Barriers and facilitators to virtual education in cardiac rehabilitation: a systematic review of qualitative studies

Abstract

Background Due to restrictions imposed by the severe acute respiratory syndrome coronavirus 2 pandemic much attention has been given to virtual education in cardiac rehabilitation (CR). Despite growing evidence that virtual education is effective in teaching patients how to better self-manage their conditions, there is very limited evidence on barriers and facilitators of CR patients in the virtual world. Aims To identify barriers and facilitators to virtual education participation and learning in CR. Methods A systematic review of peer-reviewed literature was conducted. Medline, Embase, Emcare, CINAHL, PubMed, and APA PsycInfo were searched from inception through April 2021. Following the PRISMA checklist, only qualitative studies were considered. Theoretical domains framework (TDF) was used to guide thematic analysis. The Critical Appraisal Skills Program was used to assess the quality of the studies. Results Out of 6662 initial citations, 12 qualitative studies were included (58% ‘high’ quality). A total of five major barriers and facilitators were identified under the determinants of TDF. The most common facilitator was accessibility, followed by empowerment, technology, and social support. Format of the delivered material was the most common barrier. Technology and social support also emerged as barriers. Conclusion This is the first systematic review, to our knowledge, to provide a synthesis of qualitative studies that identify barriers and facilitators to virtual education in CR. Cardiac rehabilitation patients face multiple barriers to virtual education participation and learning. While 12 qualitative studies were found, future research should aim to identify these aspects in low-income countries, as well as during the pandemic, and methods of overcoming the barriers described.

Effectiveness of Telehealth Cardiac Rehabilitation Programs on Health Outcomes of Patients With Coronary Heart Diseases

“…Future work is required to address these concerns if telehealth interventions are to be successfully implemented. [48][49][50] Despite the rigorous methods used to undertake the umbrella review, some limitations of this review need to be considered. First, the quality of reviews was moderate with some systematic reviews noncompliant with the PRISMA reporting guidelines.…”

“…In addition, low health and digital literacy, cultural appropriateness, and language barriers pose barriers among patients. Future work is required to address these concerns if telehealth interventions are to be successfully implemented 48–50…”

Acceptability, Preferred Medium, and Components of Nurse-Led Cardiac Telerehabilitation: A Cross-Sectional Study

“…2023), which were proved to improve the participation and effectiveness in CR (Su & Yu, 2021;Vanzella et al, 2022). Unlike previous studies that primarily focused on outcomeoriented components, such as physical function, our study has a unique patient-centered approach, identifying the components of Ne-CTR that are higher in demand.…”

Feasibility of Remote Delivering an Exercise and Lifestyle Education Program for Individuals Living with Prediabetes and Diabetes in Brazil

“…Technology has been used to deliver diabetes education remotely, mitigating barriers to accessing and expanding the delivery of educational interventions in settings in which health services or patient resources are insufficient or limited [ 6 , 15 ]. In addition, due to the complex scenario of the COVID-19 pandemic and the social distancing measures adopted to prevent the spread and contagion of the virus, widespread attention has recently been paid to the remote delivery of educational interventions [ 16 ]. Previous studies have shown the benefits of educational interventions delivered remotely for people living with diabetes and prediabetes, including reduction of glycated hemoglobin (HbA1c) [ 17 , 18 , 19 ], increase in disease-related knowledge [ 20 ], and positive changes in health behaviors [ 21 , 22 ].…”