title: 'Just not for me' - contributing factors to nonattendance/noncompletion at phase III cardiac rehabilitation in acute coronary syndrome patients: a qualitative enquiry.
abstract: OBJECTIVE
  To explore what reasons do nonattenders and noncompleters give for their patterns of participation or nonparticipation in cardiac rehabilitation programmes and how future uptake could be enhanced.
  
  
  BACKGROUND
  Cardiac rehabilitation is a cost-effective clinical intervention designed for adults with acute coronary syndrome. Despite evidence from meta-analyses demonstrating that cardiac rehabilitation programmes facilitate physical and psychological recovery from acute coronary syndrome, only 20-50% of eligible patients attend Phase III outpatient programmes.
  
  
  METHODS
  A qualitative study using thematic analysis.
  
  
  METHODS
  Within the context of a larger mixed-method study, acute coronary syndrome patients were recruited between 2012-2014 from three hospitals in Scotland. Of 214 patients who consented to enrol in the main study, a purposive subsample of 25 participants was recruited. Semi-structured interviews were conducted and analysed using thematic analysis.
  
  
  RESULTS
  Three major influences of participation were identified: (1) personal factors, (2) programme factors and (3) practical factors. In addition, valuable suggestions for future programme modifications were provided. A significant barrier to attending cardiac rehabilitation programmes is that participants perceived themselves to be unsuitable for the programme alongside a lack of knowledge and/or misconceptions regarding cardiac rehabilitation.
  
  
  CONCLUSIONS
  The responses of nonattenders and noncompleters revealed misconceptions related to programme suitability, the intensity of exercise required and the purpose of a cardiac rehabilitation programme. As long as these misconceptions continue to persist in coronary syndrome patients, this will impact upon attendance. The lack of perceived need for cardiac rehabilitation stems from a poor understanding of the programme, especially among nonattenders and noncompleters and subsequently an inability to comprehend possible benefits.
  
  
  CONCLUSIONS
  The knowledge of common misconceptions puts clinical nurses in a better position to identify and pro-actively address these erroneous assumptions in their patients in order to improve participation in cardiac rehabilitation.
authors.affiliation: School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK.|Institute of General Practice (ifam), Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Oliver Rudolf
authors.identifier: http://orcid.org/0000-0003-3041-4098
authors.initials: OR
authors.lastname: Herber
authors.affiliation: Ninewells Hospital and Medical School, Dundee DD1 9SY and School of Nursing & Health Sciences, University of Dundee, Dundee, Scotland.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
authors.affiliation: Department of Ageing and Health, Ninewells Hospital and Medical School, Dundee, UK.
authors.forename: Myra
authors.initials: M
authors.lastname: White
authors.affiliation: School of Nursing & Health Sciences, University of Dundee, Dundee, UK.
authors.forename: Martyn C
authors.identifier: http://orcid.org/0000-0001-7759-3797
authors.initials: MC
authors.lastname: Jones
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology / Q000534:rehabilitation*; D000328:Adult; D000368:Aged; D000072038:Cardiac Rehabilitation / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D036301:Qualitative Research; D012606:Scotland
keywords: acute coronary syndrome; barriers; cardiac rehabilitation programme; cardiovascular disease; face-to-face interviews; facilitators; nonattendance; noncompletion; patient participation; qualitative research