title: Thinking outside the black box: the importance of context in understanding the impact of a preoperative education nursing intervention among Chinese cardiac patients.
abstract: OBJECTIVE
  In a randomized controlled trial of a preoperative education intervention conducted for Chinese cardiac patients, we observed a greater effect on symptoms of anxiety and depression than that reported with regard to similar interventions in western care settings. The objective of this qualitative study was to help explain the findings of the trial by exploring Chinese patients' experience of seeking and receiving information before cardiac surgery.
  
  
  METHODS
  Semi-structured interviews were conducted with a purposive sample of 20 trial participants before discharge (ten from the preoperative education group; ten from the usual care control group). Data were analyzed using a thematic analysis approach.
  
  
  RESULTS
  A total of five themes were generated: the role of reputation and hierarchy; gaining strength from knowledge; information as a low priority; being kept in the dark; and learning through peer support.
  
  
  CONCLUSIONS
  In health care systems where service users are given relatively little information, interventions designed to inform patients about their treatment are likely to have a much greater impact on their psychological health.
  
  
  CONCLUSIONS
  Providers of services for patients undergoing cardiac surgery in China should be encouraged to incorporate information giving into routine practice, tailored according to individual need.
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, UK; The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China. Electronic address: P.Guo@sgul.kingston.ac.uk.
authors.forename: Ping
authors.initials: P
authors.lastname: Guo
authors.affiliation: School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: East
authors.affiliation: School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Arthur
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000517:prevention & control*; D044466:Asian People; D006348:Cardiac Surgical Procedures / Q000451:nursing / Q000523:psychology*; D002681:China; D003863:Depression / Q000517:prevention & control; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D010353:Patient Education as Topic / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D036301:Qualitative Research; D016896:Treatment Outcome
keywords: Anxiety; Cardiac surgery; Preoperative education; Qualitative research