Edinburgh Napier University

  Background: Participation in cardiac rehabilitation (CR) benefits patients with coronary heart disease (CHD), yet
worldwide only some 15–30% of those eligible attend. To improve understanding of the reasons for poor participation
we undertook a systematic review and meta-synthesis of the qualitative literature.
Methods: Qualitative studies identifying patient barriers and enablers to attendance at CR were identified by searching
multiple electronic databases, reference lists, relevant conference lists, grey literature, and keyword searching of the
internet (1990–2010). Studies were selected if they included patients with CHD and reviewed experience or understanding
about CR. Meta-synthesis was used to review the papers and to synthesize the data.
Results: From 1165 papers, 34 unique studies were included after screening. These included 1213 patients from eight
countries. Study methodology included interviews (n¼25), focus groups (n¼5), and mixed-methods (n¼4). Key reasons
for not attending CR were physical barriers, such as lack of transport, or financial cost, and personal barriers, such
as embarrassment about participation, or misunderstanding the reasons for onset of CHD or the purpose of CR.
Conclusions: There is a vast amount of qualitative research which investigates patients’ reasons for non-attendance at
CR. Key issues include system-level and patient-level barriers, which are potentially modifiable. Future research would
best be directed at investigating strategies to overcome these barriers.