title: Reframing the dilemma of poor attendance at cardiac rehabilitation: an exploration of ambivalence and the decisional balance.
abstract: OBJECTIVE
  To discuss the problem of poor attendance at cardiac rehabilitation from the alternative perspective of patient ambivalence.
  
  
  BACKGROUND
  Evidence supports the benefits of cardiac rehabilitation as a means for secondary prevention of coronary heart disease, yet current literature continues to document poor attendance at these programmes. Whilst extrinsic factors, such as transportation and lack of physician support have been identified as barriers, patients who choose not to attend these programmes are often described as lacking motivation or being non-compliant. However, it is possible that non-attendance is the result of ambivalence - the experience of simultaneously wanting to and yet not wanting to, or the 'I want to, but I don't want to' dilemma.
  
  
  METHODS
  Discussion paper.
  
  
  METHODS
  This discussion paper draws on the literature of ambivalence and decision-making theory to reframe the issue of poor attendance at cardiac rehabilitation.
  
  
  CONCLUSIONS
  This paper has demonstrated that the problem of poor attendance may be explained from the perspective of patient ambivalence and that using strategies such as the decisional balance may assist these individuals in exploring their ambivalence to engage in secondary prevention programmes.
  
  
  CONCLUSIONS
  Understanding the dynamics of ambivalence provides an alternative to thinking of patients as lacking motivation, being non-compliant, or even resistant. Helping patients to explore and resolve their ambivalence may be all that is needed to help them make a decision and move forward.
authors.affiliation: School of Nursing, University of Western Sydney, Bankstown Campus, Building 3, Locked Bag 1797, Penrith South DC 1797, Sydney, NSW, Australia. b.everett@uws.edu.au
authors.forename: Bronwyn
authors.initials: B
authors.lastname: Everett
authors.forename: Yenna
authors.initials: Y
authors.lastname: Salamonson
authors.forename: Robert
authors.initials: R
authors.lastname: Zecchin
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
mesh_terms: D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000451:nursing; D006801:Humans; D010349:Patient Compliance