1. Shanmugasegaram, Shamila
  2. Stewart, Donna E.
  3. Winstanley, Jane
  4. Parsons, Cynthia
  5. Oh, Paul
  6. Grace, Sherry L.

Article Content

Background: Despite the many benefits of cardiac rehabilitation (CR), it is greatly under-utilized. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to systematically and comprehensively assess the patient, provider, and system-level CR barriers identified in the literature for both enrollees and non-enrollees. The objectives of this study were to investigate the convergent validity, test-retest reliability, and potential social-desirability response bias of the CRBS.


Method: 2675 cardiac inpatients (27.4% female; age 65.1+/-11.2; 61.0% response rate) from 11 hospitals across Ontario completed a survey. One year later, participants were mailed a follow-up survey including the CRBS and the 10-item Marlowe-Crowne Social Desirability Scale (MCSDS). Three weeks later, a subsample of participants completed a third mailed survey which included the CRBS, Cardiac Rehabilitation Enrolment Obstacles (CREO) scale, and the Beliefs About Cardiac Rehabilitation (BACR) scale. On the CRBS, regardless of CR referral or enrollment, participants were asked to rate the degree to which 21 items represented barriers to CR on a 5-point Likert scale. Previous research has established the four-factor structure of the CRBS, namely healthcare factors, logistical factors, work/time conflicts, and comorbidities/functional status. To date, 509 participants have completed the one-year follow-up survey and 101 participants have completed the three-week post-test survey.


Results: The total CRBS (r=.31, p<.05) and healthcare factors subscale (r=.38, p<.05) scores were positively and significantly related to the health service-related subscale of the CREO, and the logistical factors subscale of the CRBS was negatively and significantly related to the practical barriers subscale of the BACR (r=-.39, p < .01). All other relationships to subscales were non-significant. The 3-week test-retest reliability of the CRBS was acceptable (r=.50, p<.001). In terms of socially-desirable responding, the association between total MCSDS (7.46+/-2.07) and total CRBS was significant (r=-.09, p<.05).


Conclusions: Preliminary results suggest that the CRBS demonstrates convergent validity and adequate test-retest reliability. The small but significant effect of social-desirability warrants further investigation. Additional psychometric evaluation such as confirmatory factor analysis of this scale is ongoing. The availability of the CRBS, among other recently published CR scales, is vital as it can enable identification of key barriers overall and in subgroups that are under-represented in CR, as well as comparison of barriers across studies, populations, and jurisdictions.