Cardiac Rehabilitation: Gender Differences in Factors Influencing Participation

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Abstract
This study investigates gender differences in the barriers and incentives that are most influential in the coronary patient's decision to participate in cardiac rehabilitation programs (CRPs) and suggests strategies to counter these barriers. Patient surveys were administered to consecutive English-speaking attenders and referred nonattenders to a cardiac rehabilitation center at a university healthcare system in Toronto, Canada. A survey questionnaire, constructed from a literature review and advice from key informants, examined potential factors affecting decisions to engage in CRPs. One hundred twenty-nine attenders at a CRP and 61 referred nonattenders completed the questionnaire. Physician recommendation was reported to be the most important factor influencing both women's and men's decisions to participate in CRPs, followed by encouragement from family members. For women who had attended CRP, encouragement from their adult children was significantly more influential than it was for men. Attention to health promotion was also a significantly more powerful motivator for women than it was for men. For CRP nonattenders, concomitant illness, transportation problems, and inconvenient timing of the program were stated to be the three most important barriers to CRP participation in both sexes, although women rated concomitant illness as a significantly more powerful barrier than did men. The decision to participate in CRPs involves several factors, some of which are different or more important for women. As physician recommendations continue to be the single most important factor in motivating both men and women to attend, strengthened and increased physician endorsement will likely encourage higher levels of participation in CRPs. For women, permission should be sought to discuss the advantages of CRPs with adult children who are apparently influential in the decision. As women nonattenders are more concerned than men about the effects of concomitant illnesses, reassurance should be provided about customized programs and exercise targets that consider the needs and limitations of individuals with other health conditions.