The Translation, Culture-Adaptation and Psychometric Evaluation of the Cardiac Rehabilitation Barriers Scale Among Chinese Older Population

Figures & data

Table 1 Basic Characteristics of the Participants

	All Participants (n=325)	One-Week Post-Test Participants (n= 50)
Age, y (M±SD)	61.23±9.68	66.52±5.33
Gender (%)
Male	206 (63.5%)	37 (74%)
Female	119 (36.5%)	26 (13%)
Marital status (%)
Married	319 (98.2%)	47 (94%)
Single	4 (1.2%)	3 (6%)
Widow/er	2 (0.6%)	0 (0)
Healthcare insurance coverage (%)		47 (94%)
UEBMI	279 (86%)	3 (6%)
URBMI	39 (12%)	0 (0)
Out-of-pocket	7 (2%)	34 (68%)
Comorbidities
CHD	141 (43.4%)	6 (12%)
Diabetes	10 (3.1%)	2 (4%)
Hypertension	58 (17.8%)	2 (4%)
Hyperlipidaemia	12 (3.7%)	0 (0%)
Arrhythmia	26 (8%)	6 (12%)
PCI	75 (23.1%)	0 (0%)
CABG	3 (0.9%)	6 (12%)
Smoking Status
Non-smoker/former smoker	287 (88.3%)	42 (84%)
Current smoker	38 (11.7%)	8 (16%)
Anxiety/Depression
Yes	102 (31.9%)	11 (22%)
No	223 (68.1%)	39 (78%)
Phase of CR
1	19 (5.8%)	2 (4%)
2	280 (86%)	45 (90%)
3	26 (8.2%)	3 (6%)
All-cause readmission
Yes	48 (14.9%)	11 (22%)
No	277 (85.1%)	39 (78%)
Adverse event
Yes	5 (1.8%)	1 (2%)
No	320 (98.2%)	49 (98%)

Abbreviations: UEBMI, Urban Employees Basic Medical Insurance; URBMI; Urban Resident Basic Medical Insurance.

Table 2 Exploratory Factor Analysis of CRBS, n=325

Factor Item	Logistical Factors	Comorbidities/Functional Status	Perceived Need/Healthcare Factors	Work/Time Conflict
1.Distance	0.727
2.Cost	0.773
3.Transportation problems	0.792
4.Family responsibilities	0.636
8.Severe weather	0.752
21.COVID-19	0.692
13.I do not have the energy		0.827
9.I find exercise tiring or painful or tiring		0.809
15.I am too old		0.805
7.I could exercise at home		0.804
20.CR team did not contact me		0.657
14.Other health problems prevent me from going		0.748
5.I did not know about CR			0.765
6.I do not need CR			0.785
16.My cardiologist did not feel it was necessary for me			0.846
18.I can manage my own problem			0.791
19.I prefer exercise alone, not in a group			0.735
11.Time constraints				0.773
10.Travel				0.711
12.Work responsibilities				0.672
17.Many people with heart problems do not go to CR centers, and they are fine				0.75
Variance explained (%)	16.283	30.128	10.294	6.232
Cumulative variance explained (%)	16.283	46.411	56.705	62.937
KMO(p-value)	0.867 (0.000)

Abbreviation: KMO, Kaiser-Meyer-Olkin.

Table 3 Goodness of Fit Indices for the Four‐factor Model in the Confirmatory Factor Analysis

	χ^2/df	RMSEA	GFI	SRMR	AGFI	NFI	IFI	TLI	CFI
Criterion	≤3	<0.08	>0.9	<0.08	>0.9	>0.9	>0.9	>0.9	>0.9
Result	1.840	0.051	0.912	0.048	0.888	0.903	0.953	0.945	0.953

Abbreviations: GFI, goodness-of-fit index; AGFI, adjusted goodness–of–fit index; CFI, comparative fit index; TLI, Tucker–Lewis index; IFI, incremental index of fit; RMSEA, root mean square error of approximation; SRMR, Standardized root mean square residual; NFI, normed fit index.

Figure 1 Scree plot.

Figure 2 Confirmatory factor analysis model with modifications.

Table 4 Internal Consistency and Reliability of the Cardiac Rehabilitation Barriers Scale

CRBS Item	Alpha	ICC	95% CI	p
Logistical factors	0.866	0.99	0.985–0.993	0000
Comorbidities/functional status	0.858	0.942	0.917–0.96	0.000
Perceived need/healthcare factors	0.88	0.894	0.646–0.953	0.000
Work/time conflict	0.801	0.91	0.753–0.957	0.000
Total	0.88	0.96	0.95–0.97	0.000

Abbreviations: ICC, intraclass correlation coefficient; CI, Confidence Interval.

Table 5 The Item-to-Total Correlation results of the Chinese Version of CRBS

Item	Item-to-Total Correlation	p
Logistical factors
1.Distance	0.655	0.000
2.Cost	0.678	0.000
3.Transportation problems	0.647	0.000
4.Family responsibilities	0.573	0.000
8.Severe weather	0.603	0.000
21.COVID-19	0.602	0.000
Comorbidities/functional state
13.I do not have the energy	0.552	0.000
9.I find exercise tiring or painful or tiring	0.491	0.000
15.I am too old	0.520	0.000
7.I could exercise at home	0.492	0.000
20.CR team did not contact me	0.533	0.000
14.Other health problems prevent me from going	0.432	0.000
Perceived need/healthcare factors
5.I did not know about CR	0.453	0.000
6.I do not need CR	0.446	0.000
16.My cardiologist did not feel it was necessary for me	0.467	0.000
18.I can manage my own problem	0.439	0.000
19.I prefer exercise alone, not in a group	0.488	0.000
Work/time conflict
11.Time constraints	0.56	0.000
10.Travel	0.513	0.000
12.Work responsibilities	0.615	0.000
17.Many people with heart problems do not go to CR centers, and they are fine	0.620	0.000

Table 6 Sex Difference by CRBS Item

CRBS Item	Total (n=325)	Male (n=207)	Female (n=118)	p
1.Distance	3.66±1.08	3.61±1.1	3.75±1.1	0.262
2.Cost	3.15±1.17	3.11±1.18	3.24±1.16	0.334
3.Transportation problems	3.41±1.16	3.41±1.15	3.43±1.2	0.845
4.Family responsibilities	3.06±1.08	3.05±1.07	3.1±1.11	0.67
8.Severe weather	3.31±1.12	3.29±1.15	3.36±1.08	0.585
21.COVID-19	2.85±1.08	2.86±1.07	2.85±1.12	0.89
13.I do not have the energy	2.96±1.16	3.01±1.16	2.87±1.19	0.294
9.I find exercise tiring or painful or tiring	2.98±1.14	3.01±1.11	2.92±1.19	0.491
15.I am too old	2.93±1.15	2.98±1.09	2.84±1.25	0.319
7.I could exercise at home	2.77±1.13	2.82±1.01	2.69±0.97	0.258
19.I prefer to exercise alone, not in a group	2.89±1.17	2.9±1.19	2.88±1.14	0.843
20.CR team did not contact me	2.75±1.1	2.77±1.07	2.71±1.15	0.605
14.Other health problems prevent me from going	2.57±0.99	2.64±0.99	2.44±0.97	0.071
5.I did not know about CR	3.85±0.97	3.88±0.97	3.78±0.99	0.373
6.I do not need CR	2.74±1.13	2.79±1.13	2.66±1.11	0.315
16.My cardiologist did not feel it was necessary for me	3.31±1.12	3.28±1.14	3.35±1.09	0.585
18.I can manage my own problem	2.76±1.05	2.81±1.05	2.67±1.04	0.254
11.Time constraints	2.95±1.11	2.92±1.1	3±1.12	0.547
10.Travel	2.63±1.06	2.56±1.04	2.75±1.09	0.116
12.Work responsibilities	2.45±1.04	2.41±1	2.51±1.1	0.4
17.Many people with heart problems do not go to CR centers, and they are fine	2.85±1.09	2.82±1.08	2.92±1.11	0.41
Total mean score	62.92±12.53	62.77±12.63	62.77±12.63	0.882