TY - JOUR
T1 - Experience of exclusion
T2 - a framework analysis of socioeconomic factors affecting cardiac rehabilitation participation among patients with acute coronary syndrome
AU - Pedersen, Maria
AU - Overgaard, Dorthe
AU - Andersen, Ingelise
AU - Baastrup, Marie
AU - Egerod, Ingrid
N1 - Funding Information: This study was funded by the Novo Nordisk Foundation (NNF14OC0011513), the Danish Nurses Organization, the Health Foundation (15-B-0051), research grants from Nordsjællands Hospital and grants from the Department of Cardiology, Nephrology and Endocrinology Nordsjællands Hospital, Denmark.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background: The Danish public healthcare system provides comprehensive care based on the principle of equal access. However, it is well documented that patients with low socioeconomic position are less likely to participate in cardiac rehabilitation. More knowledge is needed to understand this phenomenon. The aim of the study was to explore the patient experience of barriers to completion of phase II cardiac rehabilitation, and to investigate the impact of socioeconomic factors on completion of cardiac rehabilitation.Methods: The study had a qualitative explorative design using semi-structured individual or dyadic interviews with patients (n = 24) and close relatives (n = 12). Informants were sampled from a quantitative prospective study of 302 patients with acute coronary syndrome and data were analyzed using the framework method.Results: Patients in different socioeconomic groups were challenged by a rigid and non-individualized rehabilitation program. A total of five themes were identified that might explain non-participation in cardiac rehabilitation: exclusion by time and place, exclusion by health beliefs, exclusion from counseling, exclusion by alienation, and exclusion of relatives. The themes were described in a matrix of socioeconomic factors of age, sex, education and employment.Conclusions: Patients in various socioeconomic subgroups felt excluded from cardiac rehabilitation for different reasons. This study supports earlier findings and provides examples of real-life issues that need to be addressed to prevent attrition and encourage participation. Equal access to cardiac rehabilitation can only be reached if the physical and psychological needs of patient and family are met by tailoring therapy to consider age, sex, education and employment groups.
AB - Background: The Danish public healthcare system provides comprehensive care based on the principle of equal access. However, it is well documented that patients with low socioeconomic position are less likely to participate in cardiac rehabilitation. More knowledge is needed to understand this phenomenon. The aim of the study was to explore the patient experience of barriers to completion of phase II cardiac rehabilitation, and to investigate the impact of socioeconomic factors on completion of cardiac rehabilitation.Methods: The study had a qualitative explorative design using semi-structured individual or dyadic interviews with patients (n = 24) and close relatives (n = 12). Informants were sampled from a quantitative prospective study of 302 patients with acute coronary syndrome and data were analyzed using the framework method.Results: Patients in different socioeconomic groups were challenged by a rigid and non-individualized rehabilitation program. A total of five themes were identified that might explain non-participation in cardiac rehabilitation: exclusion by time and place, exclusion by health beliefs, exclusion from counseling, exclusion by alienation, and exclusion of relatives. The themes were described in a matrix of socioeconomic factors of age, sex, education and employment.Conclusions: Patients in various socioeconomic subgroups felt excluded from cardiac rehabilitation for different reasons. This study supports earlier findings and provides examples of real-life issues that need to be addressed to prevent attrition and encourage participation. Equal access to cardiac rehabilitation can only be reached if the physical and psychological needs of patient and family are met by tailoring therapy to consider age, sex, education and employment groups.
KW - Cardiac rehabilitation
KW - acute coronary syndrome
KW - framework analysis
KW - qualitative methods
KW - social inequality
KW - socioeconomic position
U2 - 10.1177/1474515117711590
DO - 10.1177/1474515117711590
M3 - Journal article
SN - 1474-5151
VL - 16
SP - 715
EP - 723
JO - European Journal of Cardiovascular Nursing
JF - European Journal of Cardiovascular Nursing
IS - 8
ER -