Skip to main content
  • Research article
  • Open access
  • Published:

Efficacy of education delivery through multimedia and text messaging on the psychological parameters of patients scheduled for coronary angiography: a single-blind randomized controlled clinical trial



Angiography is a highly effective invasive method for diagnosing coronary artery diseases but can lead to certain psychological problems such as stress, anxiety, and depression. This study aimed to compare the effects of education delivery through multimedia DVD content or text messaging in comparison with conventional printed pamphlets on the psychological parameters of patients scheduled for angiography.


This study was a randomized controlled clinical trial. We used the convenience sampling method to select 120 patients who met the inclusion criteria among individuals who were scheduled for elective coronary angiography. The patients were randomly divided into three groups through the block randomization method. The necessary educational tips for before, during, and after the angiography procedure were delivered to the patients in interventional group 1 (n = 40) and interventional group 2 (n = 40) through text messages and a multimedia DVD, respectively. The control group received routine hospital education through pamphlets besides the opportunity for verbal discussions with nurses. All educational content was delivered to the patients four days before the scheduled day of angiography. The DASS-21 questionnaire, consisting of the three domains of stress, anxiety, and depression, was used to collect the data. The questionnaire was administered at the time of delivering the educational content as the pretest evaluation and 30 min after the angiography procedure as the posttest evaluation. SPSS software, version 18, was used for statistical analysis.


There was no significant difference among the three groups of patients in terms of pretest DASS-21 scores. Conversely, the mean posttest scores in all DASS-21 domains were significantly lower among the patients receiving education via the multimedia DVD or text messaging in comparison with the control group (P < 0.001). However, there were no statistically significant differences between the mean scores in all domains between the participants in the DVD and text messaging groups.


It seems that both DVDs and text messaging are more effective than conventional pamphlets in controlling the anxiety, stress, and stress of patients scheduled for elective coronary artery angiography.

Iranian Registry of Clinical Trials: IRCT registration number: IRCT2015030121283N1, Registration date: 2015-10-05, 1394/07/13

Peer Review reports


Coronary angiography is a standard and highly reliable diagnostic method that helps the physician in managing a patient with coronary artery disease [1]. Evidence shows that patients scheduled for coronary angiography often experience anxiety, stress, and depression [2, 3]. Furthermore, having sufficient information about this invasive procedure can help control vital signs including systolic blood pressure, diastolic blood pressure, and the heart rate in patients awaiting coronary angiography [4, 5]. According to the literature, mobile phone-based patient education can decrease the anxiety of patients scheduled for coronary angiography [6, 7]. Selecting useful and applicable methods to educate patients is very important because several barriers exist in this area, including physical and psychological problems like a low capacity to learn, an inability to comprehend the information, or a lack of motivation [8].

Most of the educational materials for patients in hospitals and health centers in Iran are based on educational pamphlets made available in the Persian language. These pamphlets do not take into account the age, education level, social, economic, and cultural factors, and the native language or dialect of the patient [9], undermining their efficacy [10]. A review study revealed that nowadays, traditional patient education approaches cannot meet the substantial needs in patient–doctor and patient–nurse relationships. Hence, many experts try to modify and improve the traditional methods of education and also make use of novel means of delivering patient education [11].

Education delivery via novel technologies leads to much greater satisfaction in comparison with the traditional methods of lecturing and presenting information through pamphlets [12]. Web-based learning and educational Digital Versatile Discs (DVDs) are two popular self-study methods in electronic learning. Learning via multimedia engages the learner's various senses and allows for the simultaneous use of visual, auditory, and textual teaching material; it also helps the patient learn what they need to learn better and face the actual situations more easily [13, 14].

The Short Message Service (SMS) is an especially popular mobile phone service due to the convenience, flexibility, and possibility of establishing effective communication. In the United States and Europe, manual devices for patient monitoring and instruction delivery have become extremely popular and mobile phones have become convenient and readily available devices for patient use [15, 16]. In addition, text messaging represents a cost-efficient opportunity to transfer medical information to patients [17].

In recent years, the use of virtual media in patient education has become a popular area of research, with several studies having been conducted to evaluate the efficacy of several aspects of the related educational methods. To our knowledge, there are no prior studies on the efficacy of patient education through text messaging or DVD multimedia content in comparison with conventional pamphlets (as the control group) on anxiety, stress, and depression among patients scheduled for coronary artery angiography. Therefore, in this three-arm randomized controlled clinical trial, we tried to compare the efficacy of patient education delivery via two different modern electronic-based methods (DVDs and text messaging) with a paper-based method.


Study design

This was a single-blind randomized controlled clinical trial that was conducted with a pretest–posttest design from April to October 2015. The study population consisted of patients who were scheduled for coronary artery angiography in selected hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, namely Namazi Hospital, Faghihi Hospital, Kowsar Heart Hospital, and Al-Zahra Heart Hospital. Two cardiologists who performed coronary artery angiography in the selected hospitals were involved in the study. The investigation conformed with the principles outlined in the Declaration of Helsinki. The study protocol was explained to all participants and written informed consent was obtained. Furthermore, the participants were free to withdraw from the study at any stage. The Ethics Committee of Shiraz University of Medical Sciences approved the protocol of this study (Code: CT-93–7343). In addition, the protocol of this project was registered in the Iranian Registry of Clinical Trials (IRCT) website with code IRCT2015030121283N1 (

Sample size and study population

The minimum sample size of 40 per group was estimated using the means comparison formula based on mean anxiety scores, on the basis of an alpha = 0.05 significance level, a power of 80%, and anxiety scores of 9.6 ± 2.22 in the intervention group and 11.8 ± 4.28 in the control group reported by Hanifi et al. [12]. By considering the loss to follow-up of patients, especially because of withdrawal from the study or coronary angiography intervention cancellation, two to three extra patients were enrolled in each group to the study.

Inclusion and exclusion criteria

The inclusion criteria were as follows: (1) the scheduled coronary artery angiography would be the first experience of the patient with the procedure; (2) an age range of 25–75 years (the common age range in adults for coronary angiography); (3) lack of a job related to medical care and treatment; (4) ability to receive text messages via cell phone and to use a computer for watching multimedia content stored on a DVD; (5) literacy (defined as being able to read and write with completion of a minimum of five years of elementary school); and (6) a minimum of four days being left until the angiography appointment. The exclusion criteria were as follows: (1) experience of another invasive diagnostic procedure, such as transesophageal echocardiography or prior angiography; (2) a low level of consciousness or known case of a psychological disorder; and (3) a positive history of psychiatric medication use.

Randomization and blinding

The Random Allocation Software Ink (Version 1.0, May 2004) was applied to create a randomization table, considering a block size of six including the equal times of each intervention of the study in each block. Therefore, the patients were randomly assigned and allocated to three groups, namely the DVD (n = 40), text messaging (n = 40), and control (n = 40) groups, coding using the letters A, B, and C, respectively, thereby blinding the staff who evaluated the patients as well as the statistical analyzer.

Data collection and questionnaire

The data collection instruments included a researcher-made demographics questionnaire and Depression Anxiety Stress Scale-21 (DASS-21). This scale is used for measuring depression, anxiety, and stress using a total of 21 items. The instrument is designed based on the four-point Likert scale scored with 0 for never, 1 for sometimes, 2 for often, and 3 for almost always. In this regard, stress was evaluated through items 1, 6, 8, 11, 12, 14, and 18, anxiety through items 2, 4, 7, 9, 15, 19, and 20, and depression through items 3, 5, 10, 13, 16, 17, and 21. For obtaining the total score in each domain, the scores of the mentioned items are summed up. Antony et al. (1998) used Cronbach's alpha coefficient for the internal consistency of the scale, reporting values of 87, 82, and 78 percent for the stress, anxiety, and depression domains, respectively. The overall reliability of the scale was found to be 93% [18]. The reliability of the Persian version of this questionnaire was ascertained in one study among 390 individuals from the general population of Tehran, Iran, with Cronbach's alpha coefficient value being reported at 0.85 for the depression domain, 0.85 for the anxiety domain, and 0.87 for the stress domain. Furthermore, the test–retest reliability reportedly revealed interclass correlation with absolute agreement between first and second evaluations with scales of 0.77, 0.89, and 0.85 for the depression, anxiety, and stress domains. The study also revealed acceptable discriminate validity in all domains of the questionnaire [19].

Interventions and follow-ups

Overall, 120 patients who were scheduled for elective coronary artery angiography and met the inclusion criteria were enrolled in the study. According to the block randomization method, the patients were randomly divided into three groups: the text messaging group, the DVD group, and the control group. In the pretest stage, the patients were asked to complete the demographic questionnaire (age, gender, education, and marital status) and the DASS-21. During the four days leading to the appointed day of angiography, the patients in intervention group 1 were sent seven short text messages (via mobile phone) each day with information regarding the purpose and procedure of coronary angiography and what the patients should know and do in the peri-coronary artery angiography period. The patients in intervention group 2 received a DVD containing 15 min of educational multimedia content. The educational content of the text messages, the DVD, and the pamphlets were practically the same, except that the DVD also contained related pictures and animations. The control group simply received the conventional pre-operation hospital care, which consisted of basic verbal information and a pamphlet on what to do before angiography (e.g., refraining from food), how angiography is performed, and how the medication should be taken. The content validity of the text messages, DVD multimedia, and pamphlets was approved by a six-member team including two cardiologists, two nurses each with a Ph.D. degree, and one general physician with a master’s degree in medical education. The contents of the multimedia DVD were produced using Adobe Flash Professional CS6 2015.

Thirty minutes after the completion of coronary artery angiography, the questionnaire was filled out again by the patients to determine the posttest scores. Beforehand, the researcher asked the patients whether they received and read the messages or watched the DVD content; individuals who did not take up the patient education were excluded at this point in the study.

Statistical analysis

The data were analyzed using SPSS, version 18. The Kolmogroph-Smirnoff test was used to evaluate the data distribution. The chi-squared test and Fisher's exact test were used to compare the three groups in terms of their demographic variables; analysis of variance (ANOVA) was used with a post hoc test (Tukey HSD) to compare the patients’ anxiety, stress, and depression scores. The paired t-test was used to compare the scores of the DASS-21 questionnaire before and after the intervention separately in each group. A P-value of less than 0.05 was considered significant.


The CONSORT chart of this study is shown in Fig. 1. The mean patient age was 55 ± 9.65 years, and 55% of the participants were male. The results showed no significant difference between the patients in the intervention groups and the control group in terms of marital status (P = 0.87), education (P = 0.51), gender (P = 0.90), and age (P = 0.78) (Table 1).

Fig. 1
figure 1

CONSORT flow diagram of the effects of education delivery through multimedia and short text messaging on the psychological parameters of patients scheduled for coronary angiography

Table 1 Demographic characteristics of the patients scheduled for coronary angiography in the short text messaging, DVD, and control groups

According to ANOVA conducted on the patients’ data before the interventions, there were no significant differences among the patients in the mean pretest scores of all DASS-21 domains. By the end of the study, the results showed significant drops in the mean score of anxiety (P < 0.001), stress (P < 0.001), and depression (P < 0.001) among patients in both intervention groups. However, in the patients of the control group, there was a statistically significant difference between their pretest and posttest mean anxiety score (P < 0.001), but this was not true for their depression (P = 0.15) and stress scores (P = 0.13). These results are summarized in Table 2. According to the post hoc test, the posttest depression domain score of the control group significantly differed with that of the text messaging (P = 0.019) and DVD (P < 0.001) groups. Such significant posttest differences between the control group and the text messaging and DVD intervention groups were also seen in the anxiety (P = 0.071 and P = 0.006, respectively) and stress (P < 0.001 and P < 0.001, respectively) domains.

Table 2 The pretest and posttest mean anxiety, stress, and depression scores in the patients scheduled for coronary angiography in short text messaging, DVD, and control groups

A comparison between the mean change in scores between the text message group and the control group showed that there was a significant difference between their pretest and posttest scores with regard to stress (P < 0.001), but not with regard to depression (P = 0.77) and anxiety (P = 0.07). In this regard, a comparison of the mean change in scores between the DVD group and the control group showed that the use of the DVD led to a significant reduction in anxiety (P = 0.006) and stress scores (P < 0.001), but not in depression scores (P = 0.09). However, in the control group, the only significant difference was a reduction of the mean anxiety score (P < 0.001) (Table 3).

Table 3 Comparison of the changes in the means scores of anxiety, stress, and depression in the patients scheduled for coronary angiography in the short text messaging, DVD, and control groups

There was no significant difference between the DVD and text message groups in the changes in their mean anxiety (P = 0.62), stress (P = 0.57), and depression scores (P = 0.33) (Table 3).


The results of our study revealed that there were significant decreases in the scores of anxiety, stress, and depression among the patients in the intervention groups of the study. In this regard, education through multimedia and short text messages were both effective in reducing the stress, anxiety, and depression levels of patients in the intervention groups. However, in the control group, verbal discussion and pamphlets were only effective in reducing the mean anxiety score of the patients. This reduction might be due to face-to-face contact with hospital nurses, who could immediately answer their questions about their disease, which could influence the rate of such psychological reactions as anxiety in these patients. Peterson et al. pointed out that educational and social interventions were effective ways of decreasing the level of anxiety on the day of procedure among patients awaiting cardiac catheterization [20]. The study of Najafi-Kalyani et al. revealed that the patients’ low level of awareness about how angiography is going to be done and the necessary care before and immediately after the procedure can lead to the patients’ sadness and dissatisfaction; therefore, the patients would not tolerate adhering to the necessary care, which may eventuate in an increase in vascular complications [21].

According to the literature, the most important advantages of education through multimedia content are the lack of a need for a trainer, time-efficiency, ease of use, and affordability [22]. The use of multimedia content and smartphone-based education has been considered in other aspects of the education of patients with cardiac problems. In this regard, Wang et al. revealed that a multimedia exercise training program could increase the patients’ walking distance and improve the patients’ heart rate. In addition, they found this kind of education could increase the self-efficacy of cardiac surgery patients, even in the month after discharge from the hospital [23]. Moreover, a number of smartphone-based applications have been developed for educating patients with coronary artery diseases in recent years [24].

In the present study, the multimedia DVD was made available to the patients a few days before the day of coronary artery angiography. The absence of difficult medical terms and the combination of sound with simple and interesting slides and animations allowed the patients to experience multimedia learning. These results are in line with those of previous studies, which revealed that educating patients through video and multimedia content decreased preoperative anxiety and stress [25,26,27,28,29].

The text messaging approach was highly effective as it allowed the patients to receive the required information via their personal mobile phone device. Moreover, since the messages were sent at specified times, the participants were motivated to read them immediately and to save them systematically; therefore, they learned more about coronary artery angiography, corrected their misconceptions, and consequently experienced less tension before the procedure [28, 30].

Based on the literature, sending short text messages can play an important role in patient education. The study of Kumar et al. demonstrated that short text messages could prove extremely effective for educational purposes; for example, learning via short text messages is highly flexible and is resistant to power cuts and oblivion [28, 30]. In addition, Park et al. claimed that education through short text messages was more effective than a smartphone-based application in implementing a secondary prevention program among patients with coronary artery diseases. According to that study, this method of education resulted in improved clinical outcomes and patient lifestyle [31].

A comparison between the mean change in depression scores of patients in the text message and DVD groups on one hand and the control group on the other showed that the interventions did not lead to a significant reduction in depression scores compared with the control. Accordingly, the researchers suggest that evaluation of the psychological problem of the patients due to coronary artery angiography would be more acceptable if they fill out the questionnaires at a more distant time from the end of the procedure, when he/she has had more time to come to terms with the events. Furthermore, it is suggested that the use of social virtual networks and multimedia messaging services, which allow transferring interesting and spectacular pictures and videos along with text messages, could help boost patient motivation.

In the present study, a comparison between the DVD multimedia and text message groups' mean scores for the psychological parameters of anxiety, stress, and depression showed that there was no significant difference between these two groups. In other words, both educational methods were effective in reducing the anxiety, depression, and stress of the patients. It seems that the use of text, video, and audio in delivering education to patients is effective in improving these psychological parameters before coronary artery angiography [32, 33].

It is possible that the similarity between the effects of the multimedia and text messages on the participants' psychological parameters was because of the advantages of each method and their appeal to the patients. The evident advantages of text messaging are ease of use and the possibility of sending large numbers of texts in a very short time, while the obvious advantage of multimedia is the possibility of using both audio and video content. Among the shared advantages of the two methods are their low cost, repeatability of education as desired by the learner, lack of need for face-to-face interaction, and elimination of time and place limitations [34, 35]. Among the strong points of the study was the similarity of the contents presented through both methods of education and the possibility of repeatedly making use of the content for the patients.

There were some limitations to this study. Some of the participants did not have access to or were not able to use a computer or laptop and play the multimedia DVD at home and were, therefore, excluded from the study. Accordingly, it is possible that patients with low socioeconomic conditions were excluded from the study. In this regard, we suggest that patients should receive such educational content through virtual networks, which have become quite popular among the public. Furthermore, although the patients were given information about the objectives of the study and they were asked not to share information with other participants, there was a possibility of the participants sharing information or using other sources of information because the patients were not blinded to the intervention. In this regard, the authors suggest that multi-central studies be conducted with a high number of participants.


The results of the present study showed that stress, anxiety, and depression affected most patients scheduled for coronary artery angiography; thus, there was a need for addressing this issue. According to our findings, informing patients about what they will experience in the catheterization laboratory through a multimedia DVD and short text messages can reduce the anxiety, stress, and depression of patients scheduled for coronary artery angiography. In the present study, both methods of education delivery were found to be effective in reducing these negative psychological parameters among the participants.

Lay summary

The results of the present study showed that patient education via multimedia and text messaging was effective in reducing negative psychological parameters in patients after angiography. These interventions are recommended for patient education purposes and it is suggested that nursing students should be introduced to such methods of providing patient education and their advantages. These methods can also be used for on-the-job training for nurses’ problems.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.



Depression, anxiety and stress scale—21 items


Digital versatile discs


Iranian registry of clinical trials


Short message service


Statistical package for the social sciences


  1. Fyyaz S, Rauf A, Hudson J, Olabintan O, Katsigris A, Sarojini D, Pavlidis A, Plein S, Alfakih K. 107 Nice 2016 stable chest pain guidelines: improved yield of severe coronary artery disease at invasive coronary angiography. Heart. 2019;105(Suppl 6):A88.

    Google Scholar 

  2. Delewi R, Vlastra W, Rohling WJ, Wagenaar TC, Zwemstra M, Meesterman MG, Vis MM, Wykrzykowska JJ, Koch KT, de Winter RJ. Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory. Int J Cardiol. 2017;228:926–30.

    Article  PubMed  Google Scholar 

  3. Shohani M, Mozafari M, Sayehmiri K, Amoozadeh MH. Investigation of anxiety of patients undergoing coronary angiography in Imam Hossein hospital of Mehran in 2016. Indian J Forensic Med Toxicol. 2018;12(2):232–6.

    Article  Google Scholar 

  4. Hajbaghery MA, Moradi T, Mohseni R. Effects of a multimodal preparation package on vital signs of patients waiting for coronary angiography. Nurs Midwifery Stud. 2014;3:1.

    Google Scholar 

  5. Farsi Z, Sajadi SA, Eslami R. Effects of peer education and orientation tour on anxiety in patient candidates for coronary angiography. Nurs Midwifery Stud. 2016;5(3):e31624.

    Article  Google Scholar 

  6. Zafari E, Rokhafroz D, Dashtbozorgi B, Maraghi E. The effectiveness of based-mobile education on anxiety of patients candidate coronary angiography. Crit Care Nurs. 2019;12(2):35–41.

    Google Scholar 

  7. Moradi T. ADIB HM: The effect of a multi-modal preparation package on anxiety in patients undergoing coronary angiography. Int Cardiovasc Res J. 2015;9(1):10–6.

    Google Scholar 

  8. Marcus C. Strategies for improving the quality of verbal patient and family education: a review of the literature and creation of the EDUCATE model. Health Psychol Behav Medi Open Access J. 2014;2(1):482–95.

    Article  Google Scholar 

  9. Abdollahzadeh F, Moghaddasian S, Rahmani A, Shahmari M. Effect of video education on knowledge and satisfaction of patients undergoing coronary angiography. Iran J Crit Care Nurs. 2014;7(3):168–75.

    Google Scholar 

  10. Di Noia J, Schwinn TM, Dastur ZA, Schinke SP. The relative efficacy of pamphlets, CD-ROM, and the Internet for disseminating adolescent drug abuse prevention programs: an exploratory study. Prev Med. 2003;37(6):646–53.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ferguson WJ, Candib LM. Culture, language, and the doctor–patient relationship. FMCH Publ Present. 2002;34(5):353–61.

    Google Scholar 

  12. Hanifi N, Bahraminejad N, Mirzaei KT, Ahmadi F, Khani M, Taran L. The effect of orientation program on stress, anxiety and depression of patients undergoing coronary angiography. Iran J Nurs Res. 2012;7(25):1–8.

    Google Scholar 

  13. Huang MC, Hung CH, Yu CY, Berry DC, Shin SJ, Hsu YY. The effectiveness of multimedia education for patients with type 2 diabetes mellitus. J Adv Nurs. 2017;73(4):943–54.

    Article  PubMed  Google Scholar 

  14. Lo SF, Wang YT, Wu LY, Hsu MY, Chang SC, Hayter M. Multimedia education programme for patients with a stoma: effectiveness evaluation. J Adv Nurs. 2011;67(1):68–76.

    Article  PubMed  Google Scholar 

  15. Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res. 2012;14(5):e128.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Foreman KF, Stockl KM, Le LB, Fisk E, Shah SM, Lew HC, Solow BK, Curtis BS. Impact of a text messaging pilot program on patient medication adherence. Clin Ther. 2012;34(5):1084–91.

    Article  PubMed  Google Scholar 

  17. Aguilera A, Muñoz RF. Text messaging as an adjunct to CBT in low-income populations: a usability and feasibility pilot study. Prof Psychol Res Pract. 2011;42(6):472.

    Article  Google Scholar 

  18. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176.

    Article  Google Scholar 

  19. Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. Int J Psychol. 2008;2(2):82–102.

    Google Scholar 

  20. Peterson M. Patient anxiety before cardiac catheterization: an intervention study. Heart Lung J Crit Care. 1991;20(6):643–7.

    CAS  Google Scholar 

  21. Najafi Kalyani M, Jamshidi N, Abbaszadeh A. 36 Oral Effects of video information on anxiety, stress and depression of patients undergoing coronary angiography. Eur J Cardiovasc Nurs. 2010;9(1_Suppl):S4–S4.

    Article  Google Scholar 

  22. Jlala H, French J, Foxall G, Hardman J, Bedforth N. Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. Br J Anaesth. 2010;104(3):369–74.

    Article  CAS  PubMed  Google Scholar 

  23. Wang L-W, Ou S-H, Tsai C-S, Chang Y-C, Kao C-W. Multimedia exercise training program improves distance walked, heart rate recovery, and self-efficacy in cardiac surgery patients. J Cardiovasc Nurs. 2016;31(4):343–9.

    Article  PubMed  Google Scholar 

  24. Cho MJ, Sim JL, Hwang SY. Development of smartphone educational application for patients with coronary artery disease. Healthc Inform Res. 2014;20(2):117–24.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Harkness K, Morrow L, Smith K, Kiczula M, Arthur HM. The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs. 2003;2(2):113–21.

    Article  PubMed  Google Scholar 

  26. Nilsson U. Effectiveness of music interventions for women with high anxiety during coronary angiographic procedures: a randomized controlled. Eur J Cardiovasc Nurs. 2012;11(2):150–3.

    Article  PubMed  Google Scholar 

  27. Severino GA, Haynes WDG. Development of an Italian version of the depression anxiety stress scales. Psychol Health Med. 2010;15(5):607–21.

    Article  PubMed  Google Scholar 

  28. Valk J, Rashid AT, Elder L. Using mobile phones to improve educational outcomes: an analysis of evidence from Asia. Int Rev Res Open Distrib Learn (IRRODL). 2010;11(1):117–40.

    Google Scholar 

  29. Arabul M, Kandemır A, Çelık M, Alper E, Akpinar Z, Aslan F, Vatansever S, Ünsal B. Impact of an information video before colonoscopy on patient satisfaction and anxiety. Turk J Gastroenterol. 2012;23(5):523–9.

    Article  PubMed  Google Scholar 

  30. Kumar B: The international review of research in open distance learning, India, Open University. 2007, Available from:

  31. Park LG, Beatty A, Stafford Z, Whooley MA. Mobile phone interventions for the secondary prevention of cardiovascular disease. Prog Cardiovasc Dis. 2016;58(6):639–50.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Nowicki P. Multimedia use in orthopedic surgery education. Orthopedics. 2019;42(5):246–8.

    Article  PubMed  Google Scholar 

  33. Schneiderheinze H, Prokosch HU, Apel H, Bellut L, Wullich B, Trollmann R, Schuttler C. Development and usability analysis of a multimedia econsent solution. Stud Health Technol Inform. 2019;267:297–303.

    PubMed  Google Scholar 

  34. Roy M, Chi MT. The self-explanation principle in multimedia learning. Camb Handb Multimed Learn. 2005;2005:271–86.

    Article  Google Scholar 

  35. Dai W, Fan L. Discussion about the pros and cons and recommendations for multimedia teaching in local vocational schools. Phys Proc. 2012;33:1144–8.

    Article  Google Scholar 

Download references


This paper was extracted from the thesis written by Sara Rousta as a part of the requirements for a Master of Science (M.Sc.) degree in Surgery-Internal Nursing. The authors are grateful to Professor Nasrin Shokrpour at the Research Consultation Center of Shiraz University of Medical Sciences, and Dr. Seyed Ali Hosseini, MD at Native Editor Institute for improving the use of English in the manuscript.


This study was financially supported by a Grant (No. 93-7343) from the Vice-Chancellery for Research of Shiraz University of Medical Sciences.

Author information

Authors and Affiliations



Study concept and design: CT, SR, SG, JK, KJ, MMP; acquisition of data: CT, SR, JK, KJ, MMP; data analyses: SR, MMP; drafting of the manuscript: SR, MMP, CT critical revision of the manuscript for important intellectual content: CT, SG, JK, KJ, MMP; study supervision: CT, JK, MMP, SG; final approval of the version to be submitted: CT, SR, SG, JK, KJ, MMP. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mohammad Mahdi Parvizi.

Ethics declarations

Ethics approval and consent to participate

The investigation conforms with the principles outlined in the Declaration of Helsinki. The details of the study were completely explained to the participants and informed written consent was obtained. Furthermore, the participants were free to withdraw from the study at any time. The Ethics Committee of Shiraz University of Medical Sciences approved the protocol of this study (Code: CT-93-7343).

Consent for publication

Not applicable.

Competing interests

The authors declare that there was no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Torabizadeh, C., Rousta, S., Gholamzadeh, S. et al. Efficacy of education delivery through multimedia and text messaging on the psychological parameters of patients scheduled for coronary angiography: a single-blind randomized controlled clinical trial. BMC Cardiovasc Disord 21, 3 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: