Abstract
Cardiac Rehabilitation (CR) is an effective healthcare service for the secondary prevention of coronary artery disease (CAD). Despite this, internationally there remains an issue of low attendance by CAD patients across all phases of CR. Research has been undertaken to understand the reasons behind this low attendance rate, however most of the research has focused on earlier stages of CR and not the maintenance community-based phase. The current study aimed to examine the reasons and outcomes of different attendance rates to two maintenance community-based CR programmes using the Health-Belief Model as the theoretical framework.
A total of 44 elderly (≥60 years old) CAD patients whom had completed out-patient CR were recruited. Patients were examined according to their attendance rate to one of the two maintenance community-based CR programmes in Dunedin [high-attenders (HA, n=11); low-attenders (LA, n=16) or non-registered (NR, n=17)]. In accordance with the Health-Belief Model, patients’ were surveyed on their perceived threat of CAD, sociodemographic characteristics, cues to action to attend CR and their perceived benefits and barriers to attending CR. Patients also had their physical functioning, physical activity levels and quality of life measured to determine the outcomes of different attendance rates.
Differences were seen between the three groups on cues to action, perceived benefits and perceived barriers sections. In cues to action differences were seen in the encouragement given to attend from external factors such as family, and others having heart problems, as well as internal factors such as worry about health and not wanting another heart attack. In perceived benefits differences were seen between the three study groups in gain of ability to perform activities of daily living, body functioning, sense of accomplishment, muscle strength and cardiovascular system functioning. The only difference in perceived barriers was the HA and LA groups perceived a greater need for healthcare compared to the NR group (HA: 1.72 ± 1.23 & LA: 1.38 ± 0.39 vs NR: 2.48 ± 0.63 p=0.001). Only physical activity level showed a difference in the outcome measures; the HA group had a higher energy expenditure over a 7-day period compared to the LA and NR groups (HA: 3819.4 ± 117.8 vs LA: 2434.2 ± 1057.8 vs NR: 2643.1 ± 1333.1 kCal/week p=0.013). Additional findings on cues to action, perceived benefits and perceived barriers have added new themes regarding the efficacy of encouragement from the cardiology team and other health-professionals, the importance of social benefits and how other commitments and undertaking own exercise routine are seen as barriers to attending maintenance community-based CR.
In conclusion it appears that the decision to attend maintenance community-based CR is influenced by cues to action, perceived benefits and perceived barriers, but not perceived threat. Additional comments made from patients on cues to action, perceived benefits and perceived barriers have added some new factors to consider when examining reasons behind attendance rates to maintenance community-based CR. The results also support the importance of considering a holistic approach to healthcare when administrating maintenance community-based CR, so as to meet the many needs of patients.