Psychometric validation of the Cardiac Rehabilitation Barriers Scale Revised (CRBS-R) for hybrid delivery

• Published in: BMJ open Vol. 14; no. 10; p. e090261
• Main Authors: Grace, Sherry L, Ghanbari, Mahdieh, Cruz, Mayara Moura Moura Alves da, Vanderlei, Luiz Carlos Marques, Ghisi, Gabriela Lima de Melo
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 15-10-2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adult; Aged; Brazil; Cardiac Rehabilitation; Cardiovascular Disease; COVID-19; Cross-Sectional Studies; Exercise; Female; Health Services Accessibility; Heart; Humans; Iran; Likert scale; Male; Middle Aged; Original Research; Pandemics; Patients; Perceptions; Polls & surveys; Psychometrics; Quantitative psychology; Rehabilitation; Rehabilitation Medicine; Reproducibility of Results; Surveys and Questionnaires; Surveys and Questionnaires - standards; Taxonomy; Validity; Weather; Iran; Brazil; Cardiovascular Disease; Psychometrics; Surveys and Questionnaires; Health Services Accessibility
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2024-090261

ObjectiveTo test the measurement properties of the revised version of the English Cardiac Rehabilitation Barriers Scale (CRBS-R), suitable for hybrid delivery, structural validity, internal reliability, as well as face, cross-cultural, construct and criterion validity were assessed.DesignCross-sectional study, where participants completed an online survey via Qualtrics (2023–2024).SettingMulticentre, with cardiac rehabilitation (CR) programmes recruiting patients globally; most patients stemmed from a hybrid programme in Iran and supervised programme in Brazil.ParticipantsParticipants include inpatients or outpatients with a cardiovascular diagnosis or procedure that is indicated for participation in CR.MeasuresIn addition to sociodemographic and CR use items, the 21-item CRBS-R was administered. It assesses multilevel barriers and was revised based on a literature review. Responses range from 1 to 5, with higher scores indicating greater barriers.Results235 patients participated from all 6 WHO regions. Items were rated as highly applicable, and open-ended responses revealing no key barriers were omitted, supporting face and cross-cultural validity. Cronbach’s α for the total CRBS-R was 0.82. Principal components analysis resulted in the extraction of 4 components, which collectively accounted for 60.5% of the variance and were all internally consistent. Construct validity was supported by associations of total CRBS scores with work status (p=0.04), exercise history (p=0.01) and social support (p=0.03). Total CRBS-R scores were significantly lower in patients who were referred and enrolled versus those who were not (both p≤0.01), confirming criterion validity.ConclusionsThe CRBS-R is a reliable and valid scale comprising four subscales, applicable to hybrid CR across diverse settings. It can serve as a valuable tool to support identification of patient’s CR barriers, to optimise secondary prevention utilisation globally.