Why the study?
South Asian individuals outside the Indian subcontinent face higher cardiac-related mortality and hospitalizations yet are under-represented in cardiac rehabilitation, making understanding specific barriers and enablers necessary.
What are the barriers and enablers to cardiac rehabilitation participation and completion in South Asian individuals living outside the Indian subcontinent?
What are the barriers and enablers to cardiac rehabilitation participation and completion in South Asian individuals living outside the Indian subcontinent?
Cultural and societal norms, including language barriers and fatalistic beliefs, significantly influence cardiac rehabilitation participation among South Asian minorities, highlighting the need for culturally tailored services.
Supports culturally tailored CR approaches for South Asians; leaves open questions on effectiveness and implementation pending further study.
AIMS: South Asian individuals living outside the Indian subcontinent are under-represented in cardiac rehabilitation (CR), despite facing higher rates of cardiac-related mortality and hospitalizations compared with White ethnic groups. Understanding how cultural differences affect CR participation and completion after referral requires the examination of barriers and enablers specific to South Asian populations. This review aims to summarize evidence on barriers and enablers to CR for South Asian minorities outside the Indian subcontinent. METHODS AND RESULTS: A systematic review of six databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane, Scopus, and Web of Science) was conducted in January 2024 (updated November 2024), with no language or date limitations. Studies from countries outside the Indian subcontinent were included. Barriers and enablers were identified, followed by thematic analysis. Thirteen studies (n = 384 South Asian participants) from the UK (n = 10) and Canada (n = 3) were included. Five key themes were generated: (i) communication and knowledge, (ii) motivation to attend CR or follow medical advice, (iii) religion, (iv) programme delivery, and (v) practical considerations. Key factors influencing CR participation included language barriers, family support, fatalistic beliefs, and motivation. Each theme encapsulates barriers and enablers and shapes participation at both service and patient level. While some barriers were common across different ethnic groups, they had stronger impact on South Asians due to distinct social determinants of health. CONCLUSION: Barriers and enablers are closely linked to cultural and societal norms. Recognizing these factors enables CR services to better address the needs of underserved populations, ensuring equitable healthcare provision and support. REGISTRATION: PROSPERO CRD42023482611.
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McAllister et al. (2025) studied this question.
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