Chengyue Zhao; Minwei Shen

doi:10.19080/JOJNHC.2023.13.555871

Research Article

Analysis of Information Needs for Cardiac Rehabilitation of Patients with Coronary Heart Disease Based on The Kano Model

Chengyue Zhao and Minwei Shen*

Fudan University, China

Submission: August 12, 2024; Published: August 27, 2024

*Corresponding author: Minwei Shen, Fudan University, China JOJ Nurse

How to cite this article: Chengyue Zhao and Minwei Shen*. Analysis of Information Needs for Cardiac Rehabilitation of Patients with Coronary Heart Disease Based on The Kano Model. JOJ Nurse Health Care. 2024; 13(5): 555871. DOI:10.19080/JOJNHC.2023.13.555871

Abstract

Purpose: Based on the Kano model, the information needs of cardiac rehabilitation of CHD patients are classified, so as to meet the information needs of CHD patients more accurately and appropriately, and better health education and self-management.

Method: The literature analysis method was used to find relevant literature data, and the Kano model to design and improve the cardiac rehabilitation information needs of patients with coronary heart disease; the demand of patients with cardiac rehabilitation information, and the univariate analysis of the questionnaire scores of patients with different demographic characteristics, understand the relevant influencing factors of the degree of cardiac rehabilitation information demand of patients with coronary heart disease; the Kano analysis method to clarify the Kano attribute to classify the demand of cardiac rehabilitation information of patients with coronary heart disease, and analyze the satisfaction and importance degree.

Bear fruit

Degree of demand for cardiac rehabilitation information in patients with coronary heart disease: the dimension of basic cardiac knowledge (4.15 ± 0.56), Nutrition knowledge dimension (4.31 ± 0.62) points, Exercise dimension (4.39 ± 0.58) score, Points of drug knowledge dimension (4.26 ± 0.51), Work and career dimensions (4.15 ± 0.63) points, Stress and psychological dimension (4.06 ± 0.47) score, Emergency and safety dimension (4.19 ± 0.52) points, Points of diagnosis and treatment (4.22 ± 0.48), Risk factor management dimension (4.35 ± 0.55) points, The total score of the questionnaire was (4.12 ± 0.65).

different demographic characteristics of coronary heart disease patients with cardiac rehabilitation information demand attribute differences, age, education, family income, previous surgery history are the factors influencing the degree, the patients with <40 years old questionnaire score lower than other ages, junior high school and below the questionnaire score higher than other degrees, family income <5000 yuan and 5000~10000 yuan patients questionnaire score higher than other income level, patients with surgical history questionnaire score is higher than no surgical history, the difference have statistical significance, P <0.05.

Kano attribute classification: 6 M attributes (25.00%), 8 O attributes (33.33%), 6 I attributes (25.00%) and 4 A attributes (16.67%).

Analysis of satisfaction and importance: There are 12 items in the dominant area, 4 items in the observation area, 3 items in the retention area, and 5 items in the area to be improved.

Conclusion

Patients with coronary heart disease have a high overall demand for cardiac rehabilitation information. Therefore, we should strengthen the supervision of cardiac rehabilitation and health education of such patients, improve the content and enrich the means of publicity and education, so as to meet the needs of patients as far as possible.

Different individual characteristics Patients with coronary heart disease have different demands for cardiac rehabilitation information. Clinical patients should pay attention to improving the pertinence of health education, and formulate individualized education programs for each patient according to the basic characteristics, so as to better make up for the cognitive defects of patients on cardiac rehabilitation information.

Clinical according to the Kano attribute classification results, on the basis of providing essential requirements, as far as possible to meet the expectations of patients, appropriate rich charm demand, continue to optimize the differential demand, maintain and develop the advantage of information service status, improve the quality of information service to improve area, in order to better meet the information needs of patients, improve their satisfaction.

Keywords: Coronary heart disease; Cardiac rehabilitation; Kano model; Information demand; Essential demand; Expected demand

Preface

Coronary heart disease is a common and dangerous chronic disease worldwide, and it is one of the important causes of human death [1]. Relevant studies have been pointed out that [2], the case fatality rate of patients with coronary heart disease is between 10% and 20%, and there is a certain upward trend. It can be seen that coronary heart disease has gradually developed into one of the serious diseases that threaten human health, so it is particularly critical to take effective measures to prevent and treat coronary heart disease as soon as possible. Cardiac rehabilitation is to improve the prognosis of patients with coronary heart disease, inhibit the disease progress of an important intervention measures, it contains diet, exercise, drugs, psychological and smoking, five prescriptions, through a series of cardiac rehabilitation strategy to correct patients’ bad habits, regulate the daily health behavior, and achieve the purpose of improving health management effect. Studies have confirmed that [3], actively implementing postoperative cardiac rehabilitation guidance for patients with coronary heart disease can effectively reduce the incidence of postoperative adverse cardiac reactions and improve the emotional condition of patients, which has a high application value.

Information demand is an essential type of demand in people’s daily life. For patients with coronary heart disease, they may encounter some incomprehensible knowledge or uncontrollable operations when receiving cardiac rehabilitation guidance, thus generating various cardiac rehabilitation information needs. To meet their personal needs, it is helpful to improve patients’ service experience and obtain a higher level of satisfaction. Kano model in quality management into the satisfactory and unsatisfactory standards, according to different demand to scientific quantitative method, understand the demand of relevant information, and provide scientific guidance for the improvement and optimization of subsequent management scheme, to better meet the information needs of the service object, has been widely used in a variety of service industry, but the application and practice in the field of health care services is still in its infancy [4-5].

This paper conducted a study on patients with coronary heart disease in the Department of Cardiology of Zhongshan Hospital of Fudan University, using the Kano model to analyze the cardiac rehabilitation information needs of patients, to understand which needs are more important for patients with coronary heart disease and can provide more help to them. It is concluded that the demand project satisfaction and important degree, analysis satisfactionimportant degree matrix distribution, for patients with coronary heart disease cardiac rehabilitation management plan to provide more reference basis, in order to improve the efficiency of patients with information acquisition, meet the needs of the cardiac rehabilitation information, improve their satisfaction, improve the self-management level of cardiac rehabilitation.

Literature Review

Domestic patients with coronary heart disease generally have problems such as low cognitive level of cardiac rehabilitation information and poor compliance with cardiac rehabilitation. Wang Qiongli et al [6]. The study pointed out that the participation in cardiac rehabilitation of elderly patients with coronary heart disease is related to their marital status, educational level, medical payment burden, one-way time consumption from residence to hospital, and cardiac rehabilitation needs and cognition. Liu Xia et al [7] A study on patients with coronary heart disease in Shanghai found that improving the awareness of cardiac rehabilitation information among patients with coronary heart disease can directly promote their participation in cardiac rehabilitation behavior. It is suggested that improving the health education service of cardiac rehabilitation for patients with coronary heart disease and enhancing their awareness of relevant knowledge is of great significance to the development of cardiac rehabilitation in China.

Foreign scholars research pointed out [8]. Among all patients with coronary heart disease investigated, nearly one-third knew little about cardiac rehabilitation, and about two-thirds knew only about cardiac rehabilitation during hospitalization, and the degree of cognition was generally low. And Tenbult N et al [9] Through questionnaire survey of coronary heart disease patients for cardiac rehabilitation information demand level, and it is concluded that 63% of patients at least nutrition, physical activity, drug use, psychological happiness four aspects of one of the information demand, and the degree of information demand and its gender, employment, social and economic status, emotional state, disease perception and other factors are closely related.

Research Purpose

Kano model is used to classify the information needs of cardiac rehabilitation in patients, so as to meet the information needs of patients more accurately and appropriately, and better health education and self-management.

Research methods

Scientific Research and Design

We retrieved relevant literature at home and abroad to understand the existing research methods and research results, summarized and analyzed the principle, operation methods, and clinical application of Kano model; adopted the questionnaire method, designed the cardiac rehabilitation information demand questionnaire of patients with coronary heart disease according to Kano model, collected and organized the questionnaire results, adopted Kano analysis method, conducted a cross-sectional survey on the current situation of cardiac rehabilitation information demand of patients with statistical analysis method, and provided scientific guidance for the improvement of clinical nursing work according to the attribute classification results.

Study Subjects

Overall: All adult (age> 18 years old) patients with CHD. Sample and sample size: The samples in this study were all derived from patients with CHD hospitalized in the cardiology ward of Zhongshan Hospital affiliated to Fudan University between October 2023 and February 2024. This study takes scholars like Xiao Shunzhen et al [10]. The proposed method estimates the sample size, and the sample calculation formula is: n= the maximum number of items (5~10), the number of variables involved in this paper is 55, and then the interval of the sample size is estimated to be 275~550 cases. Considering the invalid proportion of 10% questionnaires, the sample size is determined to be 300 cases. The questionnaire was modified according to the pre-survey results, and there were 24 items in the final questionnaire. Due to the deletion of the number of items, the sample size was adjusted from the original 300 cases to 150 cases according to the above sample size calculation formula.

Sampling method: In this study, stratified random sampling was used to select CHD patients admitted to the cardiology ward of Zhongshan Hospital, Fudan University from October 2023 to February 2024.

Sampling criteria: Following the principle of randomization, we went to the cardiology ward of Zhongshan Hospital every Tuesday and Thursday to collect the data. 10 samples were collected daily, and all samples were from different individuals.

Study Site

Research sites for Zhongshan hospital affiliated to fudan university heart medicine ward, the ward is a key subject of the Ministry of Education, national key clinical specialty, Shanghai medical leading professional, the number of patients with coronary heart disease, can provide enough sample size for research, at the same time as one of China’s top heart medicine center, functional radiation range, can provide regional factors affect smaller sample data, improve the reliability of the research data.

Study Tools

General data survey questionnaire

Through reading a large number of documents and the guidance of teachers, the general data questionnaire of patients was compiled, which included the age, gender, nationality, education, marriage, children, occupation, annual family income, main income source and previous surgical history of the respondents (see Appendix 1 for details).

Kano analysis questionnaire for cardiac rehabilitation information needs of patients with coronary heart disease

After reviewing the literature, it was found that the Chinese cardiac rehabilitation information demand table (Information Need in Cardiac Rehabilitation, INCR) [11] The content of the survey involved can well fit the ten categories of information recommended to patients in the health education prescription. In various studies, CITIC has good well and is suitable for evaluating the cardiac rehabilitation information needs of Chinese cardiovascular population. Now according to the analysis demand of Kano model (see Figure 1), the question method of the demand items in INCR is modified to form the Kano questionnaire mode of positive and negative questions, and forward questions: “ If you inform you about the relevant information, how do you feel?”,” How do you feel if you don’t know?” Each question contains five answers,” Like “,” granted, “,” okay “,” tolerable “and” dislike “, and the answers are 5,4,3,3,2 and 1. According to the question of positive and negative to answer and two-dimensional attribute belonging classification table (see table 1) to determine the demand of the object of the information attributes, divided into essential demand (M), expected demand (O), charm (A), indifference demand (I), reverse demand (R) five, with the largest frequency attribute as the Kano attribute category. Satisfaction = (A + O) / (A + O + M + I), the closer the ratio is to 1, the higher the satisfaction with such information needs; importance = (M + O) / (A + O + M + I), the closer the ratio is, the closer the respondents think such information needs are important.

The initial questionnaire included ten dimensions of basic cardiac knowledge (1~6), nutrition knowledge (7~10), exercise (11~22), medication knowledge (23~28), work and occupation (29~31), stress and psychology (32~36), social concern (37~38), emergency and safety (39~42), diagnosis and treatment (43~44), risk factor management (45~55), A total of 55 entries, Revised the initial questionnaire according to the recommendations of the respondents and experts, One to five most valuable entries were retained in each dimension, And to eliminate the social concern dimension, The Kano analysis questionnaire for cardiac rehabilitation information needs of coronary heart disease patients with a total of 24 entries was finally formed, After expert review, it is convenient to sample 5 experimental subjects for presurvey. The validity of the questionnaire results was calculated by SPSS20 for Cronbach’s α coefficient. The Cronbach’s α coefficient was 0.954 (0.700), indicating the good structural reliability of the questionnaire. The completion time was 5 to 8 minutes, and the completion degree of the questionnaire was relatively high.0 (See Appendix 2 for details) (Table 1) (Figure 1).

Data collection methods and steps

Design of the general data questionnaire and Kano information needs of patients with cardiac rehabilitation of coronary heart disease, and the field survey method was used to collect the data. After obtaining the approval of the Ethics Committee of Zhongshan Hospital affiliated to Fudan University and the consent of the department director, head nurse and patients of the nursing department and ward, To issue questionnaires to the survey respondents; For patients’ poor understanding when filling out the questionnaire, Investigators need to be patient to answer them, Until it is fully understood; All the questionnaires were distributed in a uniform form, It is distributed by WeChat, And the investigator’s explanation content is unified; The respondents were older, Difficult to understand the question, unable to use wechat to fill in the questionnaire, The investigators need to orally refer the questions to the respondents in plain language, And fill in the questionnaire according to the answers of the respondents.

Data analysis method

Data analysis was carried out by SPSS20.0, descriptive statistical analysis of the general data of respondents, counting data by frequency and percentage [n (%)], t-test between two groups and one-way analysis of variance to understand the influencing factors of patients with cardiac rehabilitation information. P <0.05 was statistically significant; Kano analysis was used to determine the classification of demand attributes.

Human rights protection measures

Before the official start of the survey, obtain the approval of the hospital ethics committee, issue the questionnaire, emphasize that the survey shall follow the principle of voluntariness and confidentiality, fully protect the personal privacy of the respondents and only use for scientific research. All the respondents have signed the informed consent and then issue the questionnaire after obtaining the consent of the respondents.

Quality control

Using the questionnaire data, the system automatically generates the average completion time of the questionnaire, and considers the questionnaire with less than 50% of the average completion time as invalid and removes the remaining questionnaire. After export by the system, the investigators carefully check each item and removes the questionnaire with missing items or unreasonable answer logic.

Results

General data of patients with CHD

In this study, 155 questionnaires were distributed, and 150 questionnaires were effectively collected, with an effective recovery rate of 96.77%. Of all the survey respondents, As high to 51.33%, Male patients were included in 61.33%, 38.67% were higher than that in female patients; The Han Chinese patients accounted for 96.67%; 43.33% of the students had a high school / technical secondary school education; Married patients accounted for 89.33%; Non-only child in the family accounted for 50%; 46.00% of the patients were retired / retirees; Patients with an annual household income of 5000~10000 yuan accounted for 42.00%, 10,000 ~ 20,000 yuan accounted for 35.33%; 52% of the patients had primary income was retirement / pension, Previous surgical history was present in 39.33% of the patients. Specific data are given in (Table 2).

Questionnaire scores for cardiac rehabilitation information needs of patients with coronary heart disease

The mean score of the cardiac rehabilitation information demand questionnaire was higher than 4 points for CAD patients in all dimensions. Specific data are given in Table (Table 3).

Univariate analysis of the cardiac rehabilitation information needs of patients with CHD

The cardiac rehabilitation information needs of patients with coronary heart disease questionnaire score is significantly lower than that of other age patients, and degree of patients with coronary heart disease is significantly higher than that of patients with other degrees, family income of <5000 yuan and 5000- 10,1000 yuan patients with coronary heart disease questionnaire score is significantly higher than the patients with other income level, patients with previous surgery history questionnaire score is significantly higher than that of patients without surgical history, the difference is statistically significant, P <0.05. Comparison of questionnaire scores among patients with CHD by gender, marriage, and children, showed no significant difference, P> 0.05. Specific data are given in Table (Table 4).

Attribute definition of cardiac rehabilitation information needs in patients with coronary heart disease

Among the Kano attributes of CHD patients’ demand for cardiac rehabilitation information, there were 6 M attributes (25.00%), 8 O attributes (33.33%), 6 I attributes (25.00%), and 4 A attributes (16.67%). Specific data are given in Table (Table 5).

Analysis of the satisfaction and significance of the cardiac rehabilitation information needs of patients with coronary heart disease

The satisfaction and importance of each item are calculated according to the classification of Kano attributes. Taking the satisfaction value as the horizontal coordinate, the importance value is the ordinate, and 0.5 as the boundary (see Figure 2), the first quadrant belongs to the advantage area with 12 items; the second quadrant belongs to the improved area with 5 items; the third quadrant belongs to the observation area with 4 items; the fourth quadrant is in the reserve area with 3 items.

Advantage areas: 1,5,7,8,10,11,12,14,15,17,18,20.

Areas to be improved: 2,6,9,16,19.

Observation area: 3,22,23 and 24.

Reservation area: 4,13, and 21.

Discussion

General demographic characteristics of patients with CHD

Of the 150 CAD patients included, The highest proportion of patients at 60 years, At 51.33%, Patients aged from 40 to <60 years were followed, At 32.00%, It can be seen that patients with CHD are mainly over 40 years old, And the proportion of elderly patients is relatively higher; From the gender of the patient, The proportion of male patients (61.33%) was higher than that of female patients (38.67%); Most of the respondents were from the Han nationality; In terms of the cultural level, The highest number of high school / technical secondary school education patients, For 43.33%, Second by patients with junior high education or below, 30.00%; Most of the patients were married, Most of his children are not the only children, Leaving / retirees accounted for 46.00%; The annual income of the patient’s family is concentrated in 5000~20000 yuan, The main sources of income are mostly, retirement funds / pension, Previous surgical history was present in 39.33% of the patients.

Information demand analysis of cardiac rehabilitation in patients with coronary heart disease

The mean score of cardiac rehabilitation information demand questionnaire of patients with coronary heart disease in all dimensions was at a high level. The results of univariate analysis showed that age, educational background, family income level and surgical history were all influencing factors affecting the cardiac rehabilitation information demand of patients with coronary heart disease. Among them, <40 years of patients with coronary heart disease cardiac rehabilitation information demand questionnaire score significantly lower than other age patients, may be due to lower age patients to receive education of more opportunities, through online, offline and other channels to understand coronary heart disease cardiac rehabilitation related information, and the understanding of clinical health education content and memory ability is relatively higher, so it is easier to master relevant knowledge, so in this information demand slightly lower than high age patients [12]; The questionnaire score of patients with junior high school or below is significantly higher than that of patients with other education. The reason is that patients with low education may lack in knowledge learning and understanding, resulting in their low cognition of cardiac rehabilitation knowledge, so they often have higher demand for cardiac rehabilitation information [13]; The questionnaire scores of CAD patients with annual family income <5,000 yuan and 5,000 ~ 10,000 yuan were significantly higher than patients with other income levels, Mainly because people with low family income levels usually have high life stress, Pay more attention to your own food and clothing in your daily life, And ignoring the health problems, Leading to its lack of knowledge about cardiac rehabilitation, Therefore, the information demand in this aspect is also relatively higher; besides, The questionnaire scores of patients with existing surgical history were significantly higher than those of patients without surgical history, The reason is that the health status of patients previously treated with surgery may be worse than that of patients without surgical history, With a greater emphasis on health care after surgery, Tend to learn more about your health, His demand for cardiac rehabilitation has increased greatly [14].

Kano attribute classification of information needs for cardiac rehabilitation in patients with coronary heart disease

Kano attribute classification results showed that among the 24 items in the cardiac rehabilitation information demand questionnaire of CHD patients, there were 6 M attributes (25.00%), 8 O attributes (33.33%), 6 I attributes (25.00%), and 4 A attributes (16.67%).

Essential demand

This study found six M attribute demand, derived from six dimensions, including cardiac basic knowledge, nutritional knowledge, exercise, medication knowledge, emergency and safety, diagnosis and treatment, with one item in each dimension. The information demand of M attribute is the most basic information demand of cardiac rehabilitation for patients with coronary heart disease. After meeting such needs of patients, it will not have a great impact on patient satisfaction, but if such needs are not met, it is very likely to lead to a significant decline in patient satisfaction [15]. Therefore, clinical in health education for patients with coronary heart disease, must pay attention to do the basic knowledge, nutrition knowledge, exercise, drugs, emergency and safety, diagnosis and treatment of health knowledge, timely ask whether patients do not understand, and patience to answer its questions, be sure to fully meet the basic needs of patients.

Expected demand

In this study, 8 O attribute demand were found from seven dimensions: basic cardiac knowledge, exercise, medication knowledge, work and occupation, stress and psychology, emergency and safety, and risk factor management. Among them, there were two items in the work and occupation dimensions, and the other dimensions were one item. Patients with O attribute demand satisfaction degree is generally proportional to the demand satisfaction degree, so clinical can by perfecting the heart basic knowledge education, exercise, drug knowledge, work and occupation, stress and psychological, emergency and safety, risk factors management of health education content, rich education form, in plain language to the relevant knowledge, and words, voice, pictures, video, and other forms to convey relevant knowledge to patients, as much as possible to meet the demand for such information, promote patient satisfaction [16].

Charm demand

In this study, A total of 4 A attributes demand were found, derived from four dimensions of drug knowledge, work and occupation, stress and psychology, diagnosis and treatment, with one item in each dimension. A attribute demand is that patients consider it less important, but it plays an important role in improving patient satisfaction. If the hospital fails to meet the information needs of the patient, it generally does not reduce their satisfaction; once the demand for such information is met, the patient satisfaction may greatly increase. Therefore, when clinical has been able to meet the necessary needs of patients with coronary heart disease and the expected demand, can continue to explore more and drug knowledge, work and career, stress and psychological, diagnosis and treatment related to cardiac rehabilitation knowledge, in order to better meet the demand of its charm, further enhance its satisfaction [17].

No differential demand

This study identified 6 I attribute demand, derived from basic cardiac knowledge (2 items) and risk factor management (4 items) dimensions. I attribute demand is the patient think low importance of information knowledge, the demand for such information is low, so the medical staff in the case of large work burden, can temporarily put such information demand, first focus on M attribute, O attribute and An attribute demand, after these demand meet then consider I attribute demand, in order to improve the integrity of the information service [18].

Analysis of the satisfaction and significance of CHD patients on cardiac rehabilitation information needs

The results of satisfaction and importance analysis show that among the 24 items in the cardiac rehabilitation information demand questionnaire of patients with coronary heart disease, 12 items are in the dominant area, and the proportion of the O attribute demand is the highest; 5 items are in the area to be improved, and the M attribute demand accounts for the highest proportion. among, demand located in the dominant area are the type of information that patients consider very important and have a high level of satisfaction influence, This kind of information is mainly based on the O attribute demand, Therefore, it is necessary for hospitals to strengthen the supervision of O attribute demand in the future, Continue to maintain and develop its advantages in patients with CHD, Constantly enrich the content and methods of this type of cardiac rehabilitation information service, Promote the continuous increase of patient satisfaction; The demand located in the area to be improved are the type of information that the patient thinks is not very important, With a low influence on satisfaction, This kind of information is mainly based on the M attribute demand, Therefore, when the hospital meets the urgent needs of patients for cardiac rehabilitation and still has the capacity, Can continue to improve the M attribute demand, Fully demonstrate the humanistic care of the hospital, To provide more help to improve patient satisfaction.

Conclusion

In this study, we investigated the cardiac rehabilitation information needs of patients in the cardiology ward of Zhongshan Hospital of Fudan University, analyzed the influencing factors, and defined the attributes of cardiac rehabilitation information needs of patients based on Kano model, and drew the following conclusions:

i. The demand for cardiac rehabilitation information of patients with coronary heart disease is at a high level;

ii. The degree of demand of coronary heart disease patients for cardiac rehabilitation information is partly related to their age, educational background, annual family income, and past surgical history;

iii. To define the attributes based on the Kano model, it is necessary to continue to consolidate the essential attributes, optimize and improve the desired attributes and attractive attributes;

iv. Draw the satisfaction-importance matrix based on the Kano model, strengthen the management of information items in the improved area, improve the quality of such information services, and continue to maintain the information service level in the dominant area to meet the information needs of patients with coronary heart disease to the maximum extent.

Recommendations and Study Limitations

i. Due to the lack of investigation and research on the cardiac rehabilitation information needs of patients with coronary heart disease based on Kano model in China, the paper only defines the attributes of the cardiac rehabilitation information needs of patients through questionnaire survey, data statistical analysis and other methods, and there is still a lack of comparative discussion with the same type of research.

ii. The subjects selected patients in this study are all hospital inpatients, and there is a lack of investigation on the information needs of cardiac rehabilitation of patients with coronary heart disease for home rehabilitation. It is necessary to continue to carry out in-depth research in the future, expand the scope of research subjects, and further analyze the cardiac rehabilitation information needs of patients with coronary heart disease in and outside the hospital.

Appendix 1: General data questionnaire

First of all, I would thank you for participating in this questionnaire, This questionnaire survey will delay you some time, The main purpose is to understand your actual information needs for cardiac rehabilitation, find the problem, This has positive implications for the improvement of undergraduate service quality, For patients to have higher satisfaction, This survey will capture a lot of data, The data are not being used for other purposes, For this research and analysis only, The questionnaire used an anonymous format, Your privacy will also be protected, Will not divulge your information, Please choose the corresponding answers to the following questions according to your own actual situation, This will be very helpful to this study, Please be sure to fill in it carefully

Thank you to you again.

1) Age: age

2) Sex: male and female

3) Ethnic groups: Han ethnic minorities.

4) Religious belief: with or without

5) Education level: Master degree or above, junior high school or technical secondary school, junior high school or below

6) Household per capita income (yuan / month): <500 500~2000 2000~4000 4000~6000 6000~8000> 8000.

7) Occupation: state civil servants professional and technical personnel service workers farmers unemployed or other

8) Whether other chronic diseases: whether.

Appendix 2: Kano questionnaire for information needs for coronary heart disease

Dear patients:

shalom! Cardiac rehabilitation is an important part of the treatment of cardiovascular diseases, including drug prescription, exercise prescription, nutrition prescription, psychological prescription (including sleep management), smoking cessation and alcohol restriction. In order to understand your information needs for participation in cardiac rehabilitation and provide you with more targeted information needs support, you need to read the following items carefully. Please make a choice according to your actual situation. All the answers are not right or wrong, please fill in truthfully.

Each question consists of two questions: positive and negative. The answers to the questions in the questionnaire adopt five-level options, and the satisfaction degree is from high to low: like, should be so, indifferent, tolerable, do not like.(1) like: I like this demand, with this demand will make me happy satisfaction (2) should be so: is necessary for me, should have (3) doesn’t matter: have I think it doesn’t matter (4) can endure: can have, but for me, no best (5) don’t like: with this demand, I feel very dissatisfied.

Thank you sincerely again for your cooperation!