Facilitators and Barriers to Cardiac Rehabilitation Uptake Among Patients with Coronary Artery Disease in Thailand: A Qualitative Study

Objectives: This study explored factors affecting cardiac rehabilitation (CR) uptake among patients with coronary artery disease (CAD) in Thailand. Study design: An exploratory qualitative design Setting: Data collection was conducted at two CR centers, one in an urban hospital and one in a remote hospital. Subjects: CR healthcare providers (HPs) and patients with CAD who had been referred for CR by medical staff during their in-patient stay. Methods: An exploratory qualitative research design using semi-structured interviews of 20 patients and 22 HPs was employed. Data were collected from June 2018 to July 2019. Transcribed interview data were analyzed thematically. Results: The common themes identified by patients and HPs that contributed to uptake of CR included culture and religion, as well as social, logistical, and educational themes. Knowledge of CR and its benefits also facilitated attendance. Both groups recognized commitments to family and work as barriers to CR. Both groups also perceived that they had misconceptions about CR exercise programs and inaccurate communication regarding CR as barriers to CR attendance. Importantly, high respect for doctors as well as Buddhist beliefs and practices were cultural factors mentioned by patients as important enablers of CR. Notably, this is the first study in Thailand to identify feeling safe attending CR as being a major enabling factor for CR uptake. Conclusions: Religious and cultural factors impact the uptake of CR among patients with CAD in Thailand. Creation of culturally-based CR programs should be considered a priority, as should identifying potential approaches to successful delivery of CR in rural areas of the country.