Mechanisms and drivers of social inequality in phase II cardiac rehabilitation attendance: a Convergent Mixed Methods study

Mechanisms and drivers of social inequality in phase II cardiac rehabilitation attendance: a Convergent Mixed Methods study
Maria PEDERSEN, Denmark
August, 22, 15.15 - 16.45, U14
Background: Cardiac rehabilitation is an essential component of secondary prevention for patients with coronary heart disease. Social inequality in cardiac rehabilitation attendance has been a problem known for many years. To date the mechanisms driving inequalities in cardiac rehabilitation attendance are, however, still not fully understood. It is important to address these inequalities as patients with low socioeconomic position often face a higher burden of disease and modifiable cardiac risk factors and may thus be in greater need of attending a rehabilitation programme.
Aim: In this study, the purpose of the quantitative component was to investigate potential factors associated with cardiac rehabilitation non-attendance and to assess if these were differentially distributed among educational groups. The purpose of the qualitative component was to explore the patient experience of barriers to completion of cardiac among different socioeconomic groups. The overall aim was to explore the extent to which the qualitative and quantitative data converged and explain mechanisms and drivers of social inequality in cardiac attendance.
Method: The study was designed as a convergent mixed methods study (i.e. the quantitative and qualitative data were collected within the same timeframe). Joint displays were developed by merging findings from a quantitative prospective observational study (n=302) and qualitative explorative study with dyadic (n=12) and single (n=12) semi-structured interviews.
Results: Qualitative and quantitative findings primarily confirmed and further expanded each other; however discordant results were also evident. Socially differentiated lifestyle, health beliefs, travel barriers and self-efficacy were potential drivers of social inequality in cardiac rehabilitation attendance. Evidence of comorbidity, anxiety, depression and relatives as potential drivers of social inequality in cardiac rehabilitation attendance could not be provided.
Conclusion: This study integrated qualitative and quantitative findings related to factors affecting social inequality in cardiac rehabilitation attendance. Socially differentiated distributions of lifestyle and health beliefs as well as differential travel barriers are potential drivers of social inequality in cardiac rehabilitation attendance. Differential self-efficacy and experienced low self-efficacy regarding healthy lifestyle changes are potential drivers of differential lifestyles and thereby potential drivers of social inequality in cardiac rehabilitation attendance. The study adds empirical evidence regarding how a mixed methods study can be utilized to obtain an understanding of complex health care problems, e.g. social inequality in cardiac rehabilitation attendance. The study enabled a thorough and comprehensive understanding of some of the mechanisms driving social inequality in cardiac rehabilitation attendance. Moreover, mixing qualitative and quantitative data helped clarify the limitations associated with individual methods. The combined qualitative and quantitative data turned out to be useful for ensuring weakness minimization legitimation, i.e. that the weakness of one study design can be compensated for by the strength of a different research design. The design enabled expanded and divergent results to be found and discussed, e.g. enabled a discussion of how the quantitative, predetermined, and rigid variables failed to capture meaningful measures on their own.