A SYSTEMATIC REVIEW ON THE IMPACT OF DIGITAL HEALTH INTERVENTIONS IN PROMOTING SELF-EFFICACY FOR SECONDARY PREVENTION AND REHABILITATION IN CORONARY ARTERY DISEASE PATIENTS

Abstract

Abstract Background Coronary artery disease (CAD) is a leading cause of global morbidity and mortality, imposing substantial burdens on individuals and healthcare systems. Secondary prevention and cardiac rehabilitation are cornerstones of management. Their success rates depend on patient self-management, an aspect that is influenced by patients' confidence in their ability to manage their health (self-efficacy). With the rapid integration of digital health, there is a need to synthesise evidence on the impact of technology-mediated interventions on this key psychological construct. Aim This systematic review aimed to evaluate the impact of technology-mediated interventions on self-efficacy for secondary prevention and cardiac rehabilitation in adults with CAD. Methods Six electronic databases (PubMed, Science Direct, CINAHL, Web of Science, Embase, and PsycINFO) were searched for peer-reviewed primary studies. Screening was done using clear exclusion/inclusion criteria. Included studies were assessed using the Joanna Briggs Institute (JBI) checklists. Due to heterogeneity in study designs, interventions and outcomes, the findings were synthesised narratively. Results Following screening using inclusion/exclusion criteria, 13 eligible studies (10 randomised controlled trials, two quasi-experimental studies, and 1 cohort study) of low-to-moderate quality were selected. The impact of technology-mediated interventions was inconsistent across different self-efficacy domains. Statistically significant improvements were observed for cardiac self-efficacy, particularly when interventions included human support (e.g., nurse coaching) and were compared against low-intensity usual care in vulnerable, post-discharge populations. Results for medication and diet self-efficacy were mixed, with benefits often limited to participants with low baseline confidence. In contrast, no significant between-group improvements were found for overall or exercise self-efficacy. High baseline self-efficacy and high-intensity control interventions often attenuated observable effects. Conclusion Technology is most promising not as a replacement for traditional care but as a tool to augment the patient-provider relationship and empower patients in their recovery.