Barriers and Facilitators to Uptake and Attendance of Secondary Cardiac Prevention Programmes for Indigenous New Zealanders

Abstract

Aim: Cardiac Rehabilitation (CR) has good success in improving health outcomes after a heart event. There is poor enrolment and attendance of CR programmes worldwide, particularly for indigenous peoples, such as New Zealand (NZ) Maori. The present study aimed to provide in-depth interview information about barriers and facilitators of both enrolment and attendance in CR, as well as identifying potential solutions. Methods: Thirty-two semi-structured interviews with Maori referred to CR who either: did not enroll; enrolled but did not complete; and completed the programme. Interview topics were based on meta-syntheses and NZspecific information as well as suggested improvements. The transcripts were inductively analysed. Results: Barriers specific to enrolment were inadequate timing or format communication about CR. Time of day or day of week of sessions, and ability to find transportation to attend were barriers to attending. Group format and cultural focus were perceived as barriers to some, but facilitators for others (enrolment and attendance). Participants suggested ways to improve CR communication (enrolment), flexibility regarding content and timing of CR, and, provision of transport (enrolment and attendance), and, increased cultural focus (enrolment and attendance). Conclusions: Providing a greater variety and flexibility in CR programme design could potentially improve enrolment and attendance for indigenous and for non-indigenous clients. Offering CR sessions after hours, in locations that are easily accessible, having different formats such as: groups, individual versus online, or, indigenous- or European dominant-focus may mean that CR appeals to a larger group of CR patients.