A scoping review of assessment tools for proactive health behaviors in patients with heart disease

The increasing prevalence of heart disease (HD) necessitates a shift in care from reactive treatment to proactive, patient-driven management.Proactive health behaviors (PHBs)—encompassing actions such as symptom monitoring, treatment adherence, lifestyle modification, and early help-seeking—are critical for improving clinical outcomes, reducing hospital readmissions, and enhancing the quality of life in this population. However, the concept of "proactive health behaviors" in the context of heart disease remains ambiguously defined, and there is no consensus on the most appropriate instruments to measure this multidimensional construct.The purpose of this scoping review is to systematically map the existing literature on assessment tools designed to evaluate proactive health behaviors in patients with heart disease. While there are numerous tools measuring related concepts like self-care, self-management, or adherence, this review specifically targets the proactive dimension—where patients take anticipatory action to prevent deterioration. By identifying and characterizing these tools, we aim to clarify the operational definitions of PHBs and provide a comprehensive overview of the psychometric properties and content domains of available instruments.This review will be guided by the following primary questions:1.What assessment tools have been developed, validated, or used to measure proactive health behaviors in patients with heart disease (including but not limited to coronary artery disease, heart failure, and valvular disorders)?2.How are "proactive health behaviors" conceptually defined and operationalized within these tools (e.g., what specific behaviors, sub-domains, or dimensions are measured)?3.What are the key characteristics of these tools, including their format, administration method, setting of use (clinical vs. research), and reported psychometric properties (reliability and validity)?This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.A comprehensive search strategy will be developed and applied to major electronic databases, including (but not limited to) PubMed/MEDLINE, CINAHL, PsycINFO, and Embase, from database inception to the present. The search strategy will combine terms related to the population (e.g., heart disease, cardiac, cardiovascular), the concept (e.g., proactive health behavior, self-monitoring, patient activation, health-seeking behavior), and the context (e.g., assessment tool, scale, questionnaire, instrument, psychometrics). Grey literature and reference lists of included studies will also be searched for additional relevant sources.Two independent reviewers will screen titles and abstracts, followed by full-text reviews against predefined inclusion criteria. Studies will be included if they: (a) focus on adult patients (≥18 years) with a diagnosis of heart disease; (b) describe the development, validation, or utilization of a specific assessment tool measuring a behavior that can be classified as proactive; (c) are published in English. Data will be extracted from included articles using a standardized data extraction tool developed by the reviewers, capturing details on the study characteristics, tool name, construct definitions, domains measured, and psychometric properties.It is anticipated that this review will reveal significant heterogeneity in how proactive health behaviors are conceptualized and measured across the literature. We expect to identify a range of tools, from generic patient activation measures to disease-specific self-care scales, and map which specific proactive behaviors (e.g., proactive communication with providers, lifestyle adjustments, technological self-monitoring) they capture.The expected outcomes include:1.A conceptual clarification of "proactive health behaviors" specific to heart disease management.2.A comprehensive map of available assessment tools, highlighting gaps in current measurement approaches (e.g., lack of tools covering digital health engagement or emotional/cognitive proactivity).3.A summary of the psychometric strength of existing instruments to guide researchers and clinicians in tool selection.4.Identification of research gaps to inform future development of more robust and comprehensive assessment tools.By consolidating the available evidence, this scoping review will provide a foundational resource for researchers seeking to measure PHBs as an outcome in intervention studies, and for clinicians aiming to assess and foster proactive engagement in their patients with heart disease. The findings will be disseminated through peer-reviewed publication and conference presentations.