Increasing attendance at cardiac rehabilitation
As cardiac rehabilitation (CR) results in reduced mortality and morbidity (e.g. Dusseldorp et al, 1999), it is essential that as many people as possible are given the opportunity to benefit from it. Yet despite proven benefits, uptake of services can be low. This study sought to explore and possibly influence factors which predict attendance, with the ultimate goal of increasing attendance at a CR programme. Whilst sociodemographic and health care systemic factors predict CR attendance, recent research has focused on investigating the role of factors more amenable to change such as psychological factors (e.g. Johnston et al, 1999). Recommendations based on the reviewed research literature are presented as ways of increasing attendance at CR. It was evident from the review that psychological factors predicted attendance. In order to increase our understanding of these factors, interviews were carried out with attenders and non-attenders of CR (n=21). Several differentiating themes were identified: use of medical versus psychological model, illness perception, causal attribution, and attitude to CR. The results were interpreted using the Self Regulatory Model and the Theory of Planned Behaviour. Finally, a simple cost effective psychological intervention was developed and implemented to influence patients' beliefs about recovery and CR, in order to increase their attendance rates at a CR programme (n=87). Using a randomised control trial design, MI patients who received an intervention in the form of two letters, were shown to be significantly more likely to attend CR than those who received normal care (p <0.0025). In conclusion, there are a number of different ways that CR attendance can be increased. Firstly by being aware of how sociodemographic and health care systemic factors influence attendance and providing services accordingly. And secondly by understanding the role of psychological factors on attendance and implementing psychological interventions accordingly.