Sex Differences in Cardiac Rehabilitation Barriers among Non-Enrollees in the Context of Lower Gender Equality

Abstract

Background Despite the benefits of cardiac rehabilitation (CR), it remains under-utilized, particularly by women. This study compared CR barriers between non-enrolling men and women in Iran, which has among the lowest gender equality globally. Methods In this cross-sectional study, CR barriers were assessed via phone interview in phase II non-attenders from March 2017 to February 2018 with the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P). T-tests were used to compare scores, with each of 18 barriers scored out of 5, between men and women. Results 357 (33.9%) of the sample of 1053 were women, and they were older, less educated and less often employed than men. Total mean CRBS scores were significantly greater in women (2.37 ± .37) than men (2.29 ± .35; p < .001). The top CR barriers among women were cost (3.35, P < 0.001), transportation problems (3.24, P < 0.001), distance (3.21, P < 0.001), comorbidities (2.97, P < 0.001), low energy (2.41, P < 0.001), finding exercise as tiring or painful (2.22, P = 0.018), and older age (2.27, P = 0.001). Men rated "already exercise at home or in community" (2.69, P = 0.001), time constraints (2.18, P < 0.001) and work responsibilities (2.24, P = 0.001) as greater CR barriers than women. Conclusion Women had greater barriers to CR participation than men. CR programs should be modified to address women’s needs. Home-based CR tailored to women’s exercise needs and preferences should be considered.

A Systematic Review of Interventions With an Educational Component Aimed at Increasing Enrollment and Participation in Cardiac Rehabilitation

“…16 Although several barriers exist, patient education as well as physician recommendation and referral are among the most consistent and important factors that influence individual enrollment and participation in CR. 17,18…”