Digital education for cardiac care readiness among coronary heart disease patients in low- and middle-income countries: A scoping review

Abstract

Introduction: Coronary heart disease (CHD) is the leading cause of cardiovascular mortality worldwide, with the greatest burden concentrated in low- and middle-income countries (LMICs). Patient readiness—encompassing knowledge, self-efficacy, and self-care behaviour—is a critical determinant of post-discharge outcomes. Digital education interventions offer an innovative, resource-efficient approach to improving CHD patient readiness in LMICs; however, the available evidence has not been systematically mapped.

Methods: This scoping review followed the Arksey and O'Malley framework and was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A systematic search was conducted across four databases—PubMed, ScienceDirect, Wiley Online Library, and the Cochrane Library—for publications from 2019 to 2026. The most recent searches were run on 1 March 2026 and supplemented by manual screening of reference lists.

Results: Eleven studies were included, comprising 7 full RCTs (63.6%), 1 pilot RCT (9.1%), 2 RCT protocols (18.2%), and 1 feasibility study (9.1%). Geographic distribution included China (n=4; 36.4%), Iran (n=4; 36.4%), Colombia (n=1; 9.1%), Tunisia (n=1; 9.1%), and Brazil (n=1; 9.1%). The most frequently used primary delivery platforms were mobile applications/smartphones (n=3; 27.3%), WeChat (n=2; 18.2%), WhatsApp (n=2; 18.2%), Web-based/online platforms (n=2; 18.2%), augmented reality (n=1; 9.1%), and digital multimedia (n=1; 9.1%). The most commonly measured outcomes were self-efficacy (n=4; 36.4%), quality of life (n=3; 27.3%), disease knowledge/illness perception (n=3; 27.3%), medication adherence/self-management (n=3; 27.3%), and clinical events (n=1; 9.1%). Discharge readiness was not measured as a primary outcome in any included study.

Conclusion: Digital education interventions show promising potential for improving the components of CHD patient readiness in LMICs; however, the evidence remains concentrated in China and Iran. Research specifically targeting discharge readiness with validated instruments is urgently needed across diverse LMIC settings, particularly in Southeast Asia, sub-Saharan Africa, and Latin America