A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral

Clark, Alexander M., King-Sshier, Kathryn M., Thompson, David R., Spaling, Melisa A., Duncan, Amanda S., Stone, James A., Jaglal, Susan B. and Angus, Jan E. (2012) A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral. American Heart Journal, 164 6: 835-845.e2. doi:10.1016/j.ahj.2012.08.020

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Author Clark, Alexander M.
King-Sshier, Kathryn M.
Thompson, David R.
Spaling, Melisa A.
Duncan, Amanda S.
Stone, James A.
Jaglal, Susan B.
Angus, Jan E.
Title A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral
Journal name American Heart Journal   Check publisher's open access policy
ISSN 0002-8703
Publication date 2012-12-01
Sub-type Article (original research)
DOI 10.1016/j.ahj.2012.08.020
Volume 164
Issue 6
Start page 835
End page 845.e2
Total pages 13
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Formatted abstract
Background Cardiac rehabilitation and secondary prevention programs can prevent heart disease in high-risk populations. However, up to half of all patients referred to these programs do not subsequently participate. Although age, sex, and social factors are common predictors of attendance, to increase attendance rates after referral, the complex range of factors and processes influencing attendance needs to be better understood.
Methods A systematic review using qualitative meta-synthesis was conducted. Ten databases were systematically searched using 100+ search terms until October 31, 2011. To be included, studies had to contain a qualitative research component and population-specific primary data pertaining to program attendance after referral for adults older than 18 years and be published as full articles in or after 1995.
Results Ninety studies were included (2010 patients, 120 caregivers, 312 professionals). Personal and contextual barriers and facilitators were intricately linked and consistently influenced patients' decisions to attend. The main personal factors affecting attendance after referral included patients' knowledge of services, patient identity, perceptions of heart disease, and financial or occupational constraints. These were consistently derived from social as opposed to clinical sources. Contextual factors also influenced patient attendance, including family and, less commonly, health professionals. Regardless of the perceived severity of heart disease, patients could view risk as inherently uncontrollable and any attempts to manage risk as futile.
Conclusions Decisions to attend programs are influenced more by social factors than by health professional advice or clinical information. Interventions to increase patient attendance should involve patients and their families and harness social mechanisms.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Nursing, Midwifery and Social Work Publications
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Created: Tue, 11 Dec 2012, 00:36:06 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work