title: A qualitative study exploring why people do not participate in cardiac rehabilitation and coronary heart disease self-help groups, and their rehabilitation experience without these resources.
abstract: BACKGROUND
  Secondary prevention and self-management of coronary heart disease (CHD) are of major importance to people who survive myocardial infarction (MI). This can be facilitated by cardiac rehabilitation (CR; the formal health service programme) and informal CHD self-help groups. Non-participation is an important issue, yet it is poorly understood. Rehabilitation difficulties and prevention challenges have been identified among people following MI, but the particular experience and perspective of CR and CHD group non-participants are largely unknown.
  
  
  OBJECTIVE
  The study aimed to understand non-participation in CR and CHD self-help groups from the perspectives of the non-participants and to provide insight into their experience and that of their 'significant others' in rehabilitating in the absence of these resources.
  
  
  METHODS
  In-depth interviews were conducted with 27 people who had not participated in either hospital-based CR or a CHD group, 6-14 months post-MI, and 17 'significant others' in Lothian, Scotland.
  
  
  RESULTS
  Factors influencing non-participation fell into three broad themes 'No need/no point', 'Not worth it', and 'Not possible'. In the latter two categories, non-participation in these resources was often considered a 'missed opportunity' and needs had remained unmet. Shifts between categories could occur over time. Non-participation was linked to rehabilitation difficulties for some people and family members. Recommendations to enhance post-MI support are made.
authors.affiliation: The Research Unit in Health, Behaviour and Change, The University of Edinburgh, Edinburgh, UK. angelajackson2@nhs.net
authors.forename: Angela Mary
authors.initials: AM
authors.lastname: Jackson
authors.forename: Brian
authors.initials: B
authors.lastname: McKinstry
authors.forename: Susan
authors.initials: S
authors.lastname: Gregory
authors.forename: Amanda
authors.initials: A
authors.lastname: Amos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003327:Coronary Disease / Q000534:rehabilitation*; D005190:Family / Q000523:psychology*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000534:rehabilitation*; D010349:Patient Compliance / Q000523:psychology*; D036301:Qualitative Research; D012606:Scotland; D055502:Secondary Prevention / Q000379:methods; D012657:Self-Help Groups / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires