Adaptation of an evidence-based home cardiac rehabilitation programme for people with coronary heart disease in Bangladesh

Cardiac rehabilitation (CR) is a clinically proven cost-effective intervention and reduces the risk of hospital readmissions and recurrent cardiac events and improves exercise capacity and health-related quality of life in people. However, access to CR in low and middle-income countries remains scarce and a high unmet need. The purpose of this study was to adapt a home-based CR programme (‘the Heart Manual’) originally developed and evaluated in the United Kingdom (UK) for the people with coronary heart disease (CHD) in Bangladesh. Guided by the 2021 ADAPT methodological framework, a multiphase approach to intervention adaptation was undertaken that included mapping of the Bangladeshi healthcare context and in-depth consultation meetings and workshops with key stakeholders (patients and their families, healthcare professionals, and health service providers). In addition to language translation (English to Bangla) and cultural adaptation, the UK Heart Manual content and structure were modified whilst retaining its core interventional components and principles. The resulting Bangla Heart Manual comprises of three main adaptions: (1) combination of the UK Heart Manual post-myocardial infarction and revascularisation manuals into a single document; (2) development of a short version for easy reference for patients; and (3) creation of audiovisual and animated versions of materials to promote patient accessibility. Using an evidence-based approach, the UK Heart Manual programme was contextually and culturally adapted for people with CHD in the Bangladesh healthcare setting. The Bangla Heart Manual provides the opportunity for access to home-based CR in a low resource setting. Research is needed to confirm the feasibility and acceptability of the delivery of the adapted Bangla Heart Manual for healthcare practitioners, patients, and their families.