Psychometric validation of the Cardiac Rehabilitation Barriers Scale

Abstract

Objective:The purpose of this study was to investigate the factor structure and psychometric properties of the Cardiac Rehabilitation Barriers Scale (CRBS).Design, setting, and participants:In total, 2636 cardiac inpatients from 11 hospitals completed a survey. One year later, participants completed a follow-up survey, which included the CRBS. A subsample of patients also completed a third survey which included the CRBS, the Cardiac Rehabilitation Enrolment Obstacles scale, and the Beliefs About Cardiac Rehabilitation scale three weeks later. The CRBS asked participants to rate 21 cardiac rehabilitation barriers on a five-point Likert scale regardless of cardiac rehabilitation referral or enrolment.Results:Maximum likelihood factor analysis with oblique rotation resulted in a four-factor solution: perceived need/healthcare factors (eigenvalue = 6.13, Cronbach’s α = .89), logistical factors (eigenvalue = 5.83, Cronbach’s α = .88), work/time conflicts (eigenvalue = 3.78, Cronbach’s α = .71), and comorbidities/functional status (eigenvalue = 4.85, Cronbach’s α = .83). Mean total perceived barriers were significantly greater among non-enrollees than cardiac rehabilitation enrollees (P < .001). Convergent validity with the Beliefs About Cardiac Rehabilitation and Cardiac Rehabilitation Enrolment Obstacles scales was also demonstrated. Test-retest reliability of the CRBS was acceptable (intraclass correlation coefficient = .64).Conclusion:The CRBS consists of four subscales and has sound psychometric properties. The extent to which identified barriers can be addressed to facilitate greater cardiac rehabilitation utilization warrants future study.

A Comparison of Barriers to Use of Home- Versus Site-Based Cardiac Rehabilitation

“…12 The Cardiac Rehabilitation Barriers Scale (CRBS) is a valid and reliable measure which assesses patients' perceptions of patient, provider, and health system-level barriers to CR enrollment and participation. 8 Participants were asked to rate their level of agreement on each of the 21 statements. Items were rated on a 5-point Likert-type scale that ranged from 1 = strongly disagree to 5 = strongly agree.…”

“…7 Patients reporting greater barriers to CR use are significantly less likely to enrol, and are more likely to dropout, ultimately not achieving the health benefits of CR. 8 Yet, many patient barriers to CR could be addressed by appropriate allocation to site or home-based programs, although this has yet to be investigated. Thus, the objectives of this study were to: (1) describe and compare barriers to participation, and (2) investigate whether these barriers are related to (a) program adherence (percentage of site or phone CR sessions attended) and (b) exercise behavior, among patients participating in site versus home-based CR programs.…”

Geographic issues in cardiac rehabilitation utilization: A narrative review

“…In another sample of 1803 CHD outpatients, the mean importance rating of distance as a barrier was 2.2±1.1, and transportation problems was 1.9±1.1 on the CRBS. In fact, distance was the third most strongly-endorsed barrier after already exercising at home and personal or business travel (Shanmugasegaram et al 2010). Mean individual item scores have not been published for the other barrier scales.…”

“…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. Overall, in a sample 1278 CHD outpatients of which 55% attended CR, the mean importance rating of distance as a barrier was 2.3±1.4, and transportation problems was 2.1±1.3, suggesting that both of these geographic barriers play an important role in CR utilization (Grace et al 2009b).…”

Análise da aderência em diferentes programas de reabilitação cardíaca: estudo preliminar

“…9,15 O instrumento é composto por 22 itens, sendo 21 divididos em cinco domínios, cada um referente a uma categoria de barreiras: Domínio1 -Comorbidades/ estado funcional (7 itens); Domínio 2 -Necessidades percebidas (5 itens); Domínio 3 -Problemas pessoais/ familiares (3 itens); Domínio 4 -Viagem/conflitos trabalho (2 itens); e Domínio 5 -Acesso (4 itens). O item 22: "Outro (s) motivo (s) para não frequentar um programa de reabilitação cardíaca" é uma questão aberta…”