Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries—A Qualitative Systematic Review with Meta-Synthesis

Physical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context

Effectiveness of an Educational Program to Enhance Self-care Skills After Acute Coronary Syndrome: A Quasi-Experimental Study

Abstract. Background: The aim of this study is to determine the effectiveness of an educational program to enhance self-care skills in patients after an acute coronary syndrome Methods: A quasi-experimental pretest-posttest design was used in the study. A rehabilitation nurse provided an educational program (PEpSCA-CARE) to the intervention group (n = 32), and the control group (n = 35) received the conventional nursing pre-discharge care. The data was collected using the Therapeutic Self-Care Scale (TSCS) in four dimensions: medications, symptoms, activities of daily living and health status management, applied before hospital discharge and one month after hospital discharge to both groups. Patients were recruited from an intensive cardiovascular care unit during 2016. Results: The results showed statistically significant differences between both groups (p < 0.001). The intervention group tended to improve their self-care skills while the control group had opposite trends, self-care skills decreased. Conclusions: According to the findings of the study, a systematized and structured educational program, is effective in developing self-care skills in patients after an acute coronary syndrome