title: Perceptions of barriers to cardiac rehabilitation use in Brazil.
abstract: Cardiovascular diseases (CVD) are the leading cause of mortality in middle-income countries, such as Brazil. However, given the diversity in health care systems in Brazil, access to proven services, such as cardiac rehabilitation (CR), varies widely.
  
  
  OBJECTIVE
  To describe and compare multilevel barriers to CR enrollment and participation in three Brazilian cohorts: (1) cardiac outpatients not attending CR (public or private system); (2) cardiac outpatients paying for CR; and (3) residents at high-risk of CVD with access to a free comprehensive exercise program but not making use of the program.
  
  
  METHODS
  Brazilian residents from two cities were invited to participate - Florianopolis, an urban center; and Luzerna, a rural center. Respondents completed a survey including the Cardiac Rehabilitation Barriers Scale. Mann-Whitney U tests were used to compare barriers between cohorts cross-sectionally.
  
  
  RESULTS
  Six hundred twenty-eight Brazilians consented to participate: 237 (37.7%) from Florianopolis, of which 139 (22.1%) participated in CR; and 391 (62.3%) from Luzerna. The mean total CR barriers for the sample were 1.66 ± 0.6 and differed significantly by cohort (P < 0.001). CR nonattendees from Florianopolis (eg, distance and not knowing about CR) and participants from Luzerna (eg, work and family responsibilities) reported significantly higher barriers than CR attendees from Florianopolis.
  
  
  CONCLUSIONS
  CR nonattendees reported significantly greater barriers than CR attendees. It is hoped that the provision of CR will increase, and that the development of the programs will be in a manner which mitigates the chief barriers identified herein.
authors.affiliation: Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada. Gabriela.meloghisi@utoronto.ca
authors.forename: Gabriela Lima de Melo
authors.initials: GL
authors.lastname: Ghisi
authors.forename: Rafaella Zulianello
authors.initials: RZ
authors.lastname: dos Santos
authors.forename: Eduardo Eugênio
authors.initials: EE
authors.lastname: Aranha
authors.forename: Alessandra Daros
authors.initials: AD
authors.lastname: Nunes
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.forename: Magnus
authors.initials: M
authors.lastname: Benetti
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D001938:Brazil; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005081:Exercise Therapy; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006331:Heart Diseases / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D010465:Perception; D017149:Private Sector; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D019037:Urban Health Services
keywords: barriers; cardiac rehabilitation; comparison study; enrollment; participation
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