Evidence-informed development of women-focused cardiac rehabilitation education
Authors: Ghisi G L M , Hebert A A , Oh P , Colella T , Aultman C , Carvalho C , Nijhawan R , Ross M K , Grace S L 
Published: June 2024

Abstract

Background
Cardiovascular rehabilitation (CR) is an outpatient model of secondary preventive care proven to mitigate the burden of cardiovascular disease (CVD). Despite their differential risk factor burden, context and often different forms of heart disease, CR programs generally do not provide women with needed secondary prevention information specific to them.

Purpose
to co-design evidence-informed, theoretically-based women-focused education for the secondary prevention of CVD. Broadly, we aim to build capacity in women-focused CR education for patients who identify as women and their care partners, multi-disciplinary healthcare professionals and trainees involved in delivery of CR, as well as decision-makers.

Methods
A multi-disciplinary, multi-stakeholder steering committee (N=18) oversaw the four-phase development of the women-focused curriculum, called ‘Cardiac College for Women’. Phase 1 involved a literature review on women’s CR information needs and preferences, phase 2 a CR program needs assessment, phase 3 content development (including determining content and mode, assigning experts to create the content, plain language review and translation), and phase 4 will comprise evaluation and implementation. In phase 2, a focus group was conducted with Canadian CR providers; it was analyzed using Braun and Clarke’s iterative approach.

Results
Nineteen providers participated in the focus group, with four themes emerging: current status of education (most CR programs tended not to have specific education for women, or an organizational culture to educate women differently than men), challenges to delivering women-focused education (cost, time, human resources, internet access / barriers to dissemination of education resources, lack of staff training on women’s health and lack of support from their institution), delivery modes and topical resources (women want a multi-modal interactive approach, which incorporates time for motivational discussions along with the education). Results were consistent with those from our related global survey, supporting saturation of themes. Co-designed educational materials included 19 videos. These were organized across 5 webpages in English and French, specific to tests and treatments, exercise, diet, psychosocial well-being, and self-management. Twelve corresponding session slide decks with notes for clinicians were created, to support program delivery in CR flexibly.

Conclusion
Cardiac College for Women is a multi-modal, accessible, co-designed, evidence-based, plain language, theoretically-informed educational curriculum with resources available in all areas of CVD secondary prevention. It can be delivered based on women’s preferences for modalities and content, as well as CR program realities (e.g., staff, dose). While further evaluation is underway to confirm utility and effectiveness, it is hoped these resources will support women to reduce their risk of cardiovascular sequelae.