Barriers and facilitators to participant adherence of dietary recommendations within comprehensive cardiac rehabilitation programmes: a systematic review

Abstract

Objective: To identify individual-, provider- and system/environmental-level barriers and facilitators affecting cardiac rehabilitation (CR) participants’ adherence to dietary recommendations. Design: A systematic review of the medical literature was conducted. Six databases were searched from inception through March 2021: APA PsycInfo, CINAHL, Embase, Emcare, Medline and PubMed. Only those studies referring to barriers and facilitators reported by CR participants were considered. Pilot and case report studies, non-peer-reviewed literature and studies published in a language other than English, Portuguese or Spanish were excluded. Results: Data were extracted and analysed on the basis of individual-, provider- and system/environmental-level factors. Of 2083 initial citations, sixteen studies were included, with nine being qualitative and seven observational in design. From these, ten multi-level barriers and seven multi-level facilitators were identified. Dietary recommendations included developing healthy eating habits, transitioning to vegetarian-rich diets and increasing fish oil and n-3 intake. Only one study reported on all of the nutrition education programme factors recommended by the Workgroup for Intervention Development and Evaluation Research. Conclusion: To the best of our knowledge, this review is the first to summarise specific barriers and facilitators to recommendation adherence among CR participants. Few of the studies offered any conclusions regarding programme design that could facilitate improved dietary adherence practices. Future studies should aim to explore patient perspectives on the nutritional patterns and recommendations outlined in the Mediterranean Diet, the Dietary Approaches to Stop Hypertension Diet, Vegetarian or Vegan diets and the Portfolio Diet.

Barriers and Facilitators of Center-Based Cardiac Rehabilitation Utilization in South Asian Ethnic Minorities

“…These findings are consistent across different scoping and narrative literature reviews. 34,35 The authors of a qualitative literature review identified that the cultural and religious beliefs of South Asian minorities living in the United Kingdom highly influence their involvement in physical activity and participation in other health practices. 34,35 To mitigate this challenge, religious leaders might be able to play a crucial role.…”

“…34,35 The authors of a qualitative literature review identified that the cultural and religious beliefs of South Asian minorities living in the United Kingdom highly influence their involvement in physical activity and participation in other health practices. 34,35 To mitigate this challenge, religious leaders might be able to play a crucial role. There is some precedent in other ethnic groups that faith leaders can influence health behaviors not only at individual levels but also at community levels.…”

“…Another barrier was the negative attitude of health care staff at CR centers. 35 South Asian minorities were at greater risk to experience racism, stigma, and differential attitudes from health care professionals while accessing CR services at rehabilitation centers than those in the dominant culture. Thus, comprehensive measures are necessary to enhance the attitude of CR staff, detect biases, and improve standards of care.…”

“…40 In a scoping review of the literature, authors found that ethnic minorities may face difficulties accessing CR centers due to limited public transportation and long distance. 35 The recent guidelines on the CR model designed for women have identified safety concerns and the rehabilitation environment as significant factors that can affect the decision of potential participants to enroll or not enroll in CR program. Therefore, it is essential to prioritize safety and privacy to increase participation in center-based programs.…”

Acceptability of a high-protein Mediterranean-style diet and resistance exercise protocol for cardiac rehabilitation patients: Involving service users in intervention design using a mixed-methods participatory approach

“…However, while RE may be incorporated into some CR programmes, there is a clear emphasis on aerobic exercise-based CR (22)(23)(24)(25). Similarly, while Mediterranean diets are recommended to reduce CVD risk (26)(27)(28)(29)(30)(31)(32), there is little evidence for adherence to such dietary advice in current CR practices, particularly in non-Mediterranean populations (33,34). A randomized controlled trial (RCT) trialing a high-protein, Mediterranean-style diet combined with RE in a CR population would contribute evidence for the efficacy of such an approach.…”