Publicly versus privately funded cardiac rehabilitation: access and adherence barriers. A cross-sectional study

Abstract

INTRODUCTIONCardiovascular rehabilitation (CR) programs are recommended in clinical guidelines, 1,2 because participation results in significantly lower mortality and morbidity, 3 including in low and middle-income countries (LMICs). 4 However, CR participation remains low, at around 20%-30% in high-income countries, [5][6][7] and 14% in LMICs such as Brazil. 8 The reasons for underuse of CR have been well-characterized in high-resource settings 7,9,10 and include factors at the healthcare system, provider and patient levels. However, barriers in lower-resource settings have not been well-studied. A recent review identified only 13 studies globally, 11 and there are also few studies in South America 12 or Brazil to date. [13][14][15][16] This is problematic, given the different contexts in these settings. Firstly, patients would be more socioeconomically disadvantaged, and hence face different barriers. Secondly, healthcare systems are more often two-tier. 17 So, for example, half of CR programs in Brazil are solely publicly-funded (53.3%), a third privately-funded, and the remainder a mixture. 18 It has been established that CR funding sources affect program characteristics, such as scale, healthcare providers on the team and component comprehensiveness. 17 However, to our knowledge, it has yet to be investigated how barriers might differ for patients accessing privately and publicly-funded programs in any country worldwide. 19 OBJECTIVESTherefore, the objectives of this study were to compare: (1) the sociodemographic and clinical characteristics of patients accessing publicly versus privately funded CR programs; and (2)

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.…”