The effect of a nurse-led visual education program on health beliefs and symptom burden in patients with heart failure: a randomized controlled trial

Abstract Background Heart failure (HF) is a major global health problem characterized by substantial symptom burden, recurrent hospitalizations, and considerable healthcare utilization. Effective long-term management depends largely on patients’ engagement in self-care and adherence to recommended treatment and lifestyle behaviours. Although patient education is an essential component of HF management, information-focused approaches may not adequately address the health beliefs and behavioural determinants underlying self-care. The Health Belief Model (HBM) provides a theoretically informed framework for addressing these determinants; however, evidence regarding nurse-led, HBM-based visual education for patients with HF remains limited. Aim To evaluate the effects of a nurse-led visual education program grounded in the HBM on health beliefs and symptom burden among patients with HF. Design and setting This single-centre, parallel-group randomized controlled trial was conducted in the cardiology outpatient clinic of a university hospital in western Türkiye between September 2021 and March 2022. A total of 110 patients with HF were randomly allocated to an intervention group ( n = 55) or a control group ( n = 55). Methods The intervention group received three individualized, nurse-led visual education sessions based on the HBM at baseline, 3 months, and 6 months, whereas the control group received routine nursing care and was assessed at baseline and 6 months. Data were collected using the Sociodemographic and Clinical Characteristics Form, the Health Belief Model Scale in Heart Failure (HBMS-HF), and the Memorial Symptom Assessment Scale–Heart Failure (MSAS-HF). Between-group differences in continuous variables were assessed using independent-samples t-tests, while within-group changes across repeated assessments were evaluated using one-way repeated-measures ANOVA followed by paired-samples t-tests for pairwise comparisons. Categorical variables were compared using chi-square, Fisher’s exact, McNemar, or McNemar–Bowker tests, as appropriate. Results Baseline sociodemographic, disease-related, HBMS-HF, and MSAS-HF measures were comparable between the intervention and control groups (all p > 0.05). At the final assessment, participants in the intervention group demonstrated significantly more favourable HBMS-HF scores than those in the control group across all five subscales, including perceived susceptibility, perceived severity, perceived benefits, self-efficacy, and perceived barriers, with higher reverse-coded perceived-barrier scores indicating more favourable health beliefs (all p < 0.001). The intervention group also demonstrated significantly lower MSAS-HF total, physical, psychological, and HF-related symptom scores than the control group at the final assessment (all p < 0.001). Repeated assessments showed progressive improvements in HBMS-HF scores and reductions in MSAS-HF scores across the three assessment points in the intervention group. Conclusion A nurse-led visual education program grounded in the HBM was associated with more favourable health-belief outcomes and lower HF-related symptom burden at the final assessment. The findings suggest that integrating behavioural theory with individualized visual education, repeated reinforcement, and nurse-led interaction may provide a useful approach to supporting self-management and symptom management in HF nursing practice. Further multicentre studies with larger samples, longer follow-up, and objective clinical outcomes are needed to evaluate the sustainability and broader clinical impact of this approach. Trial registration The study was retrospectively registered at ClinicalTrials.gov on December 26, 2024 (Registration Number: NCT06807671).