Cardiac rehabilitation participation and adherence in women are hindered by multilevel intrapersonal, interpersonal, logistical, program, and health system barriers across 24 reviewed studies.
Systematic Review
What are the barriers perceived by women with cardiovascular disease affecting their nonparticipation in and/or dropping out from cardiac rehabilitation programs?
Women face multilevel barriers (intrapersonal, interpersonal, logistical, program-related, and health system) to participating in and completing cardiac rehabilitation programs.
BACKGROUND: Cardiovascular disease (CVD) is a major health problem worldwide. Cardiac rehabilitation (CR) programs are effective in reducing mortality and improving the quality of life of patients with CVD. Women are under-represented in CR and have a higher dropout rate than men. We aimed to systematically review the literature on barriers perceived by women with CVD affecting their nonparticipation in and/or dropping out from CR programs. METHODS: Systematic review was done using MEDLINE, Embase, Scopus, Open Grey, and Cochrane Database from inception to September 2016. Search terms included (1) heart disease and other cardiac conditions, (2) CR and secondary prevention, and (3) nonparticipation in and/or dropout. Databases were searched following the "participants, interventions, comparisons, outcomes, and study design" method. RESULTS: A total of 24 studies (17 descriptive, 6 qualitative, and 1 randomized controlled trial) reporting several barriers were grouped into five broad categories: intrapersonal barriers (self-reported health, health beliefs, lack of time, motivation, and religious reasons); interpersonal barriers (lack of family/social support and work conflicts); logistical barriers (transport, distance, and availability of personal/community resources); CR program barriers (services offered, group format, exercise component, and CR sessions); and health system barriers (lack of referral, cost, negative experiences with the health system, and language). We found differences between the barriers related to nonparticipation in and dropout from CR programs. CONCLUSIONS: Women reported multilevel barriers for nonparticipation in and dropout from CR programs. Future clinical guidelines should evaluate and eliminate these barriers to improve adherence to CR programs in women. In addition, understanding the barriers for nonparticipation and dropout may be beneficial for future intervention trials.
Resurrección et al. (Fri,) conducted a systematic review in Cardiovascular disease (CVD). Cardiac rehabilitation programs was evaluated on Barriers for nonparticipation in and dropout from cardiac rehabilitation programs. Cardiac rehabilitation participation and adherence in women are hindered by multilevel intrapersonal, interpersonal, logistical, program, and health system barriers across 24 reviewed studies.