WOMEN’S PARTICIPATION AND EXPERIENCES IN RURAL CARDIAC TELEREHABILITATION PROGRAMS

J. King¹, J. Harris², K. Goodman¹, A. Haghandish¹, C. Martin¹, J. Wilson¹

Background: Cardiac rehabilitation (CR) reduces morbidity and mortality for patients having suffered a cardiac event, however studies indicate there is a reduced participation in CR among women. Previous studies have indicated potential barriers to women’s participation, including family obligations and poorly adjusted equipment. As well the goals of women in CR have been shown to differ from those of men, in that men aim for physical endurance and the reduction of strain in the workplace, whereas women report seeking independence in activities of daily living, the capacity to perform household chores, as well as emotional health, but these studies have predominantly been in urban settings.

Purpose: The purpose of this study was to examine the referral and participation rates of women in cardiac telerehabilitation programs (CTR) within rural communities, and to explore women’s perspectives and experiences of these programs.

Methods: This mixed methods study included the collection and analyzed of data for a 3-month period of referral and participation rates from a large urban CR program and 3 rural CTR programs. The perspectives and experiences of six women in these rural programs were collected through semi-structured interviews. Interview transcripts were then analyzed using constant comparison thematic analysis for an understanding of women’s experiences and perspectives regarding CTR in rural settings.

Results: Two locations had approximately 20% higher percentage of women participating compared to the large urban CR program, whereas one location showed less than 5% difference. Interview themes and categories were:
1) decision to enroll in CTR (referral from a health care professional, improvement in health condition, and professional support).
2) choice of rural site versus urban site (shorter travel times, fewer expenses, and avoidance of traffic and stressful driving situations).
3) overall experiences of women in CTR (gained health knowledge, knowledgeable professional supervision, gender neutral and safe environments with great equipment). CTR had encouraged these women to exercise at home if they weren't doing so already, or to continue to have an active lifestyle following the program.

Conclusion(s): Women are generally under-represented in urban CR settings, but this study of 3 rural CR programs revealed overall participation among women to be slightly higher. Facilitators to this improved participation rate include the local rural setting and gender neutral and safe environments and professional support.

Implications: Given that CR programs have been shown to have a positive impact on the health of all individuals following a cardiac event, there is a concern surrounding the studies that have reported decreased enrolment and continued participation of women in these programs. Rural CTR sites seem to attract a greater amount of enrolment in women and help them participate, however certain aspects continue to require improvement in order to maximize the participation of women in CTR. As CR gets reimagined due to COVID-19, gender as well as other aspects of a person needs to be taken into consideration.  Physiotherapists need to advocate for and help with the implementation of new models of CR that are welcoming and geared to a truly diverse group of people.

Funding, acknowledgements: None

Keywords: Gender, Cardiac Rehabilitation, Telerehabilitation

Topic: Cardiorespiratory

Did this work require ethics approval? Yes

Institution: The Ottawa Hospital/University of Ottawa

Committee: Ottawa Health Science Network Research Ethics Board

Ethics number: 20140721-01H