Date of Submission




Patients with both acute coronary syndrome (ACS) and type 2 diabetes mellitus (T2DM) are the focus of this thesis. Together these conditions represent a substantial burden of illness within Western and now Eastern countries. Patients presenting with multiple conditions are frequently encountered within clinical practice, with often poorer clinical outcomes than those with a single condition. The challenge of delivering health education is substantial when patients experience two or more health conditions. Within China, health education is provided principally during the acute admission period, often for ACS. In this unique cultural setting, there has been little research about the delivery by health professionals of health education to patients with both ACS and T2DM.


The aims of this research are to gain an understanding of the current health education delivered by health care professionals and received by patients with ACS and T2DM within Shanghai. In particular the impact of such education on patients’ behavioural change, clinical outcomes, and self-efficacy and self-management was examined.


An umbrella systematic review was conducted including 51 eligible reviews (15 for ACS and 36 for T2DM). This was followed by a qualitative study of 15 health professionals’ experience of delivering health education to this patient group (Study 1). Finally, a mixed methods study of delivering health education to this patient group (Study 1). Finally, a mixed methods study of patients, including a cross-sectional survey (n = 160), patient health care record audit of clinical outcomes (n = 160), and two interviews with patients at discharge and at follow-up (n = 21) in the community, was conducted. The study setting was a coronary care unit (CCU) within a major referral hospital within Shanghai, China. Data were collected from July 2016 to March 2017. Perceived health education received was measured using a visual analogue scale (VAS) ranging from 1 (little or no education) to 100 (comprehensive education) in the survey for patients. The survey for patients was followed by a semi-structured interview before discharge and a telephone-based follow-up interview up to four weeks after discharge from hospital. Twenty-one of the 160 patients completed the survey and participated in the two semi-structured interviews.


School of Nursing, Midwifery & Paramedicine

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Access Rights

Open Access


335 pages

Degree Name

Doctor of Philosophy (PhD)


Faculty of Health Sciences

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.


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