Open Access Open Badges Study protocol

The effect of problem-based learning in patient education after an event of CORONARY heart disease – a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study

Anita Kärner1*, Staffan Nilsson2, Tiny Jaarsma1, Agneta Andersson3, Ann-Britt Wiréhn3, Peter Wodlin4, Lisa Hjelmfors5 and Pia Tingström6

Author Affiliations

1 Department of Social and Welfare studies (HAV), Linköping University, Linköping, Sweden

2 Vikbolandet Health Care Center, Primary Health Care in eastern Östergötland, County Council of Östergötland, Norrköping, Sweden

3 Local Health Care Research and Development Unit, County Council in Östergötland, Linköping University, Linköping, Sweden

4 Department of Cardiology, County Council of Östergötland, Linköping University Hospital, Linköping, Sweden

5 Faculty of Health Sciences, Linkoping University, Linköping, Sweden

6 Department of Medical and Health Sciences (IMH), Linkoping University, Linköping, Sweden

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BMC Family Practice 2012, 13:110  doi:10.1186/1471-2296-13-110

Published: 20 November 2012



Even though there is convincing evidence that self-care, such as regular exercise and/or stopping smoking, alters the outcomes after an event of coronary heart disease (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention programmes are structurally and pedagogically applied using adult learning principles e.g. problem-based learning (PBL). Until now, most education programs for patients with CHD have not been based on such principles. The basic aim is to discover whether PBL provided in primary health care (PHC) has long-term effects on empowerment and self-care after an event of CHD.


A randomised controlled study is planned for patients with CHD. The primary outcome is empowerment to reach self-care goals. Data collection will be performed at baseline at hospital and after one, three and five years in PHC using quantitative and qualitative methodologies involving questionnaires, medical assessments, interviews, diaries and observations. Randomisation of 165 patients will take place when they are stable in their cardiac condition and have optimised cardiac medication that has not substantially changed during the last month. All patients will receive conventional care from their general practitioner and other care providers. The intervention consists of a patient education program in PHC by trained district nurses (tutors) who will apply PBL to groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients in the control group will not attend a PBL group but will receive home-sent patient information on 11 occasions during the year.


We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy and empowerment to achieve self-care goals significantly more than one year of standardised home-sent patient information. The assumption is that PBL will reduce cardiovascular events in the long-term and will also be cost-effective compared to controls. Further, the knowledge obtained from this study may contribute to improving patients’ ability to handle self-care, and furthermore, may reduce the number of patients having subsequent CHD events in Sweden.

Trial registration