Barriers to hospital-based phase 2 cardiac rehabilitation among patients with coronary heart disease in China: a mixed-methods study

Abstract

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.

Translation, Cross-Cultural Adaptation and Psychometric Validation of the Arabic Version of the Cardiac Rehabilitation Barriers Scale (CRBS-A) with Strategies to Mitigate Barriers

“…Indeed, the CRBS has now been administered in four EMR countries (i.e., Qatar [ 9 ], Iran [ 23 , 24 ], Saudi Arabia, Jordan), establishing that it is valid in the socio-religious context as well. The CRBS has been administered in other countries with very low CR availability [ 25 ] such as Brazil [ 26 , 27 , 28 , 29 , 30 , 31 ], Colombia [ 32 , 33 , 34 ], Iran [ 23 , 24 ], Czechia [ 35 ], Indonesia [ 36 ], China [ 37 , 38 , 39 , 40 ], Malaysia [ 41 , 42 ], and South Korea [ 43 , 44 ], again supporting its applicability globally. This may have been the first study however where the CRBS has been administered in a context without available CR, which did render it infeasible to fully assess construct and criterion validity.…”

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

“…In China, a mere 5% of the population is reportedly enrolled in CR (Liu et al, 2021). Several barriers can be identified: first, at an individual level, conflicts in scheduling and socioeconomic factors, including economic status, educational attainment, and access to healthcare, contribute to declined health and exacerbate inequalities in CR (Rocha et al, 2023; Xie et al, 2022). Second, from a healthcare system perspective, the scarcity of equipment, space, human resources, and financial means hinders CR service availability (Abreu et al, 2019).…”

Effectiveness of a short-term multimodal prehabilitation program in adult patients awaiting selective cardiac surgery: study protocol for an open-label, pilot, randomized controlled trial

“…Qualitative interviews with patients who underwent elective cardiac surgery revealed that physical factors such as reduced mobility and weakness can easily lead to negative emotions in patients, which may hinder their participation in rehabilitation programs (18). Psychological distress and malnutrition have also been identified as potential barriers to participation in rehabilitation (19). Conversely, exercise has been shown to improve emotional distress such as anxiety and depression in patients with heart disease by reducing stress and behavioral activation (20).…”