Assessing patients' beliefs about cardiac rehabilitation as a basis for predicting attendance after acute myocardial infarction

Abstract

Background: Some sociodemographic and psychological variables such as patients' belief about illness are associated with attendance at cardiac rehabilitation. Exploration of patients' beliefs about treatment regarding cardiac rehabilitation has been limited to qualitative studies; their role in relation to attendance at cardiac rehabilitation after acute myocardial infarction (AMI) remains speculative. Objectives: To develop a valid and reliable measure of patients' beliefs regarding cardiac rehabilitation and to ascertain the relationship between such beliefs and attendance. Design: A prospective questionnaire-based study. Setting: Coronary care unit of a London teaching hospital. Patients: 130 patients with AMI; 104 (83%) men; mean age 58.4 (standard deviation (SD) 10.7) years. Interventions: Patients completed a 26-item questionnaire consisting of statements pertaining to beliefs about cardiac rehabilitation. Main outcome measures: Cardiac rehabilitation attendance; beliefs of patients about cardiac rehabilitation. Results: Four subscales pertaining to patients' beliefs about cardiac rehabilitation were produced, accounting for 65.3% of the attendance variance: perceived necessity of cardiac rehabilitation (a = 0.71), concerns about exercise (a = 0.79), practical barriers (a = 0.70) and perceived personal suitability (a = 0.74). Patients who attended were more likely to believe that cardiac rehabilitation was necessary and to understand its role compared with non-attenders (17.7 (SD 2.7) v 16.9 (SD 3.0), p = 0.029). Patients who thought cardiac rehabilitation was suitable for a younger, more active person were less likely to attend (5.6 (SD 1.9) v 4.6 (SD 1.7), p = 0.007). Patients who expressed concerns about exercise or who reported practical barriers to attendance were less likely to attend, although these did not reach statistical significance. Conclusion: Beliefs about cardiac rehabilitation can be quantified and differ between attenders and nonattenders of cardiac rehabilitation.

Cardiac rehabilitation for heart failure: Do older people want to attend and are they referred?

“…Patie ts espo ses to pa ti ipatio a d o -participation were often focused on the exercise component of programmes, consistent with other studies [28]. Among those willing to attend, group hospital-based options were most frequently preferred; supporting previous findings of positive associations of exercising in a safe environment with supervision with future participation in cardiac rehabilitation [28]. Perceptions of satisfaction with current activity levels of those preferring not to participate has also been described by community-dwelling older people as a reason for not wishing to increase physical activity levels [14].…”

“…However, qualitative findings indicated that patients weight their health problems differently and functional limitations may u de pi hoi es fo se i es odels. Patie ts espo ses to pa ti ipatio a d o -participation were often focused on the exercise component of programmes, consistent with other studies [28]. Among those willing to attend, group hospital-based options were most frequently preferred; supporting previous findings of positive associations of exercising in a safe environment with supervision with future participation in cardiac rehabilitation [28].…”

Geographic issues in cardiac rehabilitation utilization: A narrative review

“…Notably, the Cardiac Rehabilitation Barriers Scale (CRBS) (Shanmugasegaram et al 2010) developed by our group, the Cardiac Rehabilitation Enrolment Obstacles scale (CREO) (Fernandez et al 2008), the Cardiac Rehabilitation Preferences Form (CRPF) (Fernandez et al 2007), and the Beliefs About Cardiac Rehabilitation scale (BACR) (Cooper et al 2007) all include geographic barriers to CR utilization. With regard to the former, factor analysis of the CRBS has consistently revealed a 'logistical barriers' factor, where distance, transportation problems, cost (which would be related to travel in the Canadian context where it has been administered because CR services are paid through provincial health insurance), and severe weather have been consistently shown to be significantly and negatively associated with CR utilization (Shanmugasegaram et al 2010, Grace et al 2004.…”

How people present symptoms to health services: a theory-based content analysis

“…However, it may be necessary for clinicians to prompt the remaining components to obtain a fuller understanding of people's representations of their illness. A better understanding of individuals' illness representations has the potential to improve adherence with advice, 7,8 improve communication, 9 and lead to increased patient satisfaction. 10 Leventhal's CS-SRM accounts for a large proportion of people's initial presentations to health services.…”

“…[3][4][5] In addition, coherence, or the degree to which someone's illness representation makes sense, has been identified as important. 6 Elicitation of patients' illness representations by clinicians may lead to improved adherence with advice, 7,8 improved communication, 9 and increased patient satisfaction. 10 However, research exploring the extent to which the components of illness representation are communicated in people's presentations to health professionals is lacking.…”