Women are 36% less likely1 to enroll in cardiac rehabilitation programs compared to men, despite its known benefits. “In previous research, patients who participated in 25 or more cardiac rehab sessions had a reduced relative risk of death in the next five years by 19%,” says Lee Anne Siegmund, PhD, RN, ACSM-CEP, Nurse Scientist I in the Office of Nursing Research and Innovation at Cleveland Clinic. “We know the benefits of cardiac rehab, and we know that women attend at a significantly lower rate than men. But we don’t know why.”
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Siegmund and her nurse scientist colleagues, Christian Burchill, PhD, MSN, RN, CEN and Sandra Siedlecki, PhD, RN, APRN-CNS, conducted a study to find out why women attend cardiac rehab at such low rates. “Previous research and interventions were directed toward removing barriers to participation,” says Siegmund. “Ours is the first study to explore factors that facilitate – rather than impede – completion and to identify requisite factors specific to women.”
Interviews help researchers understand patient motivation
The nurse scientists used a grounded theory design to develop a theoretical understanding of the decision-making process employed by women who attended 25 or more cardiac rehab sessions. They digitally recorded interview data from 12 women and two men (contrary cases) from a quaternary care center’s Phase-II cardiac program. The researchers asked women a handful of open-ended questions, such as “What motivates you to attend cardiac rehabilitation?” and “Who are the people…” and “What are the things that help you stay motivated to attend?”
Researchers utilized a constant comparative method, collecting data and analyzing it simultaneously. “After interviewing 12 women, we felt we had achieved saturation,” says Siegmund. “No new themes were surfacing.”
Data analysis revealed several requisite conditions for completion of cardiac rehab by women. “It was interesting to see the facilitators of participation, but more importantly, the factors that were requisite for completion,” says Siegmund.
Findings could help improve the cardiac rehab experience
Siegmund, Burchill and Siedlecki are currently drafting the manuscript of their findings and plan to present the findings nationally. They created a visual model for the requisite conditions for completion of cardiac rehabilitation for women and believe the findings will be helpful for designing interventions that will help women complete cardiac rehab.
“Once women are in cardiac rehab, this might be helpful in keeping them there,” says Siegmund.
- Can J Cardiol. 2014 Jul;30(7):793-800. doi: 10.1016/j.cjca.2013.11.007. Epub 2013 Nov 12.