Purpose: Despite the well-established benefits of cardiac rehabilitation (CR) and greater need, under-represented populations are less likely to utilize CR compared to their counterparts. To date, there has been limited research to quantify CR barriers in these under-represented groups and there has been lack of research to assess whether barriers differ by program model. This dissertation examined CR utilization and barriers to CR use among rural and urban inhabitants, patients of low socioeconomic status (SES) and high SES, Chinese-Canadian and North American patients, and home-based versus site-based CR.
Method: Cardiac patients from hospitals across Ontario, Canada completed a survey which included the Cardiac Rehabilitation Barriers Scale among other variables for this cross-sectional study.
Results: Findings suggested that rural inhabitants attended significantly fewer CR sessions, and perceived greater CR barriers overall compared to urban inhabitants. These included distance, cost, and transportation problems. In addition, patients of lower SES were less likely to be referred, enroll, and participate in CR, and reported significantly greater barriers to CR compared to their high-SES counterparts. Greater barriers for low-SES patients included severe weather, distance, cost, and transportation problems. Moreover, Chinese-Canadian patients were significantly more likely to be referred to CR compared to North Americans, but there were no significant differences with regard to utilization. Chinese-Canadian patients reported significantly greater CR barriers compared to North Americans, specifically severe weather and transportation problems. Also, appropriately, home-based CR participants reported greater barriers including distance when compared to site-based participants.
Conclusion: Broader application of proven strategies to promote greater CR enrolment and completion is needed, as well as development of tailored interventions to address the primary barriers identified for these vulnerable subpopulations of patients
