Perceptions of barriers to cardiac rehabilitation use in Brazil
Authors Ghisi G, dos Santos R, Aranha EE, Nunes AD, Oh P, Benetti M, Grace SL
Received 14 May 2013
Accepted for publication 24 June 2013
Published 30 August 2013 Volume 2013:9 Pages 485—491
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Gabriela Lima de Melo Ghisi,1,2 Rafaella Zulianello dos Santos,3 Eduardo Eugênio Aranha,3 Alessandra Daros Nunes,4 Paul Oh,2 Magnus Benetti,3 Sherry L Grace1,2,5
1Exercise Sciences Department, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; 2Cardiac Rehabilitation and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; 3Health Sciences and Sports Center, State University of Santa Catarina, Florianopolis, Brazil; 4Luzerne City Hall, Luzerne, Brazil; 5School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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: cardiac rehabilitation, barriers, participation, enrollment, comparison study
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