The Effects of an E-Learning Program on Knowledge, Beliefs, and Decision-Making Regarding Suspected Acute Myocardial Infarction among Older Adults in Urban Communities: A Quasi-Experimental Study in Thailand

Background: Delayed contact with emergency medical services (EMS; 1669 in Thailand) contributes to poor outcomes following acute myocardial infarction (AMI), particularly among older adults with limited symptom recognition. This study evaluated the effects of an e-learning program on AMI-related knowledge, health beliefs, and decision-making among older adults in urban Thailand. Methods: A one-group pretest–posttest design with follow-up was conducted from December 2025 to January 2026. Thirty-five older adults aged 60–85 years from urban communities in Bangkok and nearby provinces participated. The two-week e-learning intervention comprised four interactive lessons based on the Health Belief Model and American Heart Association recommendations. AMI knowledge, health beliefs, and decision-making were assessed at pretest, posttest, and follow-up using repeated-measures analyses. Results: Knowledge of coronary artery disease risk factors (p < 0.05; η²ₚ = 0.213) and AMI symptoms (p < 0.001; η²ₚ = 0.357) increased significantly over time. Perceived self-regulation (p < 0.001; η²ₚ = 0.302) and cues to action (p < 0.05; η²ₚ = 0.110) also improved significantly. Perceived severity improved post-intervention but declined at follow-up. No significant changes occurred in perceived susceptibility, benefits, or barriers scores. Decision-making differed significantly across time, although no significant improvement was observed from baseline to either post-intervention or follow-up. The proportion intending to call EMS when encountering someone with an AMI increased from 68.6% at baseline to 88.6% immediately after intervention was completed, but this change was not statistically significant. Conclusion: The e-learning program improved AMI-related knowledge and selected health beliefs, but effects on decision-making were inconclusive. Future studies should use a randomized controlled trial with a larger and stronger scenario-based measures. Keywords: E-learning, Older adults, Acute myocardial infarction, Health belief model, Health education