title: Strategic Moments: IDENTIFYING OPPORTUNITIES TO ENGAGE CLIENTS IN ATTENDING CARDIAC REHABILITATION AND MAINTAINING LIFESTYLE CHANGES.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Susan Marilyn
authors.initials: SM
authors.lastname: Fletcher
authors.forename: Helen
authors.initials: H
authors.lastname: McBurney
mesh_terms: D000368:Aged; D000072038:Cardiac Rehabilitation; D019091:Critical Pathways / Q000458:organization & administration; D003657:Decision Making; D005260:Female; D006297:Health Services Accessibility; D000070497:Healthy Lifestyle; D006331:Heart Diseases / Q000534:rehabilitation*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology*; D010353:Patient Education as Topic; D010358:Patient Participation; D018802:Patient-Centered Care; D012017:Referral and Consultation; D040242:Risk Reduction Behavior