Barriers to participation in cardiac rehabilitation : a rural perspective

Abstract

Cardiovascular disease is a significant health problem in rural states and complicated by the lack of access to specialized health care services such as cardiac rehabilitation programs. Researchers have documented that education, counseling, and behavioral interventions are important elements of cardiac rehabilitation (CR) that lead to decreased mortality and increased quality of life. Despite the known benefits of participation, only 10-20% of eligible persons in the United States participate in CR. While evidence exists to partially explain participation in cardiac rehabilitation programs, a major limitation of most studies reported in the literature is that they were conducted primarily in large urban areas. As a result, findings from these studies cannot be generalized to rural dwellers resulting in limited research examining participation in cardiac rehabilitation amongst rural persons.The purpose of this study was to explore rural persons' perceptions of community level barriers to participation in cardiac rehabilitation programs. A non-random convenience sample of persons admitted to a regional acute care hospital in south central Montana for treatment of an acute coronary event or exacerbation of a chronic cardiovascular condition were asked to participate in the study. Participants completed surveys containing questions regarding rurality and perceived community level barriers to participation in CR. Comparisons of rural and non-rural persons were statistically significant in the areas of distance and access to resources. These results suggest that rural persons may perceive distance and lack of access to resources as more of a barrier to participation in cardiac rehabilitation. The implications for nursing include identifying new ways to deliver specialized health care services that increase accessibility to rural persons such as flexible scheduling, home classes, and the use of distance technology.