Susan Fletcher has worked as a Counsellor, Social Worker, Lecturer and Researcher in both Hospital and Educational Institutions. Her Expertise is in evaluation of effective service delivery and behavioral change interventions for people with chronic cardiac health conditions.


Purpose: There has been extensive investigation of attendance rates at Cardiac Rehabilitation (CR) but little attention to client reasoning around attendance. This study explored participants’ decision-making drivers for attendance or non-attendance at CR programs available in rural Victoria, Australia. Method: All new patients referred to the CR programs at either the local hospital or community health service over a six months period were invited to participate and were interviewed before, after and at six months post CR. Content analysis was used to identify and group common themes that emerged from the semi-structured interviews. Results: Eighty-four of the 114 patients referred agreed to participate in the study. Multiple barriers or facilitators affected the decisions of all clients. Two main themes emerged; The first theme described the participant decision-making experience, the invitation and information about participation in CR and identified the need for a person centered approach to CR provision and on-going support. The second theme identified significant decision-making points: Following the cardiac event; before and after hospital-based CR; before and after community-based CR and at six months post the cardiac event. At any time, there is a risk that the client can become lost or disengaged in the service system but providing contact at these points can facilitate re-engagement. Conclusion: This study provided the opportunity to hear participants’ voices describing their decisions around CR attendance after a cardiac event and their ability to sustain lifestyle behavioral change. They highlighted the complexity of issues confronting them and suggested improvements to optimize their attendance and to maintain lifestyle changes.