training followed by remote follow-up and telephone follow-up can improve the self-efficacy and quality of life of patients in the intervention group compared to the control group, because telephone follow-up can increase patients' self-efficacy and quality of lifere gardless of time andplace, creating and maintaining a dynamic, flexible, and continuous care relationship between the nurse and the patient. However, in contrast to this finding, Lee et al. reported that the level of self-efficacy among hemodialysis patients in the post-intervention stage did not differ significantly from that of the control group [27]. The difference in the study findings can be attributed to the different types of patients studied because hemodialysis patients can experience numerous other problems due to the chronic nature of the disease, which can affect the self-efficacy of these patients. The present study's results are also inconsistent with the study by Aimi et al. [28]. The findings of their study showed that multimedia and virtual education did not affect the level of self-efficacy of patients with chronic pulmonary obstruction. It seems that the difference in the findings of the two present studies is related to the type of educational content and the type of underlying disease of the patients. In that study, researchers were trained on medical equipment and how to use it, and it is expected that the study results will change due to the different levels of education and understanding of the patients. In addition, patients with respiratory problems due to pulmonary problems have lower levels of activity tolerance and training than the patients in the present study, and this factor could also be one of the reasons for the differences in the results of the two studies. The present study's findings regarding comparing the mean scores of medication adherence before and after the intervention between the intervention and control groups showed that the mean scores of medication adherence in the intervention group increased after the intervention compared to the control group, which was statistically significant. This means the intervention group had better medication adherence than the control group. This finding from the present study was consistent with the study by Haryati et al. The findings of the study by Haryati et al. (2024) (29) showed that web-based telenursing improved adherence to antimalarial drugs in the intervention group significantly compared to the control group who did not receive telenursing intervention, with a better willingness and understanding of adhering to their medication regimen. The findings of the study by Başoğlu and Polat (2024) (30) are consistent with this finding. The present study showed that education and monitoring provided to elderly cancer patients through telenursing has a positive effect on their self-efficacy and adherence to medication. However, this present study's finding was contrary to the study by Gamar et al. The findings of their study showed that in the medication adherence dimension, education in two methods with and without telephone follow-up had no significant effect on increasing medication adherence in patients with MI compared to the control group [30]. The reason for the inconsistency of the results can be attributed to the method. In the present study, the cognitive level of the patients was first examined, and patients with a cognitive level higher than seven were included as the inclusion criteria. Then, patients with a level of self-efficacy were identified, and these cases were considered after these two stages of intervention. However, these cases were not considered in the study of those researchers. Also, the difference in the education content, measurement tool, and 1-month messaging follow-up could be other reasons for the inconsistency of the results. On the other hand, different from the present findings, the study by Bersing et al. showed no statistically significant difference between the two study groups regarding medication adherence [31]. The reason for the inconsistency of the results can be attributed to the difference in the type of disease. Rheumatoid arthritis patients have chronic and persistent pain. Reduced mobility and dependence on others are other characteristics of these patients. Therefore, the patient's inability to perform personal tasks and dependence on others is perhaps the most important reason for the difference in the findings. The findings of this study indicated the positive effect of telenursing based on a self-care program on improving self-efficacy and adherence to medication in patients with MI. These results emphasize the importance of modern communication technologies in providing nursing services, which can be used as an effective strategy for managing chronic diseases. From a clinical perspective, telenursing can facilitate patients' access to education and follow-up care by reducing geographical and time constraints and improving their treatment outcomes. It also increases the participation of the elderly, providing personal care, and creating a sense of responsibility for themselves, which consequently increases independence and a sense of self-worth in the elderly.This is especially important in countries with developing health systems, such as Iran, which may face limitations in providing nursing services. Conclusion and suggestions The results of this study showed that telenursing based on a self-care program is an effective approach in improving self-efficacy and adherence to medication in elderly patients with myocardial infarction. For this reason, remote nursing in diseases such as myocardial infarction is important in increasing patients' self-efficacy, ensuring medication use, especially in the early stages, and the results of disease treatment. By creating continuous and dynamic communication between the patient and the nurse, this method can reduce barriers to access to care services and improve the quality of chronic disease management. The use of telenursing in health systems, especially in conditions of resource and access limitations, can be used as a practical and cost-effective solution. Performing telenursing in longer time intervals and expanding this intervention and its implementation in other patient groups and other ages pave the way for further research and improving the performance of health systems. Clinical application The findings of this study can provide practical guidance for nurses in enhancing their role in remote care. Telenursing allows nurses to provide educational and supportive services to patients in less time and facilitates ongoing follow-up. For hospital administrators, these results represent a cost-effective strategy to reduce the burden of repeated hospitalizations and increase patient satisfaction. Policymakers can also use this evidence to develop national telenursing programs and improve access to health services in underserved areas. Limitations and Strengths The strengths of this study include the regular follow-up of patients through telephone calls and sending educational text messages, as continuous communication with patients has enhanced the effects of the intervention. The findings of the present study provide a comprehensive source for the implementation of telenursing in the healthcare setting. In addition, attention to patients' individual needs through personalization of education and answering their specific questions in telephone calls has increased the effects of the intervention. However, this study also had limitations. One of the limitations is the reliance on self-reported data from patients, which may be biased by the patients' current condition; in this regard, an attempt was made to select a suitable time for the elderly to fill out the questionnaire, and not to complete the questionnaire under stressful conditions and to postpone it to a later time. There is also the possibility of researcher bias in sample selection, which is reduced by random blocking. In addition, factors such as social support or economic status, which could affect the results and consequently affect self-care education in the elderly, were not examined in this study. Declarations Ethics approval and consent to participate This article results from a master's thesis in Geriatric Nursing from Guilan University of Medical Sciences, with clinical trial code IRCT20240416061511N1 and ethical code IR.GUMS.REC.1403.032. The studies were conducted in accordance with the local legislation and institutional requirements. The current study included only those who presented their informed consent. For this purpose, an informed consent form (Additional file2.ICF) was completed by all participants after being explained the study’s aims. All participants’ information was private and nameless; there was no personal information that could link the answers with any of the participants in the present study. All methods in the study were in accordance with relevant regulations & guidelines (General Ethical Guidance for Medical Research with Human Participants in the Islamic Republic of Iran).. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of interest The authors declare that they have no competing interests. Financial support The authors did not receive support from any organization for this research. Acknowledgments We would like to express our deepest gratitude to all the patients who participated in the study and cooperated sincerely. We would also like to thank the Vice Chancellor of Research and Technology of Guilan University of Medical Sciences for supporting this study and all those who contributed in any way to it. Author Contributions Study idea and design: A.M, P.P, F.B, sampling: A.M, data analysis and interpretation: S.M, manuscript preparation: A.M, critical review: P.P and F.B. All authors approved the final version. All authors are involved in compiling the content and writing the article. References Rodrigues F, Domingos C, Monteiro D, Morouço P. A review on aging, sarcopenia, falls, and resistance training in community-dwelling older adults. International journal of environmental research and public health. (2022) ;19(2):874. doi: 10.3390/ijerph19020874 Cowley S, Tzouvara V, Da Silva THR. Public Health: Healthy Ageing and Well-Being. Redfern's Nursing Older People. (2023) :87. Dindar Farkosh J, Kazemipour Sabet S, Ansari H. Foresight of the aging trend of the Iranian population in different regions and population groups until 1420. Future study Management. (2022) ;33(1401). doi: 10.30495/jmfr.2022.20259 Mamashli L. Telenursing in cardiovascular diseases: a critical review of systematic reviews of evidence. Iranian Journal of Systematic Review in Medical Sciences. (2023) ;1(3):20-32. URL: http://ijsr.ir/article-1-74-en.html Mahmoudzadeh H, Aghayari Hir T, Hatami D. Study and Analysis of the Elderly Population of the Iran. Geographical Researches. (2022) ;37(1):111-25. doi: 10.29252/geores.37.1.111 Novrouzi R, Ghaffari M, Sabouri M, Marashi T, Rakhshanderou S. Investigating the effect of self-care on the nutritional status of the elderly by structural equation modeling analysis. Iranian Journal of Ageing. (2023) ;18(1):46-59. doi: 10.32598/sija.2022.3368.1 CHAN SW-C. Chronic Disease Management, Self-Efficacy and Quality of Life. Journal of Nursing Research. (2021) ;29(1):e129. doi: 10.1097/JNR.0000000000000422 Dinh TTH, Bonner A. Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases. BMC Health Services Research. (2023) ;23(1):923. doi: 10.1186/s12913-023-09907-5 Farley H. Promoting self‐efficacy in patients with chronic disease beyond traditional education: A literature review. Nursing open. (2020) ;7(1):30-41. doi: 10.1002/nop2.382 Hyun K, Hollings MA, Hafiz N, Zwack C, Free C, Perel P, et al. Mobile phone text messaging for medication adherence in secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews. (2024) (3):CD011851. doi: 10.1002/14651858.CD011851.pub3. Natarajan P. Genomic aging, clonal hematopoiesis, and cardiovascular disease. Arteriosclerosis, thrombosis, and vascular biology. (2023) ;43(1):3-14. doi: 10.1161/ATVBAHA.122.318181 Sasanipour M, Khosravi A. Increase in life expectancy due to changes in the patterns of deaths from cardiovascular diseases in Iran during 2006-2019. Payesh (Health Monitor). (2022) ;21(6):581-92. doi:10.52547/payesh.21.6.581 Qiu X. Nurse-led intervention in the management of patients with cardiovascular diseases: a brief literature review. BMC nursing. (2024) ;23(1):6. doi: 10.1186/s12912-023-01422-6 Fathizadeh P, Heidari H, Masoudi R, Sedehi M, Khajeali F. Telenursing strategies in Iran: a narrative literature review. International Journal of Epidemiology and Health Sciences. (2020) ;1(e03):1-15. doi: 10.51757/IJEHS.1.3.2020.46189 Abraham C, Jensen C, Rossiter L, Dittman Hale D. Telenursing and Remote Patient Monitoring in Cardiovascular Health. Telemed J E Health. 2024;30(3):771-9. Bakhtiyari F, Foroughan M, Fakhrzadeh H, Nazari N, Najafi B, Alizadeh M, et al. Validation of the persian version of Abbreviated Mental Test (AMT) in elderly residents of Kahrizak charity foundation. Iranian journal of Diabetes and Metabolism. (2014) ;13(6):487-94. URL: http://ijdld.tums.ac.ir/article-1-5271-en.html Sullivan MD, LaCroix AZ, Russo J, Katon WJ. Self-efficacy and self-reported functional status in coronary heart disease: a six-month prospective study. Psychosom Med. (1998) ;60(4):473-8. doi: 10.1097/00006842-199807000-00014 Shamsizadeh M, Shaadi S, Mohammadi Y, Borzou SR. The effects of education and telephone nurse follow-up (tele-nursing) on diabestes management self–efficacy in patients with type 2 diabetic referred to Hamadans Diabetes Center in (2018). Avicenna Journal of Nursing and Midwifery Care. 2021;29(2):81-90. doi: 10.30699/ajnmc.29.2.81 Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Retracted: predictive validity of a medication adherence measure in an outpatient setting. The journal of clinical hypertension. (2008) ;10(5):348-54. doi: 10.1111/j.1751-7176.2008.07572.x Yadollahi S, Ashktorab T, Zayeri F. Medication adherence and related factors in patients with epilepsy. Hayat, Journal of School of Nursing and Midwifery, Tehran University of Medical Sciences. (2015) ; 21(2): 67-80. URL: http://hayat.tums.ac.ir/article-1-1135-en.html Yang A, Wang B, Zhu G, Jiao Z, Fang Y, Tang F, et al. Validation of Chinese version of the Morisky medication adherence scale in patients with epilepsy. Seizure. (2014) Apr; 23(4): 295-9. doi: 10.1016/j.seizure.2014.01.003 Sharafi S, Nasrabadi T, Beyranvand A, Sheykhi A. Self-care in coronary artery diseases. Tehran: Jame_e Negar Publishing House; (2017). Kumar S. The power of self-care: Transforming heart health with lifestyle medicine. India: Notion Press; (2023). Keshavaraz N, Naderifar M, Firouzkohi M, Abdollahimohammad A, Akbarizadeh MR. Effect of telenursing on the self-efficacy of patients with MI: A quasi-experimental study. Signa Vitae. (2020) ;16(2):92-6. doi: 10.22514/sv.2020.16.0039 Gohari F, Hasanvand S, Gholami M, Heidari H, Baharvand P. Effectiveness of rehabilitation by telephone follow-up on the self-efficacy of patients undergoing coronary artery bypass graft surgery. Interdisciplinary Journal of Acute Care. (2021) ;1(2):66-73. doi: 10.22087/ijac.2020.127194 Yuan Y, Hou P, Wang S, Kitayama A, Yanagihara K, Liang J. Intervention effects of telenursing based on M-O-A model in empty-nest older adult individuals with chronic diseases: a randomized controlled trial. Front Public Health. 2024;12:1239445. Lee MC, Wu SFV, Lu KC, Liu CY, Liang SY, Chuang YH. Effectiveness of a self‐management program in enhancing quality of life, self‐care, and self‐efficacy in patients with hemodialysis: a quasi‐experimental design. Seminars in Dialysis. (2021) ;34(4):292-9. doi: 10.1111/sdi.12957 Emme C, Mortensen EL, Rydahl‐Hansen S, Østergaard B, Svarre Jakobsen A, Schou L, et al. The impact of virtual admission on self‐efficacy in patients with chronic obstructive pulmonary disease–a randomised clinical trial. Journal of Clinical Nursing. (2014) ;23(21-22):3124-37. doi: 10.1111/jocn.12553 Haryati DT, Anwar S, Badriah S. The Effectiveness of Using Telenursing in Supporting Patient Adherence to Antimalarial Medication. Journal of Research in Science Education. 2024;10(10):7464-73. Haryati DT, Anwar S, Badriah S. The Effectiveness of Using Telenursing in Supporting Patient Adherence to Antimalarial Medication. Journal of Research in Science Education. 2024;10(10):7464-73. Gomar E, Karampourian A, Vardanjani MM, Manafi B, Khazaei S. Effect of Education and Telephone Follow-up on Patients' Adherence to the Treatment Regimen after Myocardial infarction . Avicenna J Nurs Midwifery Care. (2022) ;30(3):151-62. Doi: 10.32592/ajnmc.30.3.151 Unk JA, Brasington R. Efficacy study of multimedia rheumatoid arthritis patient education program. Journal of the American Association of Nurse Practitioners. (2014) ;26(7):370-7. dio: 10.1002/2327-6924.12064. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1.ICF2.docx Additionalfile2..docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6029063","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":440847550,"identity":"cf3c391e-8abe-4ece-a85d-912c29d2f50a","order_by":0,"name":"Arian Mobasheri","email":"","orcid":"","institution":"Guilan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Arian","middleName":"","lastName":"Mobasheri","suffix":""},{"id":440847551,"identity":"d496c2b8-037b-42d0-b1e3-17970991f8b5","order_by":1,"name":"Parand Pourghane","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYLACxgYQyXwASEjIkKKFLQGkhYcULTwGYJKganP2HrOPX3fY5fFL93x+daPGgoeB/fDRDfi0WPacMZ4teya5WHLO2W3WOceADuNJS7uBT4vBjRxjZsk25sQNN3K3GeewAbVI8JgRo6U+cf+NnGfGOf+I1ML4se1w4gaJHObHuW1EaLHsOVbMzNh2PHHGnWNmzLl9EjxshPxizt68mfFnW3Vi/+zmx59zvtXJ8bMfPobfYUDMDI4LCQY2CRDNhk85TAvjD4gW5g+EVI+CUTAKRsHIBACM3EgFoNav4wAAAABJRU5ErkJggg==","orcid":"","institution":"Guilan University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Parand","middleName":"","lastName":"Pourghane","suffix":""},{"id":440847552,"identity":"b2817bd9-b348-45cb-aa00-7d09a0715368","order_by":2,"name":"Fereshteh Besharati","email":"","orcid":"","institution":"Guilan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fereshteh","middleName":"","lastName":"Besharati","suffix":""},{"id":440847553,"identity":"ed10d03c-ca43-46f5-9fc0-bfc35ef656ab","order_by":3,"name":"Saman Maroufizadeh","email":"","orcid":"","institution":"Guilan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Saman","middleName":"","lastName":"Maroufizadeh","suffix":""}],"badges":[],"createdAt":"2025-02-14 09:08:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6029063/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6029063/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80297301,"identity":"678de1ac-2d17-4ead-8908-d998515c2889","added_by":"auto","created_at":"2025-04-10 08:41:39","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":612089,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6029063/v1/e6b9b931ae38cadbd1ef0464.jpeg"},{"id":80298079,"identity":"db978eb8-8c3f-46ea-a77a-5a58ec796ac6","added_by":"auto","created_at":"2025-04-10 08:49:39","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44665,"visible":true,"origin":"","legend":"\u003cp\u003eWithin-group analyses of the CSEQ and MMAS-8 total scores in patients with MI by control and intervention groups.\u003c/p\u003e\n\u003cp\u003eAbbreviation. CSEQ: Cardiac Self-Efficacy Questionnaire; MMAS-8: 8-item Morisky Medication Adherence Scale.\u003c/p\u003e\n\u003cp\u003eP-valuess are based on the paired t test.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6029063/v1/d73692d7888415bbafb05421.jpg"},{"id":80297298,"identity":"871bfbf6-470c-459b-bceb-695e174fea1c","added_by":"auto","created_at":"2025-04-10 08:41:39","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":31632,"visible":true,"origin":"","legend":"\u003cp\u003eEvaluating the effect of telenursing on cardiac self-efficacy and medication adherence in patients with MI.\u003c/p\u003e\n\u003cp\u003eAbbreviation. CSEQ: Cardiac Self-Efficacy Questionnaire; MMAS-8: 8-item Morisky Medication Adherence Scale.\u003c/p\u003e\n\u003cp\u003eValues are presented as mean with 95% confidence interval.\u003c/p\u003e\n\u003cp\u003eBetween-group differences were examined using ANCOVA after adjusting for pretest scores.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6029063/v1/28ab37071d27e04b617240dd.jpg"},{"id":87917540,"identity":"7d894728-35ba-4a4a-853e-e75d0bd77fe8","added_by":"auto","created_at":"2025-07-30 11:17:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1496482,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6029063/v1/2da7a9e7-5612-4443-9298-f4441faa5011.pdf"},{"id":80297299,"identity":"c122fa9a-34a5-470b-8533-644fa3a84357","added_by":"auto","created_at":"2025-04-10 08:41:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16355,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile1.ICF2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6029063/v1/4b66940e64fe92f7c78048e9.docx"},{"id":80299647,"identity":"aa864ab1-e7c3-470a-a0a6-72427fe8f860","added_by":"auto","created_at":"2025-04-10 09:05:39","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16362,"visible":true,"origin":"","legend":"","description":"","filename":"Additionalfile2..docx","url":"https://assets-eu.researchsquare.com/files/rs-6029063/v1/15223af249990c25eb06c1ac.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Impact of Telenursing in Elderlies with Myocardial Infarction Based on a Self- care Program: A Randomized Clinical Trial","fulltext":[{"header":"Background","content":"\u003cp\u003eMyocardial infarction (MI) is one of the most common and severe cardiovascular diseases, which is known as the leading cause of death and disability worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In addition to physical consequences, this disease has profound psychological and social effects on patients and severely reduces their quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Iran, with rapid changes in the population structure and lifestyle, the prevalence of cardiovascular diseases, including MI, has increased significantly, and this increase and, as a result, the limitations of access to specialized nursing services, has revealed the need to use new solutions such as telenursing [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This approach can have a significant effect on the management of patients by reducing costs and increasing access to health care. Therefore, this situation reveals the need for continuous and effective management of affected patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOne key factor in the successful management of chronic diseases, including MIs, is self-care. Self-care includes patients' behaviors and actions to maintain their health and improve their condition [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This process is important in preventing disease complications, reducing frequent hospitalizations, and improving quality of life. However, self-care is only effective if the patient has a high level of self-efficacy, meaning that the individual trusts their ability to manage the disease [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSelf-efficacy refers to a person's belief in his ability to perform the necessary behaviors to achieve specific goals. This concept plays a fundamental role in managing chronic diseases because the patient's confidence in his ability to deal with the challenges related to the disease is the basis for starting and continuing positive self-care behaviors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Research has shown that patients with chronic diseases, including cardiovascular diseases, have a high level of self-efficacy and are more likely to show healthy behaviors, medication Adherence, and effective disease management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMedication adherence is also important as a part of the treatment plan for MI patients. Non-adherence to drug therapy can lead to worsening of symptoms, serious complications, and even death [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, many patients have difficulty adhering to medication due to various reasons, including lack of awareness, psychological problems, or limitations in access to care services [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTelenursing, which includes providing nursing services through communication technologies, is considered a new solution to improve self-efficacy and patient adherence to treatment. By providing the possibility of continuous communication between patients and nurses and receiving the necessary training, telenursing can strengthen the sense of self-efficacy and promote self-care behaviors [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This method is especially efficient in managing chronic diseases such as MI and brings benefits such as reducing costs, easy access, and improving clinical results [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough telenursing has been used in many countries to manage chronic diseases, there is still insufficient evidence worldwide about the effectiveness of this method specifically for elderly people with heart attacks. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, the present study was designed to fill this gap by investigating telenursing's effect on self-efficacy and medication adherence in Elderlies with MI based on a self-care program.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e \u003cb\u003eEthical approval and Study design\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis article results from a master's thesis in Geriatric Nursing from Guilan University of Medical Sciences, with clinical trial code IRCT20240416061511N1 and ethical code IR.GUMS.REC.1403.032. All ethical considerations were considered, including maintaining confidentiality, voluntary participation in the study, patient confidentiality, unconditional freedom of the patient to withdraw from the study at any stage, etc. Informed consent was obtained to use their data for research purposes.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eType of Study\u003c/h2\u003e \u003cp\u003eThis study was a randomized clinical trial with two parallel groups (intervention and control) and an allocation ratio of 1:1, conducted in 2024 in Rasht, Iran.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and study environment\u003c/h3\u003e\n\u003cp\u003eThe research population included elderly patients with MI hospitalized in the CCU and PCCU of Dr. Heshmat Hospital in Rasht. The inclusion criteria included not having speech and hearing problems, not suffering from psychological diseases, having a landline and cell phone to establish telenursing, willingness to participate in the study, suffering from MI, and having a diagnosis of the disease by a cardiologist. Exclusion criteria included the death of the patient, unwillingness to continue participating, and simultaneous participation in other studies.\u003c/p\u003e\n\u003ch3\u003eRandom assignment method\u003c/h3\u003e\n\u003cp\u003eThe allocation of participants to intervention and control groups was done using block randomization (block sizes of 4 and 6). The allocation list was prepared using the Sealed Envelope Ltd online tool. Allocation concealment was done using opaque and numbered envelopes.\u003c/p\u003e\n\u003ch3\u003eSample size\u003c/h3\u003e\n\u003cp\u003eThe sample size calculation was done for detecting a difference between the means of two independent samples. With an effect size of 0.8 (Cohen\u0026rsquo;s d) for CSEQ and MMAS-8 total scores, a power of 0.8, and an alpha value of 0.05, 26 subjects would be required in each group. Assuming a potential drop-out rate of 15%, 31 subjects were needed in each group.\u003c/p\u003e\n\u003ch3\u003eIntervention\u003c/h3\u003e\n\u003cp\u003eThe intervention group received a self-care training program that included the following:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIn-person training session: Each individual will be trained separately about heart anatomy, MI pathophysiology, and essential self-care measures at the hospital. This meeting was held for 30 to 60 minutes.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTelephone follow-up: Our team made phone calls twice weekly for one month after discharge (8 calls total). Each call lasted 10 to 20 minutes.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMessaging follow-up: During one month, 55 educational text messages were sent to the Elderly of this group to strengthen their learning.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eIn the control group, there was no intervention, and they only received routine care, including drug recommendations and scheduling for their next doctor's appointments.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection method\u003c/h2\u003e \u003cp\u003eTo conduct the present study, after obtaining permission from the vice president of research, the hospital managers, and the officials of the CCU PCCU of Dr. Heshmat Hospital, the medical records of all patients were reviewed based on the inclusion criteria to determine the eligible patients to participate in the study. Verbal and written consent to participate in the study was obtained from all selected patients who met the inclusion criteria (Additional file 1.ICF). Then, the Abbreviated Mental Test (AMT) was taken from cases that met the inclusion criteria. The patients were examined in terms of mental and cognitive health, and the ones with an AMT score of 7 or higher were included in the study. The AMT cognitive questionnaire is an abbreviated cognitive test suitable for screening cognitive disorders in the elderly. This questionnaire has 10 items, and the elderly in question must be able to score 7 to 10. A score lower than seven on this test means the presence of cognitive disorders. The items include age, time of day, year, name of residence, identification of two companions or employees, date of birth, year of the Islamic Revolution, name of the leader of the time, ability to count backward from 20 to 1, and repetition of an address (Additional file 2). Bakhtiari et al. confirmed this test's validity and reliability with a Cronbach's alpha coefficient of 0.76 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Then, demographic information was taken from the selected patients to determine their demographic information and history of diseases. The demographic questionnaire consists of personal information and information related to the disease. The personal information section included age, gender, place of residence, marital status, level of education, insurance status, employment status, and monthly income. The information related to the disease included questions about the history of other diseases, the duration of the disease, and the duration of treatment. After that, patients were evaluated using Sullivan's Cardiac Self-Efficacy Questionnaire, and patients with insufficient self-efficacy (patients who scored between 0 and 22) were included in the study. The cardiac self-efficacy questionnaire was designed and developed by Sullivan et al. in 1998 to measure cardiac self-efficacy [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This questionnaire consists of 16 questions, the answers scored on a Likert scale from zero (not at all sure) to four (completely sure). In this questionnaire, the total score is between 0\u0026ndash;64, and higher scores indicate better self-efficacy. The range of scores of the questionnaire is as follows: scores of 0 to 22 are considered low self-efficacy (insufficient), scores of 23 to 32 are considered moderate self-efficacy, and scores of 33 to 64 are considered high self-efficacy. The validity and reliability of this questionnaire were confirmed by Shamsizadeh et al., and its reliability was assessed as desirable with a Cronbach's alpha coefficient of 0.80 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Then, the study employed a validated questionnaire adapted from the Morisky Medication Adherence Scale (MMAS-8) to the patients and completed it on their behalf. This questionnaire was designed by Morisky et al. (2008) and was created to measure adherence to medication treatment in patients with hypertension [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The MMAS questionnaire consists of seven two-choice questions (with yes and no answers) and one Likert-type question. Its total score range is between 0 and 8. The higher the score, the higher the medication adherence of the individuals. In questions 1 to 7, yes answers were given a score of 0, and no answers a score of 1. Question 5 was scored in reverse order, and in question 8, the answer \"never\" was given a score of 0, sometimes a score of 0.25, usually a score of 0.5, usually a score of 0.75, and always a score of 1. The validity and reliability of this questionnaire were confirmed in the study by Yadollahi et al., and its reliability was reported to be 71% using Cronbach's alpha method [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Also, in the study by Yang et al., its reliability was calculated to be 72% using Cronbach's alpha test [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study translated the questionnaire into Persian using a forward-backward translation approach. Two specialists in medical translation and experienced translators of the questionnaire were translated. The translated versions were compared to ensure the questions accurately reflected the intended meanings and concepts. The most appropriate translations were chosen to create a final Persian version of the instrument. To verify that the Persian translation aligned closely with the original text and retained accurate sentence structures, two additional translators fluent in English, who had not seen the original questionnaire, reviewed the initial translation. Two metrics were employed to assess the quantitative content validity. the Content Validity Ratio (CVR) and the Item Content Validity Index (CVI). Initially, the questionnaire was distributed to 12 experts to evaluate the CVR. They rated each item on a three-point Likert scale, indicating whether it was \"useful\" or \"not necessary.\" The CVR was computed using the formula: (ne - (N/2)) / (N/2), where N represents the total number of specialists and ne counts those who deemed the item \"necessary.\" Each expert also evaluated the content validity index (CVI) for each question, providing their ratings. To assess the questionnaire's stability over time (test-retest), the intra-class correlation coefficient (ICC) was calculated at a 95% confidence interval. For this assessment, a group of 30 patients completed the tool on two occasions, two weeks apart. A score above 0.75 indicates optimal stability. Additionally, the internal consistency of the questionnaire items was determined to be 0.81 using Cronbach\u0026rsquo;s alpha.\u003c/p\u003e \u003cp\u003eThen, the cases were divided into two groups: an intervention and a: control group. In the control group, no intervention was applied. They received routine care that included instructions on taking medications, guidance on activity types, drug recommendations, and scheduling for their next doctor's appointments. For the intervention group, in addition to routine training, a 30\u0026ndash;60 minute face-to-face session was held at the hospital covering the anatomy and physiology of the heart in simple terms, the pathophysiology of M), and the necessary care and actions for patients to avoid complications. Patients' questions were also answered. After discharge, telephone follow-up for one month was conducted twice a week (8 calls per month) based on the needs of each patient for 10 to 20 minutes. Then, 55 educational text messages were sent to patients in this group over one month to reinforce learning. The educational content of the face-to-face sessions and telephone calls was compiled from reputable and relevant books and articles [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The content included topics such as anatomy and physiology of the heart, definition of MI, signs, and symptoms of MI, diagnostic tests for MI, self-care training for MI patients including diet, blood pressure control, blood lipid control, diabetes control, smoking cessation, stress control, adherence to medication regimen, and physical activity. The validity of the educational content was assessed by several nursing professors of the research team, faculty members, and a cardiologist consultant. After receiving their comments, the necessary amendments were made. The patients were provided a phone number to answer their questions. The subjects were informed about the study's purpose and the information's confidentiality. Four weeks after the last contact in the intervention group, patients in both groups completed the questionnaires again.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eIn this study, categorical variables were expressed as frequency (percentage) and continuous variables as mean (standard deviation (SD)). We conducted paired t tests to assess changes in CSEQ and MMAS-8 total scores between pre- and post-test measurement by groups. Additionally, ANCOVA was used to compare the groups at posttest after controlling for pretest scores. The effect size was reported in partial eta squared (η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e) for ANCOVA and Cohen\u0026rsquo;s d for paired t test; η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e values of 0.01\u0026ndash;0.06, 0.06\u0026ndash;0.14, and \u0026gt;\u0026thinsp;0.14 and Cohen\u0026rsquo;s d values of 0.2\u0026ndash;0.5, 0.5\u0026ndash;0.8, and \u0026gt;\u0026thinsp;0.8 were considered as small, medium, and large effect size, respectively. Data analysis was performed using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA), and graphs were depicted using GraphPad Prism, Version 8.0.1 (GraphPad Prism Software Inc., San Diego, CA, USA). A P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatients characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1 shows the flow of participants through the trial. A total of 120 patients with MI were screened and 62 elderly underwent randomization. The first patients underwent randomization on 2024 05, 28 and the last on 2024, 11, 23. Of these, posttest data were available for 55 patients to be included in the intention-to-treat analysis (control: 29 patients, and intervention: 26 patients). The demographic and clinical characteristics of the patients are shown in Table 1. The mean age of the patients was 71.6 (SD=9.1) years and the mean of the disease duration was 6.9 (SD=6.1) years. Of the patients, 60.0% were female, 49.1% were married, 9.1% had university education, 45.5% were resident in rural area and 81.8% had chronic disease. Demographics and clinical characteristics were well balanced between control and intervention groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Personal and clinical characteristics of the patients studied in the control and intervention.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eTotal (n=55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eControl Group (n = 29)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eIntervention Group (n=26)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e22 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e12 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e10 (38.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e33 (60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e17 (58.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e16 (61.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e27 (49.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e15 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e12 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Single\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e3 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e1 (3.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e2 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e20 (36.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e11 (38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e9 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e5 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e2 (6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e3 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Illiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e26 (47.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e15 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e11 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Below Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e13 (23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e6 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e7 (26.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e11 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e6 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e5 (19.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e5 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e3 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e1 (3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Self-Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e22 (40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e13 (44.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e9 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Retired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e15 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e7 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e8 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Unemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e17 (30.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e8 (30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Urban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e30 (54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e15 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e15 (57.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Rural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e25 (45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e14 (48.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e11 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eSmoking History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e21 (38.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e12 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e9 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e34 (61.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e17 (58.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e17 (65.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eChronic Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e45 (81.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e25 (86.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e20 (76.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e10 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e6 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eAge (y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e71.6 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e70.6 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e72.7 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eDisease duration (y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e6.9 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e7.0 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e6.9 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation. SD: Standard Deviation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison between pretest and posttest scores\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCSEQ total score\u003c/p\u003e\n\u003cp\u003eAs presented in\u0026nbsp;Table 2, in the intervention group, the mean of CSEQ total score in the posttest measurement significantly increased by 12.38 (95% CI: 9.57 to 15.20) points compared to the pretest measurement (t\u003csub\u003e(25)\u003c/sub\u003e=9.06, P\u0026lt;0.001, Cohen\u0026rsquo;s d=1.776), while in the control group, the mean of CSEQ total score significantly decreased by 2.31 (4.35, 95% CI: 0.27) points (t\u003csub\u003e(28)\u003c/sub\u003e=-2.32, P=0.028, Cohen\u0026rsquo;s d=0.431).\u003c/p\u003e\n\u003cp\u003eMMAS-8 total score\u003c/p\u003e\n\u003cp\u003eIn the intervention group, the mean of MMAS-8 total score in the posttest measurement increased significantly by 1.81 (95% CI: 1.32 to 2.30) points compared to the pre-test measurement (t\u003csub\u003e(25)\u003c/sub\u003e=7.60, P\u0026lt;0.001, Cohen\u0026rsquo;s d=1.489), while in the control group, the mean of MMAS-8 total scores decreased significantly by 0.69 (95% CI: 0.35 to 1.03) points (t(28)=-4.12, P\u0026lt;0.001, Cohen\u0026rsquo;s d=0.765) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Within-group analyses of the of the CSEQ and MMAS-8 total scores in patients with MI by control and intervention groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003ePretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003ePosttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMean of differences (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eCSEQ total score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e18.00 (8.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e15.69 (9.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e-2.31 (-4.35 to -0.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e23.00 (10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e35.38 (14.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e12.38 (9.57 to 15.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e9.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.776\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eMMAS-8 total score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.91 (1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.22 (1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e-0.69 (-1.03 to -0.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e-4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.765\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.79 (1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e5.60 (1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e1.81 (1.32 to 2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e7.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.489\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation. CI: Confidence Interval; CSEQ: Cardiac Self-Efficacy Questionnaire; MMAS-8: 8-item Morisky Medication Adherence Scale.\u003c/p\u003e\n\u003cp\u003eCohen\u0026rsquo;s d values of 0.2-0.5, 0.5-0.8, and \u0026gt;0.8 were considered as small, medium, and large effect size, respectively.\u003c/p\u003e\n\u003cp\u003eP-value is based on paired t test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparison between control and intervention groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCSEQ total score\u003c/p\u003e\n\u003cp\u003eAt the posttest measurement, results of the ANCOVA showed a significantly higher CSEQ total scores for the patients in the intervention group compared to the patients in the control group after adjusting for the pretest scores (F\u003csub\u003e(1, 52)\u003c/sub\u003e=67.31, P\u0026lt;0.001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003csub\u003eP\u003c/sub\u003e=0.564). The effect size, calculated using partial eta squared, was 0.564, which is considered to be large (Table 3).\u003c/p\u003e\n\u003cp\u003eMMAS-8 total score\u003c/p\u003e\n\u003cp\u003eAfter adjusting for pretest scores, patients in the intervention group\u0026nbsp;scored, on average, 2.47 (95% CI: 1.91 to 3.04) points higher on the MMAS-8 total score than patients in the control group at the posttest assessment (F\u003csub\u003e(1, 52)\u003c/sub\u003e=77.39, P\u0026lt;0.001, \u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003csub\u003eP\u003c/sub\u003e=0.598).\u0026nbsp;The effect size was 0.598, which is considered to be large (Table 3).\u003cspan dir=\"RTL\"\u003e\u003c/span\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Evaluating the effect of telenursing on cardiac self-efficacy and medication adherence in patients with MI.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eAdjusted mean difference (95% CI)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003eF\u003csub\u003e(1, 52)\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eCSEQ total score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Pretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e18.00 (8.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e23.00 (10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Posttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e15.69 (9.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e35.38 (14.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e13.94 (10.53 to 17.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e67.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.564\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eMMAS-8 total score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Pretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.91 (1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e3.79 (1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Posttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.22 (1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e5.60 (1.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2.47 (1.91 to 3.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e77.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation. CI: Confidence Interval; CSEQ: Cardiac Self-Efficacy Questionnaire; MMAS-8: 8-item Morisky Medication Adherence Scale.\u003c/p\u003e\n\u003cp\u003eData are mean (SD), unless otherwise specified.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eAdjusted for pretest scores.\u003c/p\u003e\n\u003cp\u003e\u0026eta;\u003csup\u003e2\u003c/sup\u003e\u003csub\u003ep\u003c/sub\u003e values of 0.01-0.06, 0.06-0.14, and \u0026gt;0.14 were considered as small, medium, and large effect size, respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study was conducted to determine the effect of telenursing based on a self-care program on self-efficacy and adherence to medication in Elderlies with MI. The findings of the present study regarding the comparison of the mean self-efficacy scores before and after the intervention between the intervention and control groups showed that the self-efficacy score in the intervention group was significantly higher than the control group and showed that telephone follow-up and education had a significant effect on the self-care of patients in the test group. In line with this finding, the findings of the study by Keshavarz et al. [24], Gohari et al. [25], and Yuan et al. (2024) (26) showed that training in methods such as face-to-face training followed by remote follow-up and telephone follow-up can improve the self-efficacy and quality of life of patients in the intervention group compared to the control group, because telephone follow-up can increase patients\u0026apos; self-efficacy\u0026nbsp;and quality of lifere\u0026nbsp;gardless of time andplace, creating and maintaining a dynamic, flexible, and continuous care relationship between the nurse and the patient.\u003c/p\u003e\n\u003cp\u003eHowever, in contrast to this finding, Lee et al. reported that the level of self-efficacy among hemodialysis patients in the post-intervention stage did not differ significantly from that of the control group [27]. The difference in the study findings can be attributed to the different types of patients studied because hemodialysis patients can experience numerous other problems due to the chronic nature of the disease, which can affect the self-efficacy of these patients. The present study\u0026apos;s results are also inconsistent with the study by Aimi et al. [28]. The findings of their study showed that multimedia and virtual education did not affect the level of self-efficacy of patients with chronic pulmonary obstruction. It seems that the difference in the findings of the two present studies is related to the type of educational content and the type of underlying disease of the patients. In that study, researchers were trained on medical equipment and how to use it, and it is expected that the study results will change due to the different levels of education and understanding of the patients. In addition, patients with respiratory problems due to pulmonary problems have lower levels of activity tolerance and training than the patients in the present study, and this factor could also be one of the reasons for the differences in the results of the two studies.\u003c/p\u003e\n\u003cp\u003eThe present study\u0026apos;s findings regarding comparing the mean scores of medication adherence before and after the intervention between the intervention and control groups showed that the mean scores of medication adherence in the intervention group increased after the intervention compared to the control group, which was statistically significant. This means the intervention group had better medication adherence than the control group. This finding from the present study was consistent with the study by Haryati et al. \u0026nbsp;The findings of the study by Haryati et al. (2024) (29) showed that web-based telenursing improved adherence to antimalarial drugs in the intervention group significantly compared to the control group who did not receive telenursing intervention, with a better willingness and understanding of adhering to their medication regimen. The findings of the study by Başoğlu and Polat (2024) (30) are consistent with this finding. The present study showed that education and monitoring provided to elderly cancer patients through telenursing has a positive effect on their self-efficacy and adherence to medication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, this present study\u0026apos;s finding was contrary to the study by Gamar et al. The findings of their study showed that in the medication adherence dimension, education in two methods with and without telephone follow-up had no significant effect on increasing medication adherence in patients with MI compared to the control group [30]. The reason for the inconsistency of the results can be attributed to the method. In the present study, the cognitive level of the patients was first examined, and patients with a cognitive level higher than seven were included as the inclusion criteria. Then, patients with a level of self-efficacy were identified, and these cases were considered after these two stages of intervention. However, these cases were not considered in the study of those researchers. Also, the difference in the education content, measurement tool, and 1-month messaging follow-up could be other reasons for the inconsistency of the results.\u003c/p\u003e\n\u003cp\u003eOn the other hand, different from the present findings, the study by Bersing et al. showed no statistically significant difference between the two study groups regarding medication adherence [31]. The reason for the inconsistency of the results can be attributed to the difference in the type of disease. Rheumatoid arthritis patients have chronic and persistent pain. Reduced mobility and dependence on others are other characteristics of these patients. Therefore, the patient\u0026apos;s inability to perform personal tasks and dependence on others is perhaps the most important reason for the difference in the findings.\u003c/p\u003e\n\u003cp\u003eThe findings of this study indicated the positive effect of telenursing based on a self-care program on improving self-efficacy and adherence to medication in patients with MI. These results emphasize the importance of modern communication technologies in providing nursing services, which can be used as an effective strategy for managing chronic diseases. From a clinical perspective, telenursing can facilitate patients\u0026apos; access to education and follow-up care by reducing geographical and time constraints and improving their treatment outcomes. It also increases the participation of the elderly, providing personal care, and creating a sense of responsibility for themselves, which consequently increases independence and a sense of self-worth in the elderly.This is especially important in countries with developing health systems, such as Iran, which may face limitations in providing nursing services.\u003c/p\u003e"},{"header":"Conclusion and suggestions","content":"\u003cp\u003eThe results of this study showed that telenursing based on a self-care program is an effective approach in improving self-efficacy and adherence to medication in elderly patients with myocardial infarction. For this reason, remote nursing in diseases such as myocardial infarction is important in increasing patients' self-efficacy, ensuring medication use, especially in the early stages, and the results of disease treatment. By creating continuous and dynamic communication between the patient and the nurse, this method can reduce barriers to access to care services and improve the quality of chronic disease management. The use of telenursing in health systems, especially in conditions of resource and access limitations, can be used as a practical and cost-effective solution. Performing telenursing in longer time intervals and expanding this intervention and its implementation in other patient groups and other ages pave the way for further research and improving the performance of health systems.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical application\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The findings of this study can provide practical guidance for nurses in enhancing their role in remote care. Telenursing allows nurses to provide educational and supportive services to patients in less time and facilitates ongoing follow-up. For hospital administrators, these results represent a cost-effective strategy to reduce the burden of repeated hospitalizations and increase patient satisfaction. Policymakers can also use this evidence to develop national telenursing programs and improve access to health services in underserved areas.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and Strengths\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe strengths of this study include the regular follow-up of patients through telephone calls and sending educational text messages, as continuous communication with patients has enhanced the effects of the intervention. The findings of the present study provide a comprehensive source for\u0026nbsp;the implementation of\u0026nbsp;telenursing\u0026nbsp;in the healthcare setting.\u0026nbsp;In addition, attention to patients' individual needs through personalization of education and answering their specific questions in telephone calls has increased the effects of the intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, this study also had limitations. One of the limitations is the reliance on self-reported data from patients, which may be biased by the patients' current condition; in this regard, an attempt was made to select a suitable time for the elderly to fill out the questionnaire, and not to complete the questionnaire under stressful conditions and to postpone it to a later time. There is also the possibility of researcher bias in sample selection, which is reduced by random blocking. In addition, factors such as social support or economic status, which could affect the results and consequently affect self-care education in the elderly, were not examined in this study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article results from a master's thesis in Geriatric Nursing from Guilan University of Medical Sciences, with clinical trial code IRCT20240416061511N1 and ethical code IR.GUMS.REC.1403.032.\u0026nbsp;The studies were conducted in accordance with the local legislation and institutional requirements.\u0026nbsp;The current study included only those who presented their informed consent. For this purpose, an informed consent form (Additional file2.ICF) was completed by all participants after being explained the study’s aims. All participants’ information was private and nameless; there was no personal information that could link the answers with any of the participants in the present study. All methods in the study were in accordance with relevant regulations \u0026amp; guidelines (General Ethical Guidance for Medical Research with Human Participants in the Islamic Republic of Iran)..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organization for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our deepest gratitude to all the patients who participated in the study and cooperated sincerely. We would also like to thank the Vice Chancellor of Research and Technology of Guilan University of Medical Sciences for supporting this study and all those who contributed in any way to it.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy idea and design: A.M, P.P, F.B, sampling: A.M, data analysis and interpretation: S.M, manuscript preparation: A.M, critical review: P.P and F.B. All authors approved the final version. All authors are involved in compiling the content and writing the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRodrigues F, Domingos C, Monteiro D, Morou\u0026ccedil;o P. A review on aging, sarcopenia, falls, and resistance training in community-dwelling older adults. International journal of environmental research and public health. (2022) ;19(2):874. doi: 10.3390/ijerph19020874\u003c/li\u003e\n\u003cli\u003eCowley S, Tzouvara V, Da Silva THR. Public Health: Healthy Ageing and Well-Being. Redfern\u0026apos;s Nursing Older People. (2023) :87. \u003c/li\u003e\n\u003cli\u003eDindar Farkosh J, Kazemipour Sabet S, Ansari H. Foresight of the aging trend of the Iranian population in different regions and population groups until 1420. Future study Management. (2022) ;33(1401). doi: 10.30495/jmfr.2022.20259\u003c/li\u003e\n\u003cli\u003eMamashli L. Telenursing in cardiovascular diseases: a critical review of systematic reviews of evidence. Iranian Journal of Systematic Review in Medical Sciences. (2023) ;1(3):20-32. URL: \u003cu\u003ehttp://ijsr.ir/article-1-74-en.html\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eMahmoudzadeh H, Aghayari Hir T, Hatami D. Study and Analysis of the Elderly Population of the Iran. Geographical Researches. (2022) ;37(1):111-25. doi: 10.29252/geores.37.1.111\u003c/li\u003e\n\u003cli\u003eNovrouzi R, Ghaffari M, Sabouri M, Marashi T, Rakhshanderou S. Investigating the effect of self-care on the nutritional status of the elderly by structural equation modeling analysis. Iranian Journal of Ageing. (2023) ;18(1):46-59. doi: 10.32598/sija.2022.3368.1\u003c/li\u003e\n\u003cli\u003eCHAN SW-C. Chronic Disease Management, Self-Efficacy and Quality of Life. Journal of Nursing Research. (2021) ;29(1):e129. doi: 10.1097/JNR.0000000000000422\u003c/li\u003e\n\u003cli\u003eDinh TTH, Bonner A. Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases. BMC Health Services Research. (2023) ;23(1):923. doi: 10.1186/s12913-023-09907-5\u003c/li\u003e\n\u003cli\u003eFarley H. Promoting self‐efficacy in patients with chronic disease beyond traditional education: A literature review. Nursing open. (2020) ;7(1):30-41. doi: 10.1002/nop2.382\u003c/li\u003e\n\u003cli\u003eHyun K, Hollings MA, Hafiz N, Zwack C, Free C, Perel P, et al. Mobile phone text messaging for medication adherence in secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews. (2024) (3):CD011851. doi: 10.1002/14651858.CD011851.pub3.\u003c/li\u003e\n\u003cli\u003eNatarajan P. Genomic aging, clonal hematopoiesis, and cardiovascular disease. Arteriosclerosis, thrombosis, and vascular biology. (2023) ;43(1):3-14. doi: 10.1161/ATVBAHA.122.318181\u003c/li\u003e\n\u003cli\u003eSasanipour M, Khosravi A. Increase in life expectancy due to changes in the patterns of deaths from cardiovascular diseases in Iran during 2006-2019. Payesh (Health Monitor). (2022) ;21(6):581-92. doi:10.52547/payesh.21.6.581\u003c/li\u003e\n\u003cli\u003eQiu X. Nurse-led intervention in the management of patients with cardiovascular diseases: a brief literature review. BMC nursing. (2024) ;23(1):6. doi: 10.1186/s12912-023-01422-6\u003c/li\u003e\n\u003cli\u003eFathizadeh P, Heidari H, Masoudi R, Sedehi M, Khajeali F. Telenursing strategies in Iran: a narrative literature review. International Journal of Epidemiology and Health Sciences. (2020) ;1(e03):1-15. doi: 10.51757/IJEHS.1.3.2020.46189\u003c/li\u003e\n\u003cli\u003eAbraham C, Jensen C, Rossiter L, Dittman Hale D. Telenursing and Remote Patient Monitoring in Cardiovascular Health. Telemed J E Health. 2024;30(3):771-9.\u003c/li\u003e\n\u003cli\u003eBakhtiyari F, Foroughan M, Fakhrzadeh H, Nazari N, Najafi B, Alizadeh M, et al. Validation of the persian version of Abbreviated Mental Test (AMT) in elderly residents of Kahrizak charity foundation. Iranian journal of Diabetes and Metabolism. (2014) ;13(6):487-94. URL: \u003cu\u003ehttp://ijdld.tums.ac.ir/article-1-5271-en.html\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eSullivan MD, LaCroix AZ, Russo J, Katon WJ. Self-efficacy and self-reported functional status in coronary heart disease: a six-month prospective study. Psychosom Med. (1998) ;60(4):473-8. doi: 10.1097/00006842-199807000-00014\u003c/li\u003e\n\u003cli\u003eShamsizadeh M, Shaadi S, Mohammadi Y, Borzou SR. The effects of education and telephone nurse follow-up (tele-nursing) on diabestes management self\u0026ndash;efficacy in patients with type 2 diabetic referred to Hamadans Diabetes Center in (2018). Avicenna Journal of Nursing and Midwifery Care. 2021;29(2):81-90. doi: 10.30699/ajnmc.29.2.81\u003c/li\u003e\n\u003cli\u003eMorisky DE, Ang A, Krousel‐Wood M, Ward HJ. Retracted: predictive validity of a medication adherence measure in an outpatient setting. The journal of clinical hypertension. (2008) ;10(5):348-54. doi: 10.1111/j.1751-7176.2008.07572.x\u003c/li\u003e\n\u003cli\u003eYadollahi S, Ashktorab T, Zayeri F. Medication adherence and related factors in patients with\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eepilepsy. Hayat, Journal of School of Nursing and Midwifery, Tehran University of Medical Sciences.\u003cspan dir=\"RTL\"\u003e \u003c/span\u003e(2015) ; 21(2): 67-80. URL: \u003cu\u003ehttp://hayat.tums.ac.ir/article-1-1135-en.html\u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eYang A, Wang B, Zhu G, Jiao Z, Fang Y, Tang F, et al. Validation of Chinese version of the\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eMorisky medication adherence scale in patients with epilepsy. Seizure. (2014) Apr; 23(4): 295-9. doi: \u003cu\u003e10.1016/j.seizure.2014.01.003 \u003c/u\u003e\u003c/li\u003e\n\u003cli\u003eSharafi S, Nasrabadi T, Beyranvand A, Sheykhi A. Self-care in coronary artery diseases. Tehran: Jame_e Negar Publishing House; (2017).\u003c/li\u003e\n\u003cli\u003eKumar S. The power of self-care: Transforming heart health with lifestyle medicine. India: Notion Press; (2023).\u003c/li\u003e\n\u003cli\u003eKeshavaraz N, Naderifar M, Firouzkohi M, Abdollahimohammad A, Akbarizadeh MR. Effect of telenursing on the self-efficacy of patients with MI: A quasi-experimental study. Signa Vitae. (2020) ;16(2):92-6. doi: 10.22514/sv.2020.16.0039\u003c/li\u003e\n\u003cli\u003eGohari F, Hasanvand S, Gholami M, Heidari H, Baharvand P. Effectiveness of rehabilitation by telephone follow-up on the self-efficacy of patients undergoing coronary artery bypass graft surgery. Interdisciplinary Journal of Acute Care. (2021) ;1(2):66-73. doi: 10.22087/ijac.2020.127194\u003c/li\u003e\n\u003cli\u003eYuan Y, Hou P, Wang S, Kitayama A, Yanagihara K, Liang J. Intervention effects of telenursing based on M-O-A model in empty-nest older adult individuals with chronic diseases: a randomized controlled trial. Front Public Health. 2024;12:1239445.\u003c/li\u003e\n\u003cli\u003eLee MC, Wu SFV, Lu KC, Liu CY, Liang SY, Chuang YH. Effectiveness of a self‐management program in enhancing quality of life, self‐care, and self‐efficacy in patients with hemodialysis: a quasi‐experimental design. Seminars in Dialysis. (2021) ;34(4):292-9. doi: 10.1111/sdi.12957\u003c/li\u003e\n\u003cli\u003eEmme C, Mortensen EL, Rydahl‐Hansen S, \u0026Oslash;stergaard B, Svarre Jakobsen A, Schou L, et al. The impact of virtual admission on self‐efficacy in patients with chronic obstructive pulmonary disease\u0026ndash;a randomised clinical trial. Journal of Clinical Nursing. (2014) ;23(21-22):3124-37. doi: 10.1111/jocn.12553\u003c/li\u003e\n\u003cli\u003eHaryati DT, Anwar S, Badriah S. The Effectiveness of Using Telenursing in Supporting Patient Adherence to Antimalarial Medication. Journal of Research in Science Education. 2024;10(10):7464-73.\u003c/li\u003e\n\u003cli\u003eHaryati DT, Anwar S, Badriah S. The Effectiveness of Using Telenursing in Supporting Patient Adherence to Antimalarial Medication. Journal of Research in Science Education. 2024;10(10):7464-73.\u003c/li\u003e\n\u003cli\u003eGomar E, Karampourian A, Vardanjani MM, Manafi B, Khazaei S. Effect of Education and Telephone Follow-up on Patients\u0026apos; Adherence to the Treatment Regimen after Myocardial infarction . Avicenna J Nurs Midwifery Care. (2022) ;30(3):151-62. Doi: 10.32592/ajnmc.30.3.151\u003c/li\u003e\n\u003cli\u003eUnk JA, Brasington R. Efficacy study of multimedia rheumatoid arthritis patient education program. Journal of the American Association of Nurse Practitioners. (2014) ;26(7):370-7. dio: 10.1002/2327-6924.12064.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Telenursing, Self Care, Self Efficacy, Medication Adherence, Myocardial Infarction, Telemedicine","lastPublishedDoi":"10.21203/rs.3.rs-6029063/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6029063/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e Self-care and medication adherence are key factors in the management of patients with myocardial infarction (MI), but many patients face challenges in this field and need new care approaches. This study, based on a self-care program, aimed to determine the effect of telenursing on self-efficacy and adherence to medication in Elderlies with MI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e This study was a randomized clinical trial. Sixty-two Elderly with MI were randomly assigned to the intervention or control group. The intervention group received an in-person session (30-60 minutes), telephone follow-up (8 calls in a month), and educational text messages, and the control group received routine care only. The research tools were a \u003cstrong\u003ecognitive test of \u003c/strong\u003ethe Abbreviated Mental Test (AMT), and questionnaires used before and four weeks after the intervention. Data were analyzed using paired t-test and ANCOVA by IBM SPSS Statistics version 26.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults : \u003c/strong\u003eAt the posttest measurement, results of the ANCOVA showed a significantly higher self-efficacy scores for the intervention group compared to the control group after adjusting for the pretest scores (F\u003csub\u003e(1, 52)\u003c/sub\u003e=67.31, P\u0026lt;0.001, η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003eP\u003c/sub\u003e=0.564). The similar result was obtained for medication adherence (F\u003csub\u003e(1, 52)\u003c/sub\u003e=77.39, P\u0026lt;0.001, η\u003csup\u003e2\u003c/sup\u003e\u003csub\u003eP\u003c/sub\u003e=0.598). The effect sizes, calculated using partial eta squared, were 0.564 and 0.598,\u0026nbsp;which\u0026nbsp;are considered\u0026nbsp;to\u0026nbsp;be\u0026nbsp;large.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e Telenursing based on a self-care program significantly increases self-efficacy and medication adherence in elderly with \u0026nbsp;MI, and it is recommended that telenursing programs be expanded in healthcare systems to promote self-care and medication adherence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration\u003c/strong\u003e: \u0026nbsp;https://irct.behdasht.gov.ir/user/trial/76806/view. IrCTR registry, IRCT20240416061511N1/ Registration Date: 2024-05-23\u003c/p\u003e","manuscriptTitle":"The Impact of Telenursing in Elderlies with Myocardial Infarction Based on a Self- care Program: A Randomized Clinical Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-10 08:41:34","doi":"10.21203/rs.3.rs-6029063/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab197d32-5641-4b73-b6df-73b7acb7373b","owner":[],"postedDate":"April 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-30T11:08:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-10 08:41:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6029063","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6029063","identity":"rs-6029063","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}