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barriers, cardiac, diet, rehabilitation, self-efficacy



  1. Sharp, Pamela B. PhD, RN
  2. Salyer, Jeanne PhD, RN


Background and Research Objective: Participation in cardiac rehabilitation (CR) can result in positive outcomes for patients, but this population comprises only up to 20% of the total cardiac population. Thus, it is also necessary to examine the determinants of lifestyle behaviors in cardiac patients who do not attend CR programs. Studies have focused largely on physical health and outcomes of exercise participation, with less attention to dietary habits and the psychological determinants of behavior change. The purpose of this descriptive comparative study was to examine the differences in self-efficacy for and barriers to healthy dietary intake between CR participants and nonparticipants at 6 and 12 weeks after hospital discharge.


Participants and Methods: A prospective longitudinal design was used. The sample consisted of 51 adults who (1) were diagnosed with/recovering from an acute cardiac event, treatment, or intervention; (2) received phase I CR; and (3) were physically able to participate in phase II CR. Participants were primarily male, elderly, married, and white; had more than a high school education; and had incomes more than $30 000. Analysis of covariance was used to determine differences over time in self-efficacy and barriers to healthy dietary intake between groups.


Results and Conclusions: Although time 1 findings between groups were not significant, CR participants reported higher self-efficacy for healthy dietary intake than did nonparticipants. At time 2, CR participants also reported greater self-efficacy (F3,40 = 13.69, P <= .0001), indicating more confidence they could commit to a healthy diet. A significant difference was found in barriers to healthy dietary intake (t = 2.13, P = .04) at time 1, with CR participants reporting fewer barriers. At time 2, CR participants reported fewer barriers to healthy dietary intake (F3,39 = 18.19, P < .0001), indicating a more positive perception. Findings improve understanding of factors influencing adoption of healthy diet behaviors and are useful for designing interventions to assist individuals in sustaining secondary preventive efforts over time.