- Coronary Heart Disease (CHD) accounts for almost 20% of all deaths in the
United States and is a leading cause of premature death and disability. The cost for
this disease includes not only lost work years, but billions of health care dollars.
Women account for almost half of the deaths from CHD and rates for the death of
young women have risen 30% from 1988 to 1998. For the two-thirds of women
who survive the initial coronary event, the risk of future events and disability
increases. Cardiac rehabilitation (CR) is a multi-disciplinary program designed to
reduce this risk. Unfortunately, only 25% of eligible women attend the program.
Few studies have analyzed the factors that influence women's CR enrollment
choices making a careful examination of these factors particularly relevant.
The purpose of this study was to qualitatively explore the factors associated
with a woman's decision to enroll, or not enroll, in CR from the perspectives of the
patient and her support person.
Twenty-five women (15 enrolled in CR, 10 not enrolled in CR) and 24
matched support persons (one person's supporters refused to participate) were
interviewed using a semi-structured format from September, 1999 to January, 2001.
Questions addressed the beliefs, affect, social referents, past experiences/habits,
and facilitating/constraining conditions related to CR enrollment choices. Support
persons were asked to respond to these questions from their perception of their
loved one's attitudes, beliefs and health care seeking behaviors.
Information from the interviews was transcribed verbatim, entered into
NUD*IST, and coded using the components of the Expanded Theory of Reasoned
Action (Triandis, 1977) as a framework. Descriptive analyses was done on basic
demographic information, including perceptions of health and depression.
There were specific factors identified in each of the primary categories of
affect, beliefs, facilitating/constraining factors, and social referents and
information. The key findings indicated that a lack of information on CR, feelings
related to the perceived necessity of CR, transportation, finances, and accessibility
were primary factors in enrollment behavior. Overall agreement between the
cardiac female and her support person existed in most categories, except affect,
where a minimum number of emotions was stated by the supporter.
Cardiologists are a preferred source for CR information and they and
primary care physicians need to increase the amount of positive support they
provide to post-coronary event women. Emphasis on the necessity of attending CR
as well as solutions for transportation and finances may increase enrollment. More
research should be completed on the context of depression related to CR,
importance of factors identified as having an impact on CR decision making, and
the role of support persons in the enrollment choices of women.