'DNA' may not mean 'did not participate': a qualitative study of reasons for non-adherence at home- and centre-based cardiac rehabilitation

BACKGROUND: Cardiac rehabilitation (CR) has been shown to improve prognosis and function following an acute myocardial infarction or revascularization. However, participation in CR programmes is low and adherence is poor. OBJECTIVE: To explore patients' reasons for non-participation in or non-adherence to a home- or hospital-based CR programme. METHODS: Individual semi-structured interviews were conducted with 49 patients participating in the Birmingham Rehabilitation Uptake Maximisation Study of home-based compared with hospital-based CR trial who had not completed their CR programme. Participants included 16 women, 11 aged 70 years or over with 15 from ethnic minority groups. RESULTS: Patients gave a wide range of reasons for not completing their rehabilitation programme. Many patients had other health problems, such as arthritis, and continuing cardiac problems which prevented them from exercising as much as expected. The majority of non-adherers found some aspects of their CR programme helpful and had made lifestyle changes. Lack of motivation to exercise was the main reason for patients not adhering to the home programme, particularly in the women. Domestic duties in women and ill health in ethnic minority patients were also common reasons for non-adherence. CONCLUSIONS: Reasons for non-participation/non-adherence were generally multifactorial and individualistic. Many patients who had not attended or not adhered to their CR programme had participated in rehabilitative activities in other ways. Social characteristics, individual patient needs and preferences and the location of CR programmes need to be taken into account in programme design to maximize participation.