This study adds to the limited literature from developing countries related to misconceptions that can disrupt routine activities after pacemaker implantation. We report a marked improvement in patients’ knowledge persisting for at least ten (10) days after an educational intervention.
Our main findings showed that the majority of patients had incorrect perceptions pertaining to one or more common daily activity. About half of the respondents felt patients with pacemakers should not sleep on side of implanted pacemaker, touch an electrical switch, use a mobile phone, drive a car, or turn on a domestic electric appliance like ovens, UPS and electric generators. However, it was very encouraging that a simple intervention using a pictorial brochure brought changes in knowledge that lasted till their first follow-up visit.
Although, pacemaker implantation can provide symptomatic relief, uncertainty in daily routine activities can be a source of distress for them. Fear of unemployment, feeling of inadequacy at work place especially while carrying out physical work are real life experiences of the patient which are often groundless [5]. In a South African study up to half of the patients experienced handicapped life post-device implantation and felt they had restricted activities after the device compared to before [2]. An earlier study from our institution reported similar results with a third of the patients feeling they should restrict many daily activities, and more than half felt unsafe with usage of electrical and other household appliances [3]. Similar to these studies our current study shows that between half to two thirds of the participants incorrectly perceive many routine activities as inappropriate for patients with pacemakers.
Patients’ socioeconomic status including affluence, educational background as well as their bio psycho social profile greatly influences their adjustment to life after pacemaker implantation [6]. In our study, the knowledge level at baseline was not significantly different between genders or based on income. However, illiterate patients were significantly poorer in knowledge at baseline. It is extremely gratifying that when a simple educational intervention was performed in these patients, they came at par with those with education.
Detailed counseling sessions by a trained professional have been shown to be helpful [6]. However, our study shows that a simple intervention by a member of the pacemaker implantation team can bring significant changes regardless of the patients underlying demographics.
Health care systems with limited resources that are more focused on medical interventions may not realize that without patient education complete benefit cannot be achieved. Our study demonstrates that a simple intervention based on a pictorial brochure and practical demonstration is sufficient to improve knowledge in all groups of patients including bringing illiterate patients with lower baseline knowledge at par with more educated patients.
A strength of our study is that it addresses patients from all socioeconomic groups and demonstrates an improvement across all groups. Moreover, the effects of the intervention could be observed even after a period of 10 days which demonstrated that its benefits lasted beyond short-term recall. Usage of pictorials also makes this tool universal across all languages.
Limitations
Limitations of our study include that many of the misconceptions may be rooted in local culture or myths and may not be applicable to other situations especially where patients are able to access knowledge on demand. Moreover, it is a single center study with its inherent limitations. There may also be a bias as the assessments were performed by members of the same team as provided the education. Bias may also have been introduced by the study design that excluded patients who did not appear in the follow-up. Moreover, as there was no control group improvement in knowledge in the intervening 10-day period from other sources cannot be ruled out.