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Background and Aims: Cardiac Rehabilitation (CR) has been proven to increase longevity in heart patients. Unfortunately, the success of CR is determined on patients' adherence to the program. Although research suggests that individual level correlates (e.g., gender, age, self-efficacy, etc.) influence CR program adherence, little research has investigated the potential influence of community level factors (e.g., education, number of owned dwellings, etc.) on adherence, and if this influence is different for hospital- and community-based programs. The aim of this investigation was to (a) examine the impact of community factors on CR adherence and (b) to determine whether these factors were the same for hospital and community-based CR programs.
Methods: The sample consisted of 275 individuals between the ages of 34 and 85, primarily male (69%), and white (96%) recruited from 1 hospital-based (n = 180) and 5 community-based (n = 95) programs across Nova Scotia. Participants' civic addresses were geocoded through ArcGIS and linked to their community using a point-to-polygon join. Community level variables were derived using 2006 Census data, and based on community boundaries designated by Nova Scotia Community Counts. Partial correlations controlling for individual level correlations (i.e., age, gender, income, education and employment) were conducted between adherence and community level variables overall, and then separately for hospital and community locations.
Results: A significant relationship between adherence and CR location (r=-.180; p<.01) was found indicating greater adherence to hospital (mean: 90.7%, SD: 12.3) versus community (mean: 86.9%, SD: 12.6) programs. Furthermore, communities with higher education levels (r = .176; p<.01), more families with children 6 years or younger (r = .142; p < .05), and having a greater number of owned dwellings (r = .159, p < .05) was positively associated with adherence to CR programs. However, no significant relationships between community factors and adherence to CR were found within the hospital and community-based programs.
Conclusion: Results from this study indicate that community level factors influence an individual's adherence to their CR program, regardless of the program's location (i.e. hospital vs. community). Interestingly enough, adherence to hospital based CR programs is greater than community based programs, but does not appear to vary based on community level correlates.
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