Abstract 4140323: Barriers and Facilitators to Outpatient Cardiac Rehabilitation Attendance Among Patients with Low Socioeconomic Status: A Qualitative Study

Introduction: Individuals with low socioeconomic status (SES) have a higher risk of CVD events yet are less likely to utilize outpatient cardiac rehabilitation (OCR), which is an evidence-based secondary prevention strategy. Understanding barriers and facilitators to the implementation of OCR among individuals with low SES is critical to design targeted interventions to improve attendance. Aims: To identify barriers and facilitators to OCR attendance among individuals with low SES using the Capability, Opportunity, Motivation, and Behavior (COM-B) theoretical model. Methods: We purposefully recruited patients for in-depth interviews who had: a recent CVD event (≤ 3 months); documented referral to OCR; low SES (Medicaid eligible, or in the top quartile of area deprivation index); those who attended ≥ 1 session of OCR and those who did not. Semi-structured interviews were recorded and transcribed verbatim. Codes were identified using a phenomenological approach guided by the COM-B model. Results: Participants (N=26) were 54% women, 58% Black, with mean age of 67.1 (12.7 years). Barriers and facilitators identified fit the COM-B model. Capability themes included knowledge and awareness of OCR. OCR attendees (n=12) recalled discussing OCR, the benefits, and their physicians encouraging participation pre-discharge. Non-attendees (N=14) reported no, or very little knowledge about OCR, or weak recommendations by their physician. Opportunity themes included social support from caregivers/family, peers, and their healthcare team. OCR attendees described a strong support network of caregivers who helped with logistics and motivation to participate, wanting to be with peers, and outreach of the healthcare team after discharge. Non-attendees described lack of social support, logistical barriers, and no outreach. Motivation themes reflected the strong belief in the benefits of CR to improve physical and mental health, quality of life, and prevent future events among attendees. Non-attendees generally lacked a perceived need for OCR particularly if they had returned to baseline after their CVD event. Conclusions: Non-attenders of CR were distinguishable from attendees using the COM-B model, which can be used to guide intervention development. Our findings support a multi-level strategy that includes tailored education, social support, motivational enhancement, implemented by a trained health navigator, to overcome barriers to CR attendance among patients with low SES.