Knowledge, attitude, and practice of cardiac rehabilitation referral among healthcare professionals in China: A mediation model

Objective: Despite proven clinical benefits, cardiac rehabilitation referral rates remained insufficient and low globally. Healthcare professionals' knowledge and attitudes of cardiac rehabilitation may affect their referral behaviors, yet their interrelationships are rarely studied in China. This study aims to examine the cardiac rehabilitation referral rate among Chinese healthcare professionals and explore the associations among knowledge, attitude, and practice (KAP) of cardiac rehabilitation referral. Methods: From July to August 2021, a cross-sectional study was conducted among 321 healthcare professionals from 40 hospitals in Hunan Province of China. The participants completed an online questionnaire to assess their KAP of cardiac rehabilitation referral. Mediation analysis was conducted using logistic regression analysis, Sobel test and Bootstrap method. There was a robust positive association between cardiac rehabilitation knowledge and cardiac rehabilitation referral practice, which was partially mediated by cardiac rehabilitation referral attitude, with the mediating effect accounting for 4.3 %. Conclusion: The low cardiac rehabilitation referral rate among healthcare professionals indicates an urgent need to improve cardiac rehabilitation referral. Our mediation model suggests that enhancing cardiac rehabilitation knowledge and promoting positive attitudes through education and training may effectively promote cardiac rehabilitation referral. Furthermore, the findings underscore the necessity of establishing an organized cardiac rehabilitation system to facilitate structured cardiac rehabilitation implementation and improve patient outcomes.