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Abstract P263: Understanding Facilitators Of Cardiac Rehabilitation Completion In Women: A Grounded Theory Approach

Research demonstrates that cardiac rehabilitation (CR) programs improve cardiac outcomes and decrease mortality. However, less than 20% of referred women attend CR programs. Of those studies we found, most researchers studied men or barriers to participation. Little is known about factors that motivate or facilitate women to participate in CR. The purpose of this study is to address that gap. A grounded theory (GT) design was used to develop a theoretical understanding of the decision-making process employed by women who attended 25 or more CR sessions. We sought to identify factors that facilitated CR participation. Grounded theory is theory generating, not theory testing; no research questions or hypotheses are appropriate. Digitally recorded interview data from 12 women and 2 men (contrary cases) from a single Phase II CR program at a large healthcare system was reviewed by the research team. Data collection and analysis occurred simultaneously (constant comparative method) and open, axial and selective coding was used to develop the theoretical framework. Data analysis revealed three requisite conditions (catalysts, expectations, reinforcers) for participation in CR by women. Initially, participation was predicated by a cardiac event (catalyst) and CR recommendation. Then women participated because they believed CR would be effective (expectations). Finally, friendliness, reassurance, and validation from the CR team plus feeling better (reinforcers) were the factors that kept them coming back week after week. Unlike previous studies, factors such as transportation and financial resources did not impact the decision to participate in CR. These factors were perceived by the women interviewed to be nice but not necessarily critical to their decision to participate in CR. It was interesting to note that of all reinforcing factors, the relationship between the participant and the CR staff was the most important factor that facilitated continued participation. Previous research and interventions have been directed toward removing barriers to participation. This is the first study to explore factors that facilitate rather than impede participation and to identify requisite factors specific to women. Findings from this study provide a theoretical foundation for understanding ways to improve CR participation by women.