Barriers and Facilitators of Cardiac Rehabilitation in a Middle-Income Country: A Qualitative Study from China

Ying Zou (), Sarah Janus, Jiamin Du, Ning Qu, Karel Zuidema, Huibert Burger, Kees Ahaus, Zhigang Guo and Sytse Zuidema
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Ying Zou: Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands
Sarah Janus: Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands
Jiamin Du: Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands
Ning Qu: Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands
Karel Zuidema: Center for Accounting, Auditing & Control, Nyenrode Business University, 3621BG Breukelen, The Netherlands
Huibert Burger: Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands
Kees Ahaus: Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062PA Rotterdam, The Netherlands
Zhigang Guo: Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300300, China
Sytse Zuidema: Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands

IJERPH, 2025, vol. 22, issue 4, 1-16

Abstract: Background: Although effective and recommended by guidelines worldwide, Cardiac Rehabilitation (CR) remains scarce and underutilized. CR implementation has taken place in middle-income countries, but the progress is influenced by both positive and negative factors that remain underexplored. This study identified the barriers and facilitators of CR in a middle-income country, specifically China. Methods: An exploratory qualitative study was conducted using semi-structured interviews. Results: Fifteen CR stakeholders were interviewed. According to the interviewees, the delivery of CR is impeded due to a lack of resources, a lack of CR professionals, and a lack of coordination between health institutions. The participation of CR is hindered by a lack of awareness, a lack of reimbursement, and a lack of access to CR. However, the interviewees also mentioned facilitating factors, namely, a positive attitude of stakeholders, high motivation of some patients, and policy support. Conclusions: More awareness regarding the effectiveness of CR is needed. Implementing CR in secondary and primary health institutions could overcome the barriers regarding travel distance and transportation to faraway hospitals. The CR reimbursement methods are needed to ease the financial burden on patients. Our findings reveal factors that need to be considered by policymakers to deliver CR on a wider scale in China.

Keywords: healthcare delivery; access to care; cardiac rehabilitation; barriers; facilitators (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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