Construction and Validation of Coronary CTA Health Education Program Based on Knowledge to Action Framework Combined with Teach-Back Method

Introduction

With the ongoing advancement of population aging and economic growth, both the incidence and mortality rates of cardiovascular diseases have been progressively increasing. A survey has revealed that heart disease is ranked among the top ten leading causes of death in the United States, with the proportion of deaths attributable to white individuals estimated at approximately 11.0%, black individuals at 9.7%, Hispanic individuals at 7.4%, and Asian individuals at 6.1%. Coronary heart disease (CHD) represents a substantial portion of these heart-related conditions.¹ In the United Kingdom, around 300 deaths per 100,000 individuals annually are attributed to CHD, with Scotland exhibiting the highest mortality rate from this disease.² In China, the population suffering from CHD is estimated to be about 330 million. According to 2019 statistics, the incidence rates have risen by 26.1% in men and 19% in women since 2008, leading to nearly 700,000 annual deaths due to CHD.³ Furthermore, there is an observable trend of increasing incidence and mortality rates among younger age groups, establishing CHD as the leading cause of sudden death among young individuals.⁴

Coronary angiography (CAG), which involves the insertion of a catheter into the peripheral artery under the guidance of Digital Subtraction Angiography is widely regarded as the “gold standard” for the diagnosis of CHD. Despite its status, the procedure is associated with extended examination durations and high costs, while its invasive nature introduces various risks, imposing significant physical and economic burdens on patients.⁵ In contrast, coronary computed tomography angiography (CCTA) is an advanced imaging modality that employs multi-slice spiral CT to rapidly scan the cardiac region after the intravenous administration of a bolus injection of iodine contrast agent, followed by the reconstruction of the coronary artery image through post-processing techniques.⁶ This approach is not only efficient and straightforward but has also gained widespread acceptance. It allows for the visualization of coronary artery calcification, the degree and severity of stenosis, and the condition of plaques along the vessel walls. CCTA demonstrates a sensitivity and specificity exceeding 90% in diagnosing coronary artery stenosis, coupled with an exceptionally high negative predictive value.⁷ For patients suspected of having CHD or those with mild coronary artery disease who do not require interventional treatment, CCTA plays an especially pivotal role in screening.

The CCTA examination is influenced by a range of factors, including respiratory motion, limb movement artifacts, variations in heart rate and rhythm, swallowing, coughing, breath-holding maneuvers, scanning parameters, contrast agent extravasation, concentration, temperature, and flow rate.⁸ Additionally, a lack of patient understanding regarding the procedure, the noise produced by the machine, and adverse reactions can induce tension and anxiety, which in turn may lead to alterations in heart rate, rhythm, and blood pressure.⁹ Respiratory motion artifacts are commonly observed when patients fail to follow breath-holding instructions, while physical motion artifacts arise from patient tension during the scanning process.¹⁰ Effective mitigation of these interferences requires comprehensive health education and targeted interventions. This highlights the significance of patient education in CCTA, which plays an essential role in ensuring both the success of the examination and the acquisition of high-quality images.¹¹ Although pre-examination health education has been receiving increasing attention, challenges remain, including incomplete content, insufficiently detailed guidance, and a predominance of one-way communication over more interactive approaches. Moreover, the time gap between scheduling and the actual examination can adversely affect patients’ recall, thereby reducing the effectiveness of educational efforts.¹²

The Knowledge to Action Framework (KTA) was introduced by Professor Graham’s research team in Canada in 2006 with the goal of facilitating the integration of research findings into clinical practice. This framework aims to engage policy makers, administrators, practitioners, researchers, patients, and the general public in the translation of knowledge and the reform of practices, thereby improving the quality of clinical care and patient health outcomes.¹³ KTA is composed of two primary components: knowledge generation and knowledge application. The knowledge generation process encompasses three steps: knowledge consultation, knowledge integration, and knowledge production. The knowledge application phase, on the other hand, consists of seven steps: identifying problems and selecting the appropriate knowledge to address them, introducing knowledge into specific contexts, evaluating barriers, monitoring the application of knowledge, assessing the outcomes following its application, and ensuring the sustainability of knowledge use.¹⁴ The teach-back method, also referred to as “feedback teaching”, involves educators transmitting knowledge, which is then reiterated by the recipients in their own words. This allows educators to assess the understanding and retention of the information. Any misconceptions or errors are addressed and clarified by the educators until full comprehension is achieved.¹⁵ The present study aimed to develop a CCTA health education program that integrates the KTA framework and teach-back method, with the program being implemented between the appointment and the examination. The objectives of this initiative were to enhance patients’ understanding of CCTA-related knowledge, increase the success rate and satisfaction of first-time examinations, reduce patient anxiety, lower heart rate, improve cooperation during the examination, decrease the examination duration, and ensure the quality of the imaging.

Methods

Development of the KTA-Integrated Teach-Back Coronary CTA Health Education Program

Literature Review and Evaluation

Database searches were carried out using sources such as PubMed, Web of Science, Cochrane, Clinical Guidelines, the National Guideline Clearinghouse, CNKI, and Wanfang. The PICO strategy was employed in the search process. Keywords were obtained through a combination of controlled vocabulary and free-text terms. The keywords included: coronary artery, coronary CT angiography, education, health education, nursing, and nursing research. The scope of the search encompassed relevant randomized controlled trials, guidelines, consensus statements, and systematic reviews published worldwide over the last two decades, including literature in both English and Chinese. A total of 456 articles were initially identified, from which 21 were retained after a comprehensive review. These included 16 randomized controlled trials, 3 clinical practice guidelines, 1 expert consensus, and 1 systematic review or meta-analysis derived from research literature. The evaluation and evidence extraction from the selected articles were conducted independently by two reviewers, with a third reviewer resolving any discrepancies.

Delphi Expert Consultation

In accordance with the knowledge transformation theory, relevant articles were selected through a systematic process of literature retrieval, screening, and quality assessment. Following the extraction and synthesis of evidence, a three-level health education framework for coronary CTA was preliminarily established.

The expert consultation form is structured into three sections: ① Introduction: This section outlines the research background, objectives, methods, and provides explanations for relevant terminology; ② General expert information: This part includes the expert’s basic details, their familiarity with the research, and the basis for their judgment. Familiarity levels are assigned values using a Likert 5-point scale (1.0, 0.8, 0.6, 0.4, 0.2) corresponding to five categories: very familiar, relatively familiar, moderately familiar, somewhat unfamiliar, and unfamiliar. The judgment basis includes theoretical knowledge, practical experience, reference to domestic and international materials, and subjective perception, with corresponding impact values of 1.0, 0.8, and 0.6 for high, medium, and low impact, respectively. Values for theoretical knowledge (0.3, 0.2, 0.1), practical experience (0.5, 0.4, 0.3), reference to domestic and international materials (0.1, 0.1, 0.1), and subjective perception (0.1, 0.1, 0.1) are based on existing literature;¹⁶ ③ Main questionnaire section: This part focuses on item content and importance assignment, where each item is rated using the Likert 5-point scale (ranging from unimportant to very important), with scores assigned from 1 to 5, and a column for expert suggestions is also included.¹⁷

Expert selection criteria: ① Substantial experience in the fields of imaging, health education, or nursing; ② A minimum of 10 years of relevant work experience in imaging; ③ A bachelor’s degree or higher, with an intermediate title or above; ④ A genuine interest in the research topic and a willingness to participate. An expert inquiry form concerning the health education aspects of coronary CTA is issued to those who meet these criteria.

Item selection criteria: The enthusiasm of experts is reflected in the questionnaire response rate, with a rate exceeding 70% indicating strong engagement. The expert authority coefficient (Cr) is determined by averaging the experts’ familiarity (Ca) and judgment criteria (Cs). A Cr value greater than 0.7 indicates high expert authority. The average importance assignment value reflects the consensus of expert opinions. The criteria for item selection include an average importance assignment value greater than 3.5 and a coefficient of variation less than 0.25. The Kendall concordance coefficient (W) is used to assess the degree of consensus among expert opinions, with values ranging from 0 to 1, typically fluctuating between 0.4 and 0.5.¹⁸

Validation of Health Education Programs

Sample Size

The objective of this study is to implement a coronary CTA health education program grounded in the knowledge transformation model and supplemented with the feedback method developed in the preliminary phase of clinical practice and to assess its effectiveness. Using a convenient sampling approach, a total of 300 patients who underwent coronary artery CTA at a hospital in Shanghai between May 1, 2021, and July 31, 2021, were selected. These patients were assigned to either the control or intervention group based on the parity of their appointment dates, with 150 patients in each group. The control group received the standard health education program, while the intervention group was provided with a health education program integrating the knowledge transformation model and feedback method.

Inclusion criteria: ① First-time recipients of coronary CTA; ② Aged 18 years or older, alert, and free from cognitive impairments; ③ Voluntarily agreed to participate in the study and signed the informed consent form. Exclusion criteria: ① Severe cardiac or renal insufficiency, acute myocardial infarction, serious arrhythmias, hyperthyroidism during treatment, or acute asthma; ② Patients with a documented history of severe allergic reactions to iodine contrast agents; ③ Individuals with communication impairments, such as difficulties in hearing or reading; ④ Individuals unable to hold their breath for various reasons; ⑤ Pregnant women.

Two cases from the control group were excluded from the statistical analysis due to incomplete or invalid data. Consequently, the final analysis included 150 cases from the intervention group and 148 cases from the control group.

Verification Method

Control group: The conventional health education program comprised the following components: ① Distribution of informed consent forms at the time of appointment, instructing patients to thoroughly read and complete medical and allergy histories, along with other required assessments, prior to the examination, with signatures obtained one day before the procedure; ② Routine education on the day of examination, including instructions on pre-examination precautions, administration of metoprolol for heart rates exceeding 90 beats/min, guidance on cooperation during the procedure, and breath-holding training on the examination bed; safety checks, including the removal of all metallic items; ③ Education regarding post-examination precautions.

Intervention group: A health education program tailored to coronary CTA was implemented based on the knowledge transformation theory in combination with the teach-back method (Table 1). The program involved: ① The formation of a health education team, comprising physicians, technicians, nurses, and customer service personnel, all of whom underwent comprehensive training; ② Health education timing combined with teach-back method: 20 min on appointment day, 30 min one day before examination, and 20 min on examination day for “assessment, explanation → questioning → repetition → evaluation” of relevant knowledge; ③ Pre-examination knowledge dissemination and preparation: Special preparations, such as heart rate and rhythm management, as well as breath-holding training; routine preparations, including fasting, procedural guidance, cooperation during the procedure, and emergency preparedness; ④ Assessment of iodine contrast media usage, explanation of possible adverse reactions, and warming of the contrast media to 37 °C; ⑤ Nursing care during the examination, including patient positioning, ECG gating and high-pressure injector setup and securement, ensuring patient comfort, privacy, and protection, coordinating breathing, and adhering to an individualized injection protocol with continuous monitoring; ⑥ Post-examination care, including observation, patient praise, hydration, education about potential delayed reactions, and corresponding management strategies; ⑦ Psychological support and environmental enhancement, featuring continuous psychological care, teaching relaxation and breathing techniques to alleviate anxiety, playing soothing music, and creating a comfortable atmosphere. Additionally, QR codes linking to relevant informational videos were displayed at ward and imaging department windows, with pertinent information continuously broadcasted on TV screens.

Table 1 Two Rounds of Expert Authority Coefficients

Measurement Indicators and Evaluation Tools

Figure 1 The reconstructed three-dimensional coronary artery images with excellent, good, average and poor image quality scores were added. As follows: Image quality score: excellent (no artifacts, no obvious noise, clear and recognizable blood vessels, good blood vessel brightness).

Figure 2 Image quality score: good (slight artifact, slight blur around blood vessels, good brightness of blood vessels, which can be diagnosed).

Figure 3 Image quality score: average (moderate artifact, obvious blurring around blood vessels, acceptable brightness of blood vessels, which does not affect the diagnosis).

Figure 4 Image quality score: poor (serious artifact, obvious vascular dislocation, serious peripheral blur, inability to distinguish blood vessels from surrounding components, poor brightness of blood vessels, unable to evaluate).

All measurement indicators were obtained by the designated medical staff involved in the study. The general information questionnaire was administered prior to the intervention.Self perception questionnaire of patients on CCTA knowledge, S-AI questionnaire, and heart rate were assessed both before and after the intervention. The success rate of the one-time examination, examination duration, image quality, and patient satisfaction were evaluated following the intervention.

Data Analysis

Two staff members are responsible for data entry and sorting using Excel, with one assigned to data entry and the other to verification. Statistical analysis is performed using SPSS 25. Expert consultation statistics are described using percentages, means, and other relevant measures, while the degree of coordination among expert opinions is expressed using the Kendall coordination coefficient. Demographic data are described by frequency and percentage; The measurement data is described by the mean±standard deviation; Shapiro—Wilk test is used to test the normality of data. This study is a large sample data considering normal distribution. “CCTA knowledge self-perception, S-AI, heart rate, examination time” uses t-test; “One-time inspection success rate, image quality and satisfaction” uses chi-square test or Fisher exact probability test.

Ethical Considerations

This study was conducted in strict accordance with the Helsinki Declaration, adhering to the principles of voluntariness, confidentiality, and humanistic care. It received approval from the Ethics Committee of Tongji University Affiliated Oriental Hospital (Shanghai Oriental Hospital), ensuring compliance with the institution’s medical regulations. Prior to the commencement of the study, the researcher provided a thorough explanation of the study’s objectives and significance to the participants. Consent was obtained from both the participants and their families, and informed consent forms were duly signed. The study contained no harmful elements, did not infringe upon the participants’ privacy, and was entered into voluntarily with full awareness of its purpose. Ethics Approval No.: [2024] Yen Audit No. (006).

Results

Results of the Expert Consultation

Basic information of experts: In accordance with the inclusion and exclusion criteria, a total of 15 experts from various fields, including imaging diagnosis, imaging technology, health education, and clinical nursing, were selected. All experts are affiliated with grade III class A hospitals in Shanghai, comprising 8 males and 7 females. The average age of the participants is 42.6 ± 5.03 years, with an average of 20.33 ± 6.21 years of professional experience. Regarding their professional titles, there are 2 chief physicians, 3 deputy chief physicians, 5 chief technicians, 1 deputy chief nurse, and 4 chief nurses. Concerning their academic qualifications, 3 hold doctoral degrees, 4 possess master’s degrees, and 8 have bachelor’s degrees.

The expert enthusiasm coefficient: A total of 30 questionnaires were distributed across two rounds of expert consultation, with a recovery rate exceeding 100%. The expert authority coefficient (Cr)²⁰ was ≥0.8 (Table 2). Expert opinion coordination:²⁰ The Kendall coordination coefficient (Kendall W value) ranged from 0.3 to 1 in the first round and from 0.4 to 1 in the second round (Table 3).

Table 2 Degree of Coordination of Two Rounds of Expert Opinions

Table 3 Coronary CTA Health Education Program Based on Knowledge to Action Framework Combined with Teach-Back Method

CCTA Health Education Program Based on KTA Combined with the Teach-Back Method

Through two rounds of expert consultation, a consensus was reached, resulting in a CCTA health education program based on knowledge transformation theory combined with the teach-back method. The program consists of three levels: 5 first-level items, 11 second-level items, and 31 third-level items. The main aspects include “assessment”, “pre-examination knowledge and preparation”, “contrast media adverse reactions and management”, “examination cooperation”, and “post-examination knowledge” (Table 1).

Results of the Application of Health Education Programs

Comparison of General Information Between the Two Coronary CTA Groups

Furthermore, no statistically significant difference was observed in the general information between the two patient groups (P > 0.05), and they were found to be comparable (Table 4).

Table 4 Comparison of General Information of Coronary CTA Subjects in the Two Groups (x2±s) Cases (%)

Following the intervention, both groups demonstrated an increase in the scores on patients’ self perception score of CCTA knowledge (within-group comparison before and after the intervention)

The scores in the intervention group were notably higher than those in the control group (comparison between the two groups after the intervention). A reduction in state anxiety scores (S-AI) was observed in both groups after the intervention (within-group comparison before and after the intervention), with the intervention group exhibiting a significantly greater reduction than the control group (comparison between the two groups after the intervention). Regarding heart rate, a substantial decrease was recorded in the intervention group, while an increase was noted in the control group. A significant difference between the two groups was observed after the intervention (P < 0.001) (Table 5).

Table 5 Patients’ Self Perception Score of CCTA Knowledge, State Anxiety Score and Heart Rate Between the Two Groups Before and After Intervention (x2 ± s)

After the intervention, the intervention group experienced a significantly shorter examination time compared to the control group. Additionally, the success rate of a single examination was higher, and the image quality in the intervention group was superior to that in the control group (Table 6).

Table 6 Comparison of Examination Duration (x2 ± s), Success Rate of One-Time Examination and Image Quality (%) Between the Two Groups

Comparison of satisfaction between the two groups: The overall patient satisfaction in the intervention group was significantly higher than in the control group (Table 7).

Table 7 Comparison of Satisfaction Between Two Groups (%)

Discussion

Due to the high prevalence and significant impact of CHD, CCTA is recognized as a pivotal tool for the diagnosis of CHD, especially in early detection. Effective health education is indispensable for improving patient comprehension, reducing examination duration, enhancing the success rate of initial attempts, and ensuring superior image quality. As the number of individuals requiring CCTA examinations continues to rise, the demand for comprehensive health education correspondingly increases. To date, neither domestic nor international studies have established a fully developed, individualized CCTA health education program, nor has the teach-back method been applied within the context of auxiliary examination departments for health education. The CCTA health education program proposed in this study, which integrates knowledge transformation theory with the teach-back approach, has undergone clinical validation and has been demonstrated to be effective.

Scientific and Reliability Analysis of the Program Constructed in This Study

Based on a review of domestic and international literature, expert consultations, and clinical practice, this study integrated knowledge transformation theory with feedback methods to ensure scientific rigor. During the protocol development, clinical experts from radiology departments across various tertiary hospitals in Shanghai were selected, including physicians, technicians, nurses, and health educators, all possessing extensive clinical experience. Both rounds of expert consultation achieved a 100% response rate, reflecting the high engagement of the experts. The authority coefficients were 0.87 and 0.89, respectively, demonstrating the high reliability and credibility of the expert opinions, which confirmed the validity of the consultation results. The mean importance scores for the items in both rounds exceeded 3.5, with all items in the second round scoring above 4. The coefficients of variation were less than 0.25 in both rounds, with the second round showing values below 0.2, and the ratios of perfect scores were greater than 0.2, indicating a high degree of consensus among the experts. Kendall’s coefficient of concordance (W) ranged from 0.305 to 0.436 (P < 0.05), indicating statistical significance and strong coordination among expert opinions. In conclusion, considering the high level of expert engagement, authority, and consensus on the protocol, the scientific validity and reliability of the protocol were firmly established.

Practicality and Feasibility Analysis of the Constructed Program of This Study

This protocol effectively incorporated the four stages of the teach-back method into CCTA-related education. The interval between appointment scheduling and the examination was strategically utilized for health education: patients were encouraged to restate the educational content in their own words, facilitated by demonstrations from professional nurses and peer demonstrations among patients. This approach enhanced their understanding of relevant information and fostered better cooperation during the examination. Concerning the assessment content, both absolute and relative contraindications, heart rate, and additional evaluations were refined, while renal function assessments and physician approval for metformin users were included. When imparting health education, attention was given to addressing the common concerns of patients, such as fear of the examination, anxiety in unfamiliar settings, and worries about allergic reactions to iodine contrast agents. These negative emotions may trigger elevated secretion of epinephrine and norepinephrine, resulting in an increased heart rate and potential arrhythmias.²¹ Consequently, early assessment and intervention for heart rate and rhythm were emphasized, considering the influence of emotions on heart rate and the success of the examination. Patients were also taught various relaxation techniques. Different methods for breathing and breath-holding training were introduced, including pre-recorded instructions for breath-holding aimed at preparing patients in advance to accommodate their individualized needs. Regarding adverse reactions to the contrast agent, the protocol expanded its focus beyond severe allergic reactions and extravasation, incorporating education on various adverse reaction management strategies. Additionally, it included guidance on recognizing allergic warning signs and handling “unprovoked coughing or sneezing” during scanning, as well as emphasizing education on delayed adverse reactions.²² These elements underscore the practicality and feasibility of the protocol.

Enhanced CCTA Performance Achieved Through the Study’s Protocol: Higher Success Rates, Shorter Examinations, and Quality Imaging in a Single Session

The success of CCTA examinations is influenced not only by technicians’ scanning techniques and injection methods but also by pre-examination preparation, effective health education, nursing care, and the stabilization of heart rate and breath-holding.²³ First, the traditional vascular assessment was deemed insufficient. In the present protocol, following intravenous placement, specific annotations were made on the examination form regarding vascular assessment to guide technicians and nurses in selecting optimal injection rates and enhancing observation, thereby ensuring patient safety during injection, minimizing the risk of extravasation, and improving first-time examination success rates. Second, this study’s protocol effectively utilized the interval between appointment scheduling and the examination to implement health education through the teach-back method, which proved more effective than traditional, one-time pre-examination education in addressing the memory forgetting curve.²⁴ Third, due to patients’ high medical expectations, misconceptions about the examination, and anxiety related to unfamiliar environments, large equipment, and drug side effects, which could potentially result in increased heart rate and rhythm instability,²⁵ this protocol employed a comprehensive health education approach through ward coordination. Multiple strategies, including cards, videos, questioning, demonstrations, family involvement, peer support, and group management, were integrated.^21,26–28 Various relaxation techniques and professional psychological counseling were also incorporated, not only stimulating patient interest and enhancing active learning but also ensuring an accurate understanding of the examination process and purpose while providing humanistic care. Fourth, under significant anxiety, sympathetic nervous system activation affects the endocrine system, leading to increased thyroid hormone and catecholamine secretion, which accelerates heart rate and increases heart rate variability, thereby compromising imaging clarity.²⁹ Traditional one-time pre-examination health education may exacerbate existing anxiety, while this protocol made use of the period from appointment scheduling to examination day for psychological counseling and comprehensive health education, addressing the underlying causes of anxiety and promoting emotional stability. Additionally, early medication interventions maintained heart rates below 70–90 beats/min, extending the isovolumic diastolic period and facilitating improved image acquisition. Fifth, to better meet patients’ needs, diverse and targeted formats were implemented. Communication throughout the pre-examination period helped strengthen nurse-patient relationships, foster trust, alleviate tension and anxiety, and encourage patients to actively seek information and cooperate, thereby improving overall patient satisfaction. Sixth, the health education protocol was flexible, allowing for either group or one-on-one delivery,³⁰ and included “pre-recorded breath-holding training instructions” for various breathing techniques,³¹ such as “breath-holding after deep inhalation, breath-holding after slow exhalation following deep inhalation, and breath-holding during quiet breathing”.³² To prevent excessive shoulder and thoracoabdominal movement during breathing, patients were instructed to maintain abdominal protrusion while holding their breath, ensuring sufficient separation between the abdominal aorta and the abdominal wall for optimal imaging.^33,34 Under professional guidance, patients were encouraged to demonstrate these techniques to one another, thus reducing nurses’ workload, enhancing patient engagement, and ensuring mastery of breath-holding techniques. Furthermore, health education materials and videos were converted into QR code posters, enabling patients and their families to easily access information via mobile phones. In conclusion, well-prepared patients’ active cooperation helped reduce examination time, ensured image quality, and improved both first-time examination success rates and work efficiency. Both the intervention and control groups demonstrated reduced S-AI scores post-intervention, with the intervention group showing significantly lower scores. The intervention group also exhibited decreased heart rates post-intervention, while the control group showed increased heart rates, possibly due to temporary pre-examination education inducing tension without sufficient processing time. Nevertheless, the control group’s reduced S-AI scores post-intervention warrant further investigation.

Nurses and Technicians: Their Vital Dual Function as Researchers and Practitioners in CCTA Execution

The primary participants in this study consisted of nurses and technicians who, as researchers with the necessary scientific capabilities, developed a health education program informed by the principles of knowledge transformation theory. In their roles as practitioners, they provided tailored health education to patients through systematic assessments, employing a feedback mechanism for education, evaluation, and adjustment until the knowledge was successfully converted into proactive behaviors by the patients. Patients engaged in the study alongside the nurses and technicians, thereby fully demonstrating their involvement as research collaborators. During the intervention, nurses and technicians assumed a range of roles, including that of educators, psychotherapists, caregivers, and safety officers. Their responsibilities encompassed health education, guidance in skill acquisition, patient monitoring and assessment, psychological care, first aid preparation, management of contrast agents, equipment operation and maintenance, formulation of scanning protocols, image acquisition and subsequent processing, radiation protection, and safeguarding patient privacy during the CCTA procedure. Each of these responsibilities played an essential role in ensuring patient safety, facilitating the smooth progression of the examination, and preserving the quality of the images obtained.

Conclusion

Drawing upon the principles of knowledge transformation theory, this study integrated an extensive body of both domestic and international literature with clinical cross-sectional research, utilizing a feedback approach. A health education and nursing program for coronary CTA was developed through the Delphi method, which demonstrated clinical effectiveness. The program is substantiated by a significant body of literature, rendering it both scientifically grounded and reliable, with its practicality and feasibility affirmed by experts. In clinical trials, the program notably enhanced the success rate of coronary artery CTA examinations, reduced the examination duration, and ensured the preservation of image quality. Furthermore, it alleviated patient anxiety, enhanced the patients’ understanding of relevant knowledge, facilitated improved communication between nurses and patients, and considerably increased patient satisfaction.