A personal reflection on building a more inclusive and empowering future

I grew up and began my career in Brazil, where access to health care and education—especially in low-resource settings—was not guaranteed. Early in my clinical work, I witnessed how empowering patients with knowledge could transform lives. I saw people with cardiovascular disease (CVD), often with limited formal education, become active participants in their recovery once they understood their condition and how to manage it.

That experience left an indelible mark on me and shaped my research journey for the past 20 years. I became committed to exploring how patient education—when done right—can be a cornerstone of long-term health and empowerment.

In my recent discussion paper published in Patient Education and Counseling, I proposed a new vision for patient education in cardiac rehabilitation (CR), outlining key principles and strategies to better support patients—not only in understanding their health, but in actively managing it.

The current model of education in many CR programs is often didactic: patients receive information in group sessions or through printed materials, with limited opportunity to ask questions or apply what they learn to their unique contexts. But education should not be a one-size-fits-all approach. It should be responsive, inclusive, and empowering.

So how can we transform this process?

First, we must empower patients as co-creators of knowledge, not passive recipients. This means involving them directly in designing, delivering, and evaluating educational materials. In the discussion paper, one of the core principles highlighted is the idea of “participatory education,” where people with lived experience of CVD play an active role in shaping what education looks like. Their insights help ensure the content is relevant, respectful, and usable.

Second, CR education should be interdisciplinary and collaborative. Patients don’t experience their health in silos, and neither should we teach in them. In my vision, nurses, physical therapists, dietitians, psychologists, and peer mentors work together with patients and families to co-design flexible, personalized learning experiences. For example, a patient struggling with medication adherence might benefit more from a conversation between a pharmacist, a social worker, and a family member than from a standard lecture.

Third, personalization and adaptive learning must be prioritized. Patients come to CR with different backgrounds, goals, and learning preferences. A personalized approach involves tailoring content and delivery to meet each patient’s readiness, literacy level, cultural context, and emotional state. Digital tools can support this by enabling adaptive learning platforms that respond to how a patient is engaging and progressing.

Fourth, we must embrace the digital transformation of education. Technology opens up new avenues for delivering content in accessible, engaging ways—through videos, apps, online platforms, or hybrid models that blend in-person and remote learning. In many parts of the world, digital approaches are helping bridge the gap in access to CR, especially where in-person services are limited.

Fifth, advancing equity and access requires intentional, inclusive education models. This means ensuring that materials are not just translated, but culturally adapted; not just available, but accessible. It involves outreach to underserved communities, delivering content in multiple languages and formats, and explicitly addressing the social determinants that shape patients’ ability to engage with and act on health information.

Finally, patient education in CR must be dynamic and continuously evaluated. In over two decades of research and collaboration with patients in more than 15 countries, I’ve heard firsthand how education can either empower or alienate. One participant told me, “I wish the program had asked me what I already knew or believed about my heart condition. I felt like I was being lectured to, not listened to.”

This underscores the need for respectful, dialogic education that acknowledges patients’ prior knowledge and emotional readiness to learn. Feedback—both qualitative and quantitative—should be gathered routinely to understand what works, what doesn’t, and how to adapt accordingly. Continuous learning also applies to educators: we must remain open to new ideas, technologies, and methods of engagement.

Advancing patient education in CR requires more than the adoption of new tools—it demands a paradigm shift in how education is conceptualized, delivered, and evaluated. By redefining education as a dynamic, collaborative process rooted in patients’ lived experiences, CR programs can play a transformative role in equitable, sustainable cardiovascular health promotion.

This story is part of Science X Dialog, where researchers can report findings from their published research articles. Visit this page for information about Science X Dialog and how to participate.

Dr. Gabriela Ghisi is an Affiliate Scientist at the KITE Research Institute, University Health Network (Canada), and holds adjunct faculty positions at the University of Toronto (Canada), York University (Canada), UFMG (Brazil), and the University of Sydney (Australia). Her research focuses on patient education for chronic disease management and global access to cardiac rehabilitation. She has led the implementation of an evidence-based patient education curriculum in 10+ countries, published >160 articles, authored clinical guidelines, and developed more than 10 cardiac rehab scales. Dr. Ghisi currently serves as the Chair of the ICCPR.