Fletcher Susan Marilyn, McBurney Helen
Department of Social Work (Dr Fletcher) and Department of Physiotherapy (Dr McBurney), School of Primary Health Care, Monash University and Latrobe Regional Hospital, Moe, Victoria, Australia.
J Cardiopulm Rehabil Prev. 2016 Sep-Oct;36(5):346-51. doi: 10.1097/HCR.0000000000000169.
There has been extensive investigation of attendance rates at cardiac rehabilitation (CR) but little attention to client reasoning around attendance. This study explored decision-making drivers for attendance or nonattendance at CR programs in rural Victoria, Australia.
All new patients referred to the CR programs at either the local hospital or community health service over a 6-month period were invited to participate and were interviewed before, after, and at 6 months post-CR. Content analysis was used to identify and group common themes that emerged from the semistructured interviews.
Eighty-four of the 114 patients referred agreed to participate in the study. Multiple barriers or facilitators affected the decisions of all clients. Three themes were identified that reflected the participant decision-making experience: (1) invitation and information about participation in CR; (2) person-centered approach to CR provision; and (3) ongoing support needs. Significant decision-making points identified were after the cardiac event; before and after hospital-based CR; before and after community-based CR; and at 6 months after the cardiac event. At any time there is a risk that the client can become lost or disengaged in the service system, but providing contact at these points can allow them to reengage.
This study provided the opportunity to hear participant voices, describing their decisions around CR attendance after a cardiac event. They highlighted the complexity of issues confronting them and suggested improvements to optimize their attendance and to maintain lifestyle changes.
人们对心脏康复（CR）的出勤率进行了广泛研究，但对患者参与康复的原因关注较少。本研究探讨了澳大利亚维多利亚州农村地区参加或不参加CR项目的决策驱动因素。
邀请在6个月内转诊至当地医院或社区卫生服务中心CR项目的所有新患者参与研究，并在CR前、CR后及CR后6个月进行访谈。采用内容分析法对半结构化访谈中出现的共同主题进行识别和分组。
114名转诊患者中有84名同意参与研究。多种障碍或促进因素影响了所有患者的决策。确定了三个反映参与者决策体验的主题：（1）关于参与CR的邀请和信息；（2）提供CR的以人为本方法；（3）持续的支持需求。确定的重要决策点包括心脏事件后；医院CR前后；社区CR前后；以及心脏事件后6个月。在任何时候，患者都有在服务系统中迷失或脱离的风险，但在这些时间点提供联系可以让他们重新参与。
本研究提供了倾听参与者声音的机会，描述了他们在心脏事件后关于参加CR的决策。他们强调了面临问题的复杂性，并建议进行改进以优化参与度并维持生活方式的改变。
