Social inequality in phase II cardiac rehabilitation attendance: The impact of potential mediators

Pedersen, Maria; Egerod, Ingrid; Overgaard, Dorthe; Baastrup, Marie; Andersen, Ingelise

doi:10.1177/1474515117746011

Cited by 19 publications

(26 citation statements)

References 32 publications

(57 reference statements)

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“…[29][30][31] The population characteristics of patients in our study were similar to other studies on patients with cardiac disease: 60-yearold men, typically overweight, having comorbidities and living with a partner. 13,29,32,33 However, the patients in our intervention group seemed to have a higher educational level, which has also been reported in a previous study. 29 This is important to consider, because low education has shown to be strongly linked to low health literacy and health behaviour.…”

Section: Generalisabilitysupporting

confidence: 86%

Tele-rehabilitation and hospital-based cardiac rehabilitation are comparable in increasing patient activation and health literacy: A pilot study

Knudsen

Petersen

Angel

et al. 2019

European Journal of Cardiovascular Nursing

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Background: Cardiac tele-rehabilitation is defined as using information and communication technology to support rehabilitation services. However, it requires a high level of patient activation and health literacy; this has not yet been explored. Aims: The purpose of this study was to evaluate patient activation and health literacy in tele-rehabilitation compared to hospital-based cardiac rehabilitation. Methods: We conducted a pilot study in patients with ischaemic or heart valve disease. In a non-randomised design, 24 patients attended a 12-week tele-rehabilitation programme, and 53 matched controls a 12-week hospital-based cardiac rehabilitation programme. The primary outcome was patient activation, which was assessed using the Patient Activation Measure before the intervention, at the end of the intervention and at follow-up six months after the intervention. The secondary outcome was health literacy, assessed using three dimensions from the Health Literacy Questionnaire before rehabilitation and at six-month follow-up: actively manage my health (HLQ3), ability to engage with healthcare providers (HLQ6) and understanding health information (HLQ9). Results: Patient activation improved similarly in tele-rehabilitation and hospital-based cardiac rehabilitation at all time points. Six months after the intervention, patients in tele-rehabilitation significantly improved on the dimension HLQ6 compared to patients in hospital-based cardiac rehabilitation. No significant between-group differences were found in HLQ3 or HLQ9. Conclusion: Tele-rehabilitation and hospital-based cardiac rehabilitation seemed to be equally successful in improving patient activation and health literacy. Tele-rehabilitation should be further tested in a randomised controlled trial, with a focus on whether patient levels of education and self-management at the initiation of rehabilitation are decisive factors for tele-rehabilitation participation.

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Section: Generalisabilitysupporting

confidence: 86%

Tele-rehabilitation and hospital-based cardiac rehabilitation are comparable in increasing patient activation and health literacy: A pilot study

Knudsen

Petersen

Angel

et al. 2019

European Journal of Cardiovascular Nursing

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“…In cardiac rehabilitation, a recent study found that comorbidities, self-efficacy, anxiety and depression, cohabitation, commute, disease severity or type of treatment do not significantly mediate the association of SES with attendance and participation. 9 However, health literacy and communication between physician and patient are discussed to generally explain healthcare inequalities, as they are strongly associated with SES. 10–12 Although there is no clear evidence regarding whether an increase in treatment rates reduces socioeconomic disparities in access to treatment, 13 14 Perelman et al found that socioeconomic inequalities in CHD treatment can be partly explained by different distances to hospitals with on-site cardiac facilities.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients

2018

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ObjectivesThis qualitative study aims to analyse socioeconomic differences in patients’ experiences along the treatment pathway for coronary heart disease (CHD).DesignA longitudinal qualitative study using in-depth semistructured interviews to explore patients’ experiences with treatment was conducted. We analysed the transcripts of the records according to qualitative content analysis and identified differences between patients with lower and higher socioeconomic status (SES) by comparing and contrasting the narratives.SettingThe University Hospital in Halle (Saale), Germany.Participants41 elderly patients (aged 59–80 years) who suffered from CHD.ResultsFrom various patient’s experiences along the pathway of care which were found to differ according to SES we derived three major themes: (1) information: patients with higher SES had greater knowledge about treatment and could use medical records as sources of information; (2) illness perception: patients with lower SES focused on improving symptoms and survival, while patients with higher SES focused on physical performance and disease management; and (3) perceived role in healthcare: patients with lower SES tended to delegate responsibility to healthcare professionals.ConclusionsDifferences in the patient’s knowledge about treatment, their perceived role in healthcare and illness perception can be the factors and mechanisms that contribute to explain socioeconomic inequalities in the treatment of CHD. These factors should be considered in quantitative studies to better understand the disparities in treatment and mortality. We suggest that improving patient–physician communication and patient knowledge can change the patient’s understanding of CHD and their perceived role in healthcare and reduce inequalities in CHD treatment.Trial registration numberDRKS00007839.

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“…In this study, the purpose of the quantitative component was to investigate potential factors associated with CR non‐attendance and to assess if these were differentially distributed among educational groups (Pedersen, Egerod, Overgaard, Baastrup, & Andersen, ). The purpose of the qualitative component was to explore the patient experience of barriers to completion of CR among different SEP groups (Pedersen, Overgaard, Andersen, Baastrup, & Egerod, ).…”

Section: The Studymentioning

confidence: 99%

Mechanisms and drivers of social inequality in phase II cardiac rehabilitation attendance: A convergent mixed methods study

Pedersen

Overgaard

Andersen

et al. 2018

Journal of Advanced Nursing

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Our study adds empirical evidence regarding how a mixed methods study can be used to obtain an understanding of complex healthcare problems. The study provides new knowledge concerning the mechanisms driving social inequality in cardiac rehabilitation attendance. To prevent social inequality, cardiac rehabilitation should be accommodated to patients with a history of unhealthy behaviour and low self-efficacy. In addition, the rehabilitation programme should be offered in locations not requiring a long commute.

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Social inequality in phase II cardiac rehabilitation attendance: The impact of potential mediators

Cited by 19 publications

References 32 publications

Tele-rehabilitation and hospital-based cardiac rehabilitation are comparable in increasing patient activation and health literacy: A pilot study

Tele-rehabilitation and hospital-based cardiac rehabilitation are comparable in increasing patient activation and health literacy: A pilot study

Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients

Mechanisms and drivers of social inequality in phase II cardiac rehabilitation attendance: A convergent mixed methods study

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