title: Barriers for Nonparticipation and Dropout of Women in Cardiac Rehabilitation Programs: A Systematic Review.
abstract: Cardiovascular disease (CVD) is a major health problem worldwide. Cardiac rehabilitation (CR) programs are effective in reducing mortality and improving the quality of life of patients with CVD. Women are under-represented in CR and have a higher dropout rate than men. We aimed to systematically review the literature on barriers perceived by women with CVD affecting their nonparticipation in and/or dropping out from CR programs.
  
  
  
  Systematic review was done using MEDLINE, Embase, Scopus, Open Grey, and Cochrane Database from inception to September 2016. Search terms included (1) heart disease and other cardiac conditions, (2) CR and secondary prevention, and (3) nonparticipation in and/or dropout. Databases were searched following the "participants, interventions, comparisons, outcomes, and study design" method.
  
  
  
  A total of 24 studies (17 descriptive, 6 qualitative, and 1 randomized controlled trial) reporting several barriers were grouped into five broad categories: intrapersonal barriers (self-reported health, health beliefs, lack of time, motivation, and religious reasons); interpersonal barriers (lack of family/social support and work conflicts); logistical barriers (transport, distance, and availability of personal/community resources); CR program barriers (services offered, group format, exercise component, and CR sessions); and health system barriers (lack of referral, cost, negative experiences with the health system, and language). We found differences between the barriers related to nonparticipation in and dropout from CR programs.
  
  
  
  Women reported multilevel barriers for nonparticipation in and dropout from CR programs. Future clinical guidelines should evaluate and eliminate these barriers to improve adherence to CR programs in women. In addition, understanding the barriers for nonparticipation and dropout may be beneficial for future intervention trials.
authors.affiliation: 1 Departamento de Psicología, Universidad Loyola Andalucía , Sevilla, Spain .
authors.forename: Davinia M
authors.initials: DM
authors.lastname: Resurrección
authors.affiliation: 1 Departamento de Psicología, Universidad Loyola Andalucía , Sevilla, Spain .|2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain .
authors.forename: Emma
authors.initials: E
authors.lastname: Motrico
authors.affiliation: 1 Departamento de Psicología, Universidad Loyola Andalucía , Sevilla, Spain .
authors.forename: Alina
authors.initials: A
authors.lastname: Rigabert
authors.affiliation: 2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain .|3 Research and Development Unit , Fundació Sant Joan de Déu, Barcelona, Spain .
authors.forename: Maria
authors.initials: M
authors.lastname: Rubio-Valera
authors.affiliation: 4 Instituto de Investigación Biomédica de Málaga (IBIMA) , Málaga, Spain .
authors.forename: Sonia
authors.initials: S
authors.lastname: Conejo-Cerón
authors.affiliation: 5 Hospital Nuestra Señora de Valme , Sevilla, Spain .
authors.forename: Luis
authors.initials: L
authors.lastname: Pastor
authors.affiliation: 2 Primary Care Prevention and Health Promotion Research Network (RedIAPP) , Barcelona, Spain .|4 Instituto de Investigación Biomédica de Málaga (IBIMA) , Málaga, Spain .
authors.forename: Patricia
authors.initials: P
authors.lastname: Moreno-Peral
mesh_terms: D001294:Attitude to Health; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases; D003327:Coronary Disease / Q000534:rehabilitation; D015444:Exercise; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D009042:Motivation; D009203:Myocardial Infarction / Q000534:rehabilitation; D010349:Patient Compliance; D010352:Patient Dropouts; D011788:Quality of Life; D012944:Social Support
keywords: adherence; cardiac rehabilitation; dropout; nonparticipation; systematic review; women