Multilingual Video Education for Hospitalized Patients With Myocardial Infarction (EDUCATE-MI): Single-Arm Implementation Study.

Abstract

Background: Clinical guidelines recommend the early initiation of secondary prevention strategies prior to hospital discharge for patients with myocardial infarction (MI) to reduce morbidity and mortality, but implementation is resource-intensive. Multilingual videos can deliver information in diverse preferred languages and literacy levels, but their impact on MI knowledge among hospitalized patients remains unclear.

Objective: This study aims to assess whether the delivery of a multilingual educational video to hospitalized patients with MI can improve patient MI knowledge before hospital discharge.

Methods: We conducted a single-arm pre-post study with embedded formative implementation evaluation from December 2023 to October 2024 in a tertiary hospital. The intervention was a video on post-MI management, available in English, Arabic, Hindi, and Mandarin (with Simplified Chinese subtitles). The intervention was delivered via a tablet provided by the research assistant. The primary outcome was the change in patient knowledge of MI, measured by comparing the mean number of correct responses before and after the intervention using a 2-tailed paired t test. We assessed early-stage implementation using 2 prespecified elements from the Proctor implementation outcomes framework: acceptability and fidelity of the video delivery. We performed content analysis on the notes taken from participants' feedback to improve the video.

Results: We recruited 129 participants (mean age of 59.4, SD 12.6 years) for this study. English was the preferred language (n=96, 74.4%) and Hindi was the predominant non-English language (n=17, 13.2%). Of the 129 participants enrolled, 128 completed follow-up immediately postintervention (1 lost interest). The average number of correct responses out of 10 was 5.4 (SD 2.7) at baseline and 7.2 (SD 2.5) postintervention (mean difference=1.9, 95% CI 1.6-2.2; P<.001; Cohen drm for paired change=0.72). The educational video was well-accepted, with 83.6% (107/128) of participants finding it easy to understand, 74.2% (95/128) engaging, and 87.5% (112/128) useful. Participants' feedback for improvement highlighted content complexity and a preference for conversational language and dialects. Fidelity of the intervention was subjectively assessed as reasonably achieved, given that the core components of the intervention (ie, animations and educational content conveyed through the audio and subtitles) were delivered as intended. Fidelity of the implementation strategy was similarly assessed as reasonably achieved because there were no technology issues preventing delivery of the intervention as intended, through video display from a weblink embedded in REDCap, using a tablet with internet connection.

Conclusions: A short educational video may improve patient knowledge of MI before discharge. Further scaled research is needed to evaluate the effectiveness and implementation of this intervention in additional languages and diverse populations. This study highlights the need for culturally and linguistically tailored resources in clinical settings, informing future research and policy on inclusive patient education.