Rural Residents' Use of Cardiac Rehabilitation Programs

Abstract

The goal of this study was to identify the factors that influence the use of cardiac rehabilitation services by rural residents. The Andersen-Newman framework, which consists of three determinants of health services utilization (predisposing, enabling, and need factors), was used to direct this research. The three data collection points were at time of discharge from the hospital, two weeks post discharge, and one week following the date that the cardiac rehabilitation program would have been completed. Packets for the three data collection points were unique and contained instruments to assess various factors influencing the use of health services. The sample (N = 254) were adults living in rural areas who had experienced a cardiac event and received treatment at one of four hospitals in two western states and who provided useable data on all three questionnaires. Findings indicated that 72 (28%) of the participants attended some portion of a rehabilitation program, and only 43 (17%) completed the full 36-week program. Four predisposing factors, one enabling factor, and two need factors were significant in explaining the number of cardiac rehabilitation sessions attended. Further research is needed to validate these factors and to identify others which may influence the use of cardiac rehabilitation by rural residents. Likewise, it is essential to examine alternate ways to meet the rehabilitative needs of rural cardiac clients.

Geographic issues in cardiac rehabilitation utilization: A narrative review

“…Most studies defined CR utilization as "attending at least one CR session". Only three studies (17.6%) distinguished between the effects of geographic barrier on CR enrollment versus level of participation (Harrison, Wardle 2005, Johnson, Weinert & Richardson 1998, Brual et al 2010. Of these, only one study (5.8%) assessed the impact of geographic issues on CR program completion (Harrison, Wardle 2005).…”

“…Participants were diagnosed with a variety of coronary heart diseases (CHD) ranging from angina pectoris, to myocardial infarction (MI) and heart failure, and/or had undergone coronary artery bypass graft (CABG), and percutaneous coronary interventions. Three studies (17.6%) sampled only rural participants (Yates, Braklow-Whitton & Agrawal 2003, Johnson, Weinert & Richardson 1998, De Angelis, Bunker & Schoo 2008. One study (5.8%) sampled solely females (Missik 2001).…”

“…Table 1 summarizes nine studies (47.4% of all included findings) assessing rurality in relation to CR utilization (Harrison, Wardle 2005, Suaya et al 2007, King, Humen & Teo 1999, King et al 2001, Brady et al 2005, Johnson, Weinert & Richardson 1998, Higgins et al 2008, Smith, Harkness & Arthur 2006, Sundararajan et al 2004). Table 2 summarizes 10 studies (52.6% of all findings) which examined distance/travel time to CR (Ades et al 1992, Missik 2001, Suaya et al 2007, Yates, Braklow-Whitton & Agrawal 2003, Higgins et al 2008, Melville et al 1999, Grace et al 2008b, De Angelis, Bunker & Schoo 2008, Dunlay et al 2009, Brual et al 2010.…”

Contribution of patient and physician factors to cardiac rehabilitation enrollment: a prospective multilevel study

“…This has resulted in CR service maldistribution [10]. Moreover, patients who reside in rural areas invariably face geographic barriers to healthcare utilization such as CR [46]. Results show that patients take geography into consideration when making enrollment decisions.…”

Factors influencing dietary fat intake among black emerging adults

“…The EAS has been tested in populations living in rural and urban geographical locations, such as rural residents in a cardiac rehabilitation program (N = 254) (Johnson, Weinert, & Richardson, 1998). It has also been tested among participants with multiple sclerosis (N = 807) in which a majority of the participants lived in metropolitan areas (Stuifbergen, 1999).…”