Cardiac Rehabilitation Participation and South Asian Service Users

Barriers and Enablers to Cardiac Rehabilitation Uptake, Adherence and Completion Experienced by Service Users With South Asian Heritage

The goal of this qualitative study is to learn about the barriers and enablers to cardiac rehabilitation, experience by South Asian service users based in the UK who have experienced an acute cardiac event and been referred for CR. This may allow NHS programmes to make adaptations to their services to enhance uptake, adherence and completion for this ethnic population. The main questions it aims to answer are:

• What are the barriers and enablers to uptake, adherence or completion of CR experienced by service users with South Asian heritage?
• What adaptations to the CR service could be implemented to overcome identified barriers, enhance enablers and result in increased uptake, adherence or completion to CR?

Participants will be invited to participate in a semi-structured interview and/or a focus group to explore lived experiences that can answer the research questions.

Study Overview

• Status: Recruiting
• Conditions: Cardiac Rehabilitation; South Asian Service Users
• Intervention / Treatment: Other: Qualitative exploration

Detailed Description

This study aims to explore contemporary barriers and enablers to uptake, adherence or completion of cardiac rehabilitation experienced by service users with South Asian heritage, and develop culturally relevant programme adaptations to overcome the identified barriers. Cardiac rehabilitation (CR) a highly evidenced exercise-based intervention offered to eligible patients who have experienced a cardiac event however South Asian service users are less likely to uptake, adhere to or complete CR. This may be because cultural acceptability of CR components (assessment, exercise and education sessions) are not fully considered or tailored for this ethnic population. This study will explore what barriers and enablers are experienced by South Asian service users, with a focus on cultural and psychosocial factors, and develop culturally relevant programme adaptations to increase uptake, adherence and completion. The study will also explore healthcare professionals (HCPs) perceptions of barriers and enablers to CR experienced by service users with South Asian heritage. Participants will include adult (≥ 18 years) service users who have a South Asian heritage and have been referred to University Hospitals of Leicester CR after a cardiac event. Participants will also include healthcare professions and key stakeholders involved in CR and health inequalities. Participants will be invited to a community-based interview (1 hour) and/or a workshop (3 hours) to provide their experiences of barriers and enablers to CR and help develop culturally appropriate service adaptations to overcome these barriers and enhance enablers, resulting increased uptake, adherence or completion of CR. The study is funded by the Wellcome Trust as part of the Leicestershire Health Inequalities Improvement Programme as the University of Leicester.

• Study Type: Observational
• Enrollment (Estimated): 50

Contacts and Locations

• Study Contact: Name: Joanne S McAllister; Phone Number: 0116 258 3370; Email: jsm53@leicester.ac.uk

Study Locations

• United Kingdom
  • Leicestershire
    • Leicester, Leicestershire, United Kingdom, LE3 9QP
      • Recruiting
      • Glenfield General Hospital
      • Contact: Joanne S McAllister; Phone Number: 0116 258 3370; Email: jsm53@leicester.ac.uk
      • Principal Investigator: Sally J Singh, PhD
      • Sub-Investigator: Claire Lawson, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

• adults referred to cardiac rehabilitation with South Asian heritage
• cardiac rehabilitation (CR) healthcare professionals working at University of Leicester Hospitals CR service
• key stakeholders

Description

Inclusion Criteria:

Service Users

• Adult aged ≥18 years
• Has capacity to give consent
• Been referred to UHL NHS Trust cardiac rehabilitation service
• Has experienced an acute cardiac event which is eligible for CR provided by UHL CR service
• Identifies their ethnicity as South Asian i.e. ancestral origins in India, Pakistan, Bangladesh, Afghanistan, Bhutan, Maldives, Nepal and Sri Lanka (Indian sub-continent).
• Workshop only: be able to communicate in spoken English

CR Healthcare Professionals

• Adult aged ≥18 years
• Has capacity to give consent
• HCP involved in delivering direct patient care, who works within UHL NHS Trust CR service

Key Stakeholders

• Adult aged ≥18 years
• Has capacity to give consent
• Individuals who have a direct involvement with South Asian communities, tackling health inequalities, NHS commissioning or service development, or CR policy/guideline development

Exclusion Criteria:

Service Users

• Child aged <18 years
• Unable to give consent
• Have not been referred to UHL NHS Trust CR services
• Been referred to CR due to heart failure and will conduct CR within a community-provided breathlessness pathway
• Does not self-identify as South Asian
• Workshop only: unable to speak or understand spoken English

CR Healthcare Professionals

• Child aged <18 years
• Unable to give consent
• Not a CR team member involved in delivering direct patient care, who works within UHL NHS Trust CR service

Key Stakeholders

• Child aged <18 years
• Unable to give consent
• Not an individual who have a direct influence on South Asian communities, tackling health inequalities, NHS commissioning or service development, or CR policy/guideline development
• Unable to attend workshop in person

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
South Asian Service Users; Service users who identify themselves as South Asian will be invited to participant in a semi-structured interview and/or a focus group. The interview will be used to identify lived experiences of the barriers and enablers to cardiac rehabilitation, relating to uptake, adherence or completion. The focus group will be used to collaboratively generate adaptations to CR services which could be implemented to overcome the barriers, and enhance the enablers, identified during the interviews.	Other: Qualitative exploration; Semi-structured Interviews and focus group
Cardiac Rehabilitation Healthcare Professionals; The rehabilitation healthcare professionals will be invited to participant in a semi-structured interview and/or a focus group. The interviews will be used to explore their the perceptions of barriers and enablers and knowledge around the cultural requirements of South Asian service users.	Other: Qualitative exploration; Semi-structured Interviews and focus group
Key stakeholders; Key stakeholders relating to cardiac rehabilitation, University Hospitals of Leicester (UHL) NHS Trust, and/or South Asian communities will be invited to participate in the focus group, helping to generate adaptations to CR services.	Other: Qualitative exploration; Semi-structured Interviews and focus group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Identification of contemporary barriers and enablers to cardiac rehabilitation	Barriers and enablers to cardiac rehabilitation experienced by South Asian service users	90 minute interviews
Cardiac Rehabilitation Programme Adaptations	Adaptations to the service which could be implemented to overcome identified barriers, enhance enablers and result in increased uptake, adherence or completion.	3 hour interactive focus group

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Healthcare professionals perceptions of barriers and enablers	Healthcare professionals perceptions of barriers and enablers experienced by South Asian service users which may influence uptake, adherence to and completion of cardiac rehabilitation.	90 minute interviews

Collaborators and Investigators

• Sponsor: University of Leicester
• Collaborators: Wellcome Trust; University Hospitals, Leicester; National Institute for Health Research, United Kingdom
• Investigators: Principal Investigator: Sally J Singh, PhD, University of Leicester

Study record dates

Study Major Dates

• Study Start (Actual): February 29, 2024
• Primary Completion (Estimated): September 1, 2024
• Study Completion (Estimated): November 1, 2024

Study Registration Dates

• First Submitted: January 24, 2024
• First Submitted That Met QC Criteria: February 1, 2024
• First Posted (Actual): February 2, 2024

Study Record Updates

• Last Update Posted (Actual): March 13, 2024
• Last Update Submitted That Met QC Criteria: March 12, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Other Study ID Numbers: 0960

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No