Background Coronary heart disease (CHD) has become a leading cause of morbidity and premature death worldwide. Cardiac rehabilitation (CR) was proved to have substantial benefits for patients with CHD. The CR was divided into three phases. Phase 2 is the important part of CR which involves hospital-based structured and closely monitored exercises and activities. However, CR utilization is low worldwide. The barriers to hospital-based phase 2 CR in China have not been well identified. Aims To investigate barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in China and to explore the reasons. Methods This study employed an explanatory sequential mixed-methods design. The study was conducted in a university hospital in China from July 2021 to December 2021. Quantitative data was collected through the Cardiac Rehabilitation Barrier Scale. Qualitative data was collected through unstructured face-to-face interviews. Data analysis included descriptive statistics and inductive qualitative content analysis. Results One hundred and sixty patients completed the Cardiac Rehabilitation Barrier Scale and 17 patients participated in unstructured face-to-face interviews. The main barriers identified were distance (3.29 ± 1.565), transportation (2.99 ± 1.503), cost (2.76 ± 1.425), doing exercise at home (2.69 ± 1.509) and time constraints (2.48 ± 1.496). Six themes were identified; logistical factors, social support, misunderstanding of cardiac rehabilitation, program and health system-level factors, impression of CR team and psychological distress. The first four themes confirmed the quantitative results and provide a deeper explanation for the quantitative results. The last two themes were new information that emerged in the qualitative phase. Conclusion This study provides a better understanding of the barriers to hospital-based phase 2 cardiac rehabilitation among coronary heart disease patients in the Chinese context during the Covid-19 pandemic. Innovative programs such as home-based CR, mobile health, and hybrid programs might be considered to overcome some of these barriers. In addition, psychosocial intervention should be included in these programs to mitigate some of the barriers associated with the impression of CR team and psychological distress.

AimsTo investigate barriers to hospital-based phase II cardiac rehabilitation among coronary heart disease patients in China and to explore the deeper reasons.Design An explanatory sequential mixed method design.Methods This study was conducted in a university hospital in China from July 2021 to December 2021.160 patients completed the survey by using the Cardiac Rehabilitation Barrier Scale and then 17 patients participated in the unstructured face- to- face interviews. Inductive qualitative content analysis was used to analyze data.Results Patients who are working or do not have healthcare insurance are less likely to participate in cardiac rehabilitation, while patients after percutaneous coronary intervention or have participated in phase I cardiac rehabilitation were more likely to take the program. The main barriers were distance (3.29±1.565), transportation (2.99±1.503), cost (2.76±1.425), doing exercise at home (2.69±1.509) and time constrain (2.48±1.496). Six themes were identified, logistics factors, social support, misunderstanding of cardiac rehabilitation, program and health system-level factors, impression on cardiac rehabilitation team and psychological distress. The first four themes confirmed the quantitative results and provide a deeper explanation for the quantitative results. The last two themes were new information emerged in the qualitative phase.ConclusionThis mixed methods study provided a better understanding of the barriers to hospital-based phase II cardiac rehabilitation among coronary heart disease patients in the Chinese context. It is time to move from barriers to solutions. Innovative program might be considered to overcome some of these barriers. Additionally, psychosocial interventions should be conducted to transform patient’s cognition problems and build trusted nurse(doctor)-patient relationship.