title: A qualitative study exploring factors that influence enrollment in outpatient cardiac rehabilitation.
abstract: OBJECTIVE
  This study explored patients' decision-making about whether or not to enroll in cardiac rehabilitation (CR), an underutilized program that is associated with significantly improved health outcomes.
  
  
  METHODS
  Face-to-face interviews were conducted with acute coronary syndrome patients (n = 14) after referral to a local CR center, but prior to program enrollment. Thematic analysis was used to derive themes from interview transcripts.
  
  
  RESULTS
  Three themes emerged including anticipated benefit, perceived ability, and contextual influences. Participants believed key benefits of CR would be access to specialist health care providers, improved longevity, reduced cardiovascular risk, as well as improved motivation, accountability, learning opportunities, and general fitness. Participants were concerned about their ability to engage in and travel to exercise sessions, pay the program fee, and manage scheduling conflicts. Contextual influences on decision-making included health care provider recommendation, first impressions of the CR center, knowledge gaps about what CR entails, input from family and peers, and psychological distress.
  
  
  CONCLUSIONS
  The period following CR referral but prior to enrollment represents an optimal opportunity to promote in-the-moment decisions in favor of CR. Patients report both positive and negative aspects of CR, suggesting individualized efforts to resolve ambivalence may increase program participation. Implications for Rehabilitation Cardiovascular disease is a leading cause of mortality worldwide. Cardiac rehabilitation (CR) is an effective secondary prevention strategy to improve cardiovascular morbidity and mortality, but only a subset of eligible patients enroll. After referral but prior to enrollment, patients anticipate both positive and negative aspects of CR participation. Individualized efforts to resolve ambivalence, address knowledge gaps, and problem-solve barriers may increase uptake into CR programs.
authors.affiliation: a Department of Psychology , University of Calgary , Calgary , Alberta , Canada.
authors.forename: Codie R
authors.initials: CR
authors.lastname: Rouleau
authors.affiliation: b Faculty of Nursing and Department of Community Health Sciences , University of Calgary , Calgary , Alberta , Canada.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: King-Shier
authors.affiliation: a Department of Psychology , University of Calgary , Calgary , Alberta , Canada.
authors.forename: Lianne M
authors.initials: LM
authors.lastname: Tomfohr-Madsen
authors.affiliation: c Total Cardiology Rehabilitation , Calgary , Alberta , Canada.|d Department of Cardiac Sciences , University of Calgary , Alberta , Canada.
authors.forename: Sandeep G
authors.initials: SG
authors.lastname: Aggarwal
authors.affiliation: e Department of Physical Therapy, College of Applied Health Sciences , University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.affiliation: a Department of Psychology , University of Calgary , Calgary , Alberta , Canada.
authors.forename: Tavis S
authors.initials: TS
authors.lastname: Campbell
mesh_terms: D054058:Acute Coronary Syndrome / Q000534:rehabilitation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002170:Canada; D000072038:Cardiac Rehabilitation; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation
keywords: Cardiac rehabilitation; acute coronary syndrome; enrollment; qualitative study