Access to Cardiac Rehabilitation Among South-Asian Patients by Referral Method: A Qualitative Study

Abstract

People of South‐Asian origin have an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, South Asians are among the least likely people to participate in these programs. Automatic referral increases CR use and may reduce access inequalities. This study qualitatively explored whether CR referral knowledge and access varied among South‐Asian patients. Participants were South‐Asian cardiac patients receiving treatment at hospitals in Ontario, Canada. Each hospital refers to CR via one of four methods: automatically through paper or electronically, through discussion with allied health professionals (liaison referral), or through referral at the physician's discretion. Data were collected via interviews and analyzed using interpretive‐descriptive analysis. Four themes emerged: the importance of predischarge CR discussions with healthcare providers, limited knowledge of CR, ease of the referral process for facilitators of CR attendance, and participants' needs for personal autonomy regarding their decision to attend CR. Liaison referral was perceived to be the most suitable referral method for participants. It facilitated communication between patients and providers, ensuring improved understanding of CR. Automatic referral may not be as well suited to this population because of reduced patient‐provider communication.

A secondary meta‐synthesis of qualitative studies of gender and access to cardiac rehabilitation

“…Galdas and Kang () did not report gender differences because none were found. Grewal () and Sloots et al . () questioned the influence of the researcher's gender in data collection.…”

“…, Grewal et al . ). Furthermore, we argue in this section that in uptake‐related decisions, women and men may interpret from a gendered perspective what little information they do possess about programmes to support decisions about uptake.…”

Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data

“…Qualitatative data synthesis System and service barriers affecting CR attendance. A number of studies reported the importance of physician recommendation in the decision to participate in CR, [13][14][15][16][17] particularly when the patient was ambivalent about participating (Figure 2). Some studies identified physicians as recommending against CR.…”

“I don’t do it for myself, I do it for them”: A grounded theory study of South Asians’ experiences of making lifestyle change after myocardial infarction

“…Historically, South Asians tend to have had low referral rates, uptake and adherence to cardiac rehabilitation (Banerjee, Gupta, & Singh, 2007;Beswick et al, 2004;Galdas & Kang, 2008;Jolly, Greenfield, & Hare, 2004;Scott, Gravely, Sexton, Brzostek, & Brown, 2013), although uptake may vary by country (Rana et al, 2014). A Canadian study (Grewal et al, 2010) exploring South Asian patients' barriers to CR identified a number of factors that might help explain such poor uptake; the importance of in-hospital communication with care providers, providing knowledge of the comprehensive nature of cardiac rehabilitation and the importance of post discharge follow-up and the need to support personal autonomy were identified as important factors. Chauhan, Baker, Lester, and Edwards (2010) in a British study with 20 South Asian participants reported that patients had limited understanding of their condition, had negative experiences of healthcare, valued social networks, held fatalistic health beliefs and identified religious, cultural and practical barriers.…”