Perceptions of barriers to cardiac rehabilitation use in Brazil

• Published in: Vascular health and risk management Vol. 9; no. default; pp. 485 - 491
• Main Authors: Ghisi, Gabriela Lima de Melo, dos Santos, Rafaella Zulianello, Aranha, Eduardo Eugênio, Nunes, Alessandra Daros, Oh, Paul, Benetti, Magnus, Grace, Sherry L
• Format: Journal Article
• Language: English
• Published: New Zealand Taylor & Francis Ltd 01-01-2013; Dove Press; Dove Medical Press
• Subjects: Aged; Ambulatory Care; barriers; Brazil; cardiac rehabilitation; Cardiovascular disease; Chi-Square Distribution; comparison study; Cross-Sectional Studies; enrollment; Exercise Therapy; Female; Health Behavior; Health Care Surveys; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Heart Diseases - psychology; Heart Diseases - rehabilitation; Humans; Male; Middle Aged; Original Research; participation; Patient Acceptance of Health Care - psychology; Patients - psychology; Perception; Private Sector; Rehabilitation; Rural Health Services; Surveys and Questionnaires; Urban Health Services; Brazil; participation; comparison study; barriers; cardiac rehabilitation; enrollment
• ISSN: 1178-2048; 1176-6344; 1178-2048
• DOI: 10.2147/VHRM.S48213

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.
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.
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.
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.
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.