Article

Greater participation in cardiac rehabilitation improves morbidity
and mortality in people with coronary heart disease,
but little is understood of
patients' decisions to participate. METHODS: To develop interventions aimed at
increasing completion of programmes, we conducted a qualitative systematic review
and meta-synthesis to explore the complex factors and processes influencing
participation in cardiac rehabilitation programmes after referral and initial
access. To be included in the review, studies had to contain a qualitative
research component, population specific data on programme participation in adults
>18 years, and be published >/=1995 as full articles or theses. Ten databases
were searched (31 October 2011) using 100+ search terms. RESULTS: Of 2264
citations identified, 62 studies were included involving: 1646 patients (57%
female; mean age 64.2), 143 caregivers, and 79 professionals. Patients'
participation was most strongly influenced by perceptions of the nature,
suitability and scheduling of programmes, social comparisons made possible by
programmes, and the degree to which programmes, providers, and programme users
met expectations. Women's experiences of these factors rendered them less likely
to complete. Comparatively, perceptions of programme benefits had little
influence on participation. Conclusions: Factors reducing participation in
programmes are varied but amenable to intervention. Participation should be
viewed as a 'consumer behaviour' and interventions should mobilize family
support, promote 'patient friendly' scheduling, and actively harness the social,
identity-related, and experiential aspects of participation.

Langue : ANGLAIS