Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Barriers to Education in Cardiac Rehabilitation within an Iranian Society: A Qualitative Descriptive Study

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Barriers to Education in Cardiac Rehabilitation within an Iranian Society: A Qualitative Descriptive Study

Article excerpt

Cardiovascular disease (CVD) is a major disease burden both in developed and devel- oping countries (Wachtel, Webster, & Smith, 2010) and is a leading cause of death in Iran (Ghazanfari, Mohammad Alizadeh, Azizzadeh Furozi, & Bahodini, 2010; Rabiei et ah, 2009). Acute coronary syndrome (ACS) includes a range of cardiac conditions including acute myocardial infarction and angina (Wachtel et ah, 2010). ACS is a major cause of morbidity and mortality and represents one of the most common causes of acute medical admissions in Iran (Alavi, Rabiei, Abedi, Zarfeshani, & Sarrafzadegan, 2009; Jafari et ah, 2009). Cardiac rehabilitation is a cost effec- tive secondary prevention strategy used to prevent further cardiovascular events in people with pre- existing CVD by addressing major risk factors (Bath, Bohin, Jones, & Scarle, 2009).

Current clinical guidelines recommend all patients with ACS receive secondary prevention ser- vices that aim to maximise physical, psychological and social functioning, and enable people with ACS to lead fulfilling and productive lives (American Association of Cardiovascular & Pulmonary Rehabilitation [AACVPR], 2004; Toth & Cannon, 2009; Wachtel, Kucia, & Greenhill, 2008a). The Iranian health care system aims to follow current clinical guidelines (Sarrafzadegan et al., 2007) in order to deliver quality cardiac rehabilitation ser- vices for eligible patients and family members.

Patient education is a major component of cardiac rehabilitation programmes and one of the main strategies health professionals use to assist patients to achieve their goals (Perk, Mathes, Gohlke, Monpère, & Hellemans, 2007; Strömberg, Mârtensson, Fridlund, & Dahlström, 2001). Patient education is defined as a planned, systematic, sequential and logical process of teach- ing and learning provided to patients and clients (and or their family) directed towards wellness, prevention, health promotion and meeting case- specific needs and requirements (Dreeben, 2009).

In Iran, cardiac rehabilitation services are deliv- ered by nursing and medical health professionals through group and individual training meetings, printed materials such as books and booklets, and educational videos. Several Iranian studies have supported the effectiveness of these interventions in improving patients' knowledge, abilities and well-being (Shahriari, Shahsavari, Alimohammadi, & Rafieian, 2007), quality of life (Yousefi, Keshtiaray, Yamani, Rabiei, & Baghbanian, 2009), physiological parameters (Fard, Zadegan, Sajadi, Rafiei, & Abdar, 2003) and changes in echocar- diography (Koohestani, Baghcheghi, & Zand, 2010). In addition, international studies have demonstrated the effectiveness of patient educa- tion in cardiac rehabilitation services on patient participation (Longtin et al., 2010), increased quality of life, reduction in modifiable cardiac risk factors (McVey & Hillegass, 2010), and in reduc- ing anxiety (Chan & Cheung, 2003).

Despite strong evidence for the benefits of cardiac rehabilitation services particularly in terms of patient education, existing services are significantly underutilised (Ferguson, 2006; Goto, Kohzuki, Adachi, & Mikouchi, 2007) and many people with chronic cardiac problems have knowledge deficits and lack a clear under- standing of their health conditions and strategies to improve their health and lifestyle (McAlister, Stewart, Ferrua, & McMurray, 2004).

Previous research has identified multiple bar- riers around the delivery and utilisation of such services (Sarrafzadegan et al., 2010; Strömberg, 2005). These barriers can be functional, or can involve cognitive limitations, misconceptions, low motivation and self-esteem (Strömberg, 2005). Barriers can also be organisational or involve inadequacies of the method of informa- tion provision (Breemhaar, van den Borne, & Mullen, 1996), shortage in trained nursing pro- fessionals, patients' lifestyle and ineffective com- munication (Farahani, Mohammadi, Ahmadi, Maleki, & Hajizadeh, 2008). …

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