Barriers to hospital-based phase II Cardiac Rehabilitation among Coronary Heart Disease patients in China: A Mixed-Methods Study

Aims To investigate barriers to hospital-based phase II cardiac rehabilitation among coronary heart disease patients in China and to explore the deeper reasons. Design An explanatory sequential mixed method design. Methods This study was conducted in a university hospital in China from July 2021 to December 2021.160 patients completed the survey by using the Cardiac Rehabilitation Barrier Scale and then 17 patients participated in the unstructured face- to- face interviews. Inductive qualitative content analysis was used to analyze data. Results Patients who are working or do not have healthcare insurance are less likely to participate in cardiac rehabilitation, while patients after percutaneous coronary intervention or have participated in phase I cardiac rehabilitation were more likely to take the program. The main barriers were distance (3.29±1.565), transportation (2.99±1.503), cost (2.76±1.425), doing exercise at home (2.69±1.509) and time constrain (2.48±1.496). Six themes were identified, logistics factors, social support, misunderstanding of cardiac rehabilitation, program and health system-level factors, impression on cardiac rehabilitation team and psychological distress. The first four themes confirmed the quantitative results and provide a deeper explanation for the quantitative results. The last two themes were new information emerged in the qualitative phase. Conclusion This mixed methods study provided a better understanding of the barriers to hospital-based phase II cardiac rehabilitation among coronary heart disease patients in the Chinese context. It is time to move from barriers to solutions. Innovative program might be considered to overcome some of these barriers. Additionally, psychosocial interventions should be conducted to transform patient’s cognition problems and build trusted nurse(doctor)-patient relationship.