I don't have to be terribly mobile do I?: a qualitative study on attitudes and beliefs about CR in heart failure
Authors: Waterhouse H , Barradell A , Squire I , Singh S 
Published: July 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart Foundation

Background
Factors affecting uptake of cardiac rehabilitation (CR) have been well researched in the post myocardial infarction population (1). However this is less well studied in people with chronic heart failure (CHF), who have poor engagement with this evidence based intervention (2). This qualitative study is part of a larger mixed methods study aimed at developing an intervention to improve uptake of CR by people with CHF.

Purpose
To investigate the influences of patient attitudes and beliefs on the uptake of CR in people with chronic heart failure.

Methods
An interpretive descriptive approach was taken (3). A purposive sample of participants from a tertiary hospital were recruited (at least 6 weeks post discharge from acute admission for heart failure) with representation according to gender, age and CR status. Semi-structured telephone interviews explored the reasons for accepting or rejecting an offer to participate in CR.
Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis (4). Analysis was validated by blinded collaborator coding and discussions in order to reach consensus of themes/ sub-themes.

Results
15 participant interviews were analysed. 9 were male, ages ranged from 56 to 86 years, 8 had accepted referral to CR.
Four themes were generated (Table 1 and 2)
1. Beliefs and expectations of CR: focused on participants’ understanding of what CR is and how it can benefit them. Subthemes included lack of knowledge of content or purpose of CR, focus on exercise component of the programme, uncertainty about tailoring to individual capability and needs, recognition of broader aspects of CR programme, alignment with perceived need to increase activity level/exercise.
2. Perception of health condition: focused on the relationship between participants approach to their health condition and how they perceived the need for regular exercise/activity. Subthemes include symptom burden, 'recovery' from CHF, 'chronicity' of condition, adapting to cope, no need for improving functional capacity.
3. Perception of self: focused on intrapersonal factors that impact the decision to take up CR. Subthemes include need for motivation to exercise, need to please others, social being, self-reliance and locus of control.
4. External factors: Subthemes included timing of offer, choice of CR format.

Conclusions
Study participants tended to view CR as a means of symptom management through exercise. They felt symptoms were influenced by medical management and passage of time (recovery) and those who had no improvement in symptoms had adapted their life to accommodate limitations to their functional ability (chronicity). CR was engaged in either to further improve symptoms or to make a change to the status quo. Considering both the point in the disease trajectory and the symptom burden of people with chronic heart failure may enable more targeted interventions to improve uptake of CR in this population.