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Abstract
Purpose: This study explored patients’ decision-making about whether or not to enroll in cardiac rehabilitation (CR), an underutilized program that is associated with significantly improved health outcomes.
Method: Face-to-face interviews were conducted with acute coronary syndrome patients (n = 14) after referral to a local CR center, but prior to program enrollment. Thematic analysis was used to derive themes from interview transcripts.
Results: Three themes emerged including anticipated benefit, perceived ability, and contextual influences. Participants believed key benefits of CR would be access to specialist health care providers, improved longevity, reduced cardiovascular risk, as well as improved motivation, accountability, learning opportunities, and general fitness. Participants were concerned about their ability to engage in and travel to exercise sessions, pay the program fee, and manage scheduling conflicts. Contextual influences on decision-making included health care provider recommendation, first impressions of the CR center, knowledge gaps about what CR entails, input from family and peers, and psychological distress.
Conclusion: The period following CR referral but prior to enrollment represents an optimal opportunity to promote in-the-moment decisions in favor of CR. Patients report both positive and negative aspects of CR, suggesting individualized efforts to resolve ambivalence may increase program participation.
Cardiovascular disease is a leading cause of mortality worldwide.
Cardiac rehabilitation (CR) is an effective secondary prevention strategy to improve cardiovascular morbidity and mortality, but only a subset of eligible patients enroll.
After referral but prior to enrollment, patients anticipate both positive and negative aspects of CR participation.
Individualized efforts to resolve ambivalence, address knowledge gaps, and problem-solve barriers may increase uptake into CR programs.
Implications for Rehabilitation
Acknowledgements
The authors would like to acknowledge the participants of this study for their time and honesty. The authors also thank C. Maturana and C. Hare for their assistance with data entry and interview transcription, as well as staff members at the cardiac rehabilitation center for their assistance with participant recruitment.
Disclosure statement
The authors report no conflicts of interest. C. Rouleau is supported by an Alberta Innovates Health Solutions (AIHS) Graduate Studentship and a Canadian Institutes of Health Research (CIHR) Doctoral Award. The sources of funding had no role in the study design; in the collection, analysis, or interpretation of data; in writing the manuscript; or in the decision to submit the manuscript for publication.