How coronary artery disease is portrayed in images from educational websites and resources in Aotearoa New Zealand: a content analysis

INTRODUCTION: Coronary artery disease (CAD) is a leading cause of global morbidity and disproportionately affects Māori and Pacific peoples in Aotearoa New Zealand (NZ). Poor understanding of symptoms and management contributes to delayed care. Yet visual health information can enhance patient comprehension, engagement, and long-term health outcomes. AIM: This content analysis aims to explore how CAD is portrayed in images within NZ-based online educational webpages and resources. METHODS: A content analysis was conducted on publicly available CAD images from NZ-based health educational websites. Data were collected in January 2026 using a systematic Google search strategy. Images were coded using a pre-defined framework categorising content into themes, and descriptive frequencies and proportions were calculated. RESULTS: Of the 279 webpages identified in the search, 105 met the inclusion criteria, yielding 257 images. Photographs (44.8%) and digital graphics (24.9%) were most common. Only 30% of images depicted people, with slightly more males with neutral expressions. Content primarily focused on prevention and healthy lifestyle choices (24.9%) and anatomical images (21.8%). Clinical aspects were significantly underrepresented, including depictions of screening and diagnoses (13.2%), consequences (9.0%), and medications (7.0%). DISCUSSION: CAD images in NZ webpages and educational resources emphasise healthy lifestyles and diet, but are less focused on treatment and long-term management. The scarcity of images depicting CAD symptoms, screening, medications, disease pathophysiology, and long-term management represents a missed opportunity to support health literacy. Culturally appropriate and clinically balanced visual resources are needed to improve patient understanding and reduce health inequities in NZ.