Development and validation of the message-framed exercise rehabilitation education program for post-PCI patients: a study protocol

Background: Exercise rehabilitation is essential for improving the prognosis of patients after percutaneous coronary intervention. However, patients' adherence to exercise rehabilitation is generally low. Existing health education interventions focus on the supply of message content, but generally ignore the impact of message expression on patients' cognition and behavior, which limits the promotional effect of health education to a certain extent. The theory of message framing effects states that even a message that is essentially the same can have a differential impact on an individual's behavioral decision-making through different ways of presenting it. Objective: This study aims to develop an educational program for exercise rehabilitation of post-PCI patients based on the effect of message framing, and to investigate the effects on exercise rehabilitation by integrating the gain-versus loss-framing and narrative versus non-narrative framing. Methods: In this study, we will first construct an exercise rehabilitation education program for post-PCI patients based on the message framing effect through qualitative interviews, evidence integration and Delphi expert consultation. A video-based presentation format will be developed simultaneously to deliver the intervention content. Subsequently, a 2 (gain vs. loss framing) × 2 (narrative vs. non-narrative framing) factorial randomized controlled design will be employed. Participants will be randomly assigned to four intervention groups to receive a three-week rehabilitation education intervention based on different message framing conditions. The primary outcome indicator is exercise adherence, and secondary outcomes include exercise intention, exercise fear, exercise self-efficacy and quality of life. Data will be collected at three time points: baseline, 1-month and 3-month post-intervention. Statistical analyses will be conducted using SPSS 25.0 and R 4.3.2 software, with linear mixed-effects models employed to assess the impact of different message framing conditions on primary and secondary outcomes across multiple time points. Discussion: This study will provide an innovative research method and a practical basis for exploring the optimal application of message framing effect in cardiac rehabilitation. Clinical trial registration: https://www.chictr.org.cn/index.html, Identifier ChiCTR2400087233.