Cardiac rehabilitation and the therapeutic environment: the importance of physical, social, and symbolic safety for programme participation among women.
OBJECTIVE
To report an exploration of the multidimensionality of safety in cardiac rehabilitation programmes as perceived by women who were enrolled in the Women's Cardiovascular Health Initiative in Toronto, Canada.


BACKGROUND
Cardiovascular disease is the leading cause of death among women. Although cardiac rehabilitation is clinically effective, significantly fewer women than men participate in available programmes. The literature identifies factors affecting women's cardiac rehabilitation participation, and provides possible explanations for this gender disparity. Although safety is mentioned among the barriers to women's cardiac rehabilitation participation, the extent to which safety contributes to programme participation, completion, and maintenance remains under-explored in the cardiac rehabilitation literature.


METHODS
We conducted an exploratory qualitative study to examine the role safety and place play for women engaged in cardiac prevention and rehabilitation at the Women's Cardiovascular Health Initiative. Methods.  From 2005-2006, 14 participants engaged in semi-structured, qualitative interviews lasting 30-90 minutes. Discussions addressed women's experiences at the Women's Cardiovascular Health Initiative. Interview transcripts were analysed using thematic analysis.


RESULTS
Three themes were developed: 'Safety', which was sub-categorized according to physical, social, and symbolic interpretations of safety, 'searching for a sense of place', and 'confidence and empowerment'.


CONCLUSIONS
Feeling physically, socially, and symbolically safe in one's cardiac rehabilitation environment may contribute to programme adherence and exercise maintenance for women. Focusing on comprehensive notions of safety in future cardiac rehabilitation research could offer insight into why many women do not maintain an exercise regimen in currently structured cardiac rehabilitation and community programmes.
Dalla Lana School of Public Health & the Joint Centre for Bioethics, University of Toronto, Ontario, Canada. erica.sutton@utoronto.ca
Erica J
EJ
Sutton
Danielle E
DE
Rolfe
Mireille
M
Landry
Leonard
L
Sternberg
Jennifer A D
JA
Price
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005081:Exercise Therapy / Q000458:organization & administration; D005260:Female; D006272:Health Facility Environment / Q000458:organization & administration*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D057240:Patient Preference; D011209:Power, Psychological; D011322:Primary Prevention / Q000458:organization & administration; D036301:Qualitative Research; D012047:Rehabilitation Centers / Q000458:organization & administration; D012449:Safety; D014930:Women / Q000523:psychology*; D014932:Women's Health Services / Q000458:organization & administration* / Q000592:standards