Perceptions of barriers to cardiac rehabilitation use in Brazil

Vasc Health Risk Manag. 2013:9:485-91. doi: 10.2147/VHRM.S48213. Epub 2013 Aug 30.

Abstract

Cardiovascular diseases (CVD) are the leading cause of mortality in middle-income countries, such as Brazil. However, given the diversity in health care systems in Brazil, access to proven services, such as cardiac rehabilitation (CR), varies widely.

Purpose: To describe and compare multilevel barriers to CR enrollment and participation in three Brazilian cohorts: (1) cardiac outpatients not attending CR (public or private system); (2) cardiac outpatients paying for CR; and (3) residents at high-risk of CVD with access to a free comprehensive exercise program but not making use of the program.

Methods: Brazilian residents from two cities were invited to participate - Florianopolis, an urban center; and Luzerna, a rural center. Respondents completed a survey including the Cardiac Rehabilitation Barriers Scale. Mann-Whitney U tests were used to compare barriers between cohorts cross-sectionally.

Results: Six hundred twenty-eight Brazilians consented to participate: 237 (37.7%) from Florianopolis, of which 139 (22.1%) participated in CR; and 391 (62.3%) from Luzerna. The mean total CR barriers for the sample were 1.66 ± 0.6 and differed significantly by cohort (P < 0.001). CR nonattendees from Florianopolis (eg, distance and not knowing about CR) and participants from Luzerna (eg, work and family responsibilities) reported significantly higher barriers than CR attendees from Florianopolis.

Conclusion: CR nonattendees reported significantly greater barriers than CR attendees. It is hoped that the provision of CR will increase, and that the development of the programs will be in a manner which mitigates the chief barriers identified herein.

Keywords: barriers; cardiac rehabilitation; comparison study; enrollment; participation.

Publication types

  • Comparative Study
  • Video-Audio Media

MeSH terms

  • Aged
  • Ambulatory Care
  • Brazil
  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Exercise Therapy*
  • Female
  • Health Behavior*
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice*
  • Health Services Accessibility
  • Heart Diseases / psychology
  • Heart Diseases / rehabilitation*
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / psychology*
  • Patients / psychology*
  • Perception*
  • Private Sector
  • Rural Health Services
  • Surveys and Questionnaires
  • Urban Health Services