Sustainable effects of a hybrid self-care education program on diet quality and cardiovascular risk in patients with chronic conditions: A randomized controlled trial

Abstract

Background

Inadequately managed chronic diseases heighten cardiovascular risk. Improved dietary habits are crucial for risk reduction and enhanced patient health. This study evaluated the sustained impact of a hybrid self-care education program on diet quality and cardiovascular risk in patients with chronic conditions.

Methods

In this 2023 randomized controlled trial in Saravan, Iran, 150 patients with chronic conditions were enrolled. Participants were randomly allocated to an intervention group (n = 75) or a control group (n = 75). Data were collected using a self-care nutrition questionnaire and the Mini-EAT. The intervention group received a one-month hybrid self-care education program integrating the Teach-Back method with digital education, followed by monthly follow-ups. Data were analyzed using SPSS version 26 with repeated measures ANOVA, one-way ANOVA, independent t-tests, and chi-square tests (statistical significance: p < 0.05). Follow-up assessments occurred at 3 and 12 months post-intervention.

Results

Post-intervention, nutritional self-care scores in the intervention group increased significantly from baseline (11.90) to 3 months (24.12) and remained stable at 12 months (23.74; p < 0.001). No comparable change occurred in controls. Diet quality improved markedly: the proportion with unhealthy diets decreased from 98.67 % to 49.34 %, while adherence to healthy diets rose from 0 % to 13.33 % (p < 0.001). At the 12-month follow-up, statistically significant reductions were observed across all key cardiovascular risk metrics: systolic blood pressure decreased from 142.21 mmHg to 132.22 mmHg, diastolic blood pressure from 104.70 mmHg to 92.16 mmHg, fasting blood glucose from 212.66 mg/dL to 151.48 mg/dL, and BMI from 27.91 kg/m² to 25.32 kg/m² (all p < 0.001).

Conclusion

The integrated Teach-Back and digital education intervention produced sustained improvements in nutritional self-care, diet quality, and cardiovascular risk factors among patients with chronic conditions. Effect durability at 12 months underscores the value of ongoing follow-up in educational strategies. These findings support integrating digital education into health promotion programs to reinforce self-care behaviors and improve clinical outcomes.