Feasibility and Acceptability of the Cardiac Rehabilitation Especially for Women (CREW) Web-Based Program in Rural and Remote Communities: A Mixed-Method Study

Background & Aims Women remain under-represented in cardiac rehabilitation, particularly those in rural or remote communities. Geographic distance and the lack of women-focused programs are major barriers. Home-based cardiac rehabilitation using telehealth and gender-tailored approaches may help address these challenges. This study aimed to evaluate the feasibility and acceptability of a co-designed, web-based CREW (Cardiac Rehabilitation Especially for Women) program tailored for women in rural and remote communities. Methods This was a mixed-methods study, comprising an observational prospective study with matched historical controls, followed by qualitative interviews. Women residing in rural or remote South Australia (SA), who were referred to cardiac rehabilitation through the integrated Cardiovascular Clinical Network (iCCNet) between November 2023 and November 2024, were invited to use the CREW program. The program included four educational modules designed to support self-management. The control group consisted of women referred to cardiac rehabilitation before CREW implementation, matched to the CREW group by age and referral reasons. Cardiac rehabilitation initiation and completion were assessed using digital records. Semi-structured online interviews with enrolled women and clinicians delivering cardiac rehabilitation explored program feasibility, acceptability, and perceived value. Results Forty women enrolled in CREW, of whom 33 (82.5%) initiated cardiac rehabilitation through any mode. Twenty-seven women used the CREW program only, while 18 also participated in other SA Health CR programs. Overall, 24 participants (60.0%) completed cardiac rehabilitation. In the control group (n=114), 64 women (56.1%) initiated cardiac rehabilitation and 52 (45.6%) completed. The modified Poisson regression analysis suggested that cardiac rehabilitation initiation was higher in the CREW group than in the control group (RR 1.47; 95% CI 1.12 to 1.95; p-value 0.006). However, there was little evidence of a difference in cardiac rehabilitation completion between the two groups (RR 1.28; 95% CI 0.87 to 1.87; p-value 0.211). Participants reported high satisfaction (4.5/5) with most program components. Qualitative analysis identified five themes: empowering women in cardiac rehabilitation; value of telehealth-based CR for women's participation; staffing and system-level challenges; digital divide; and recommendations for program enhancement. Conclusions The CREW program was feasible and acceptable to women and clinicians. This women-focused, web-based model shows promise for addressing gender disparities in cardiac rehabilitation access in rural and remote communities. Further research is needed to evaluate clinical effectiveness, engagement, and scalability.