{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T23:19:08Z","timestamp":1777936748127,"version":"3.51.4"},"reference-count":36,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Rehabilitation Process and Outcome"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Cardiac specialists are arguably the most influential providers in ensuring patients access cardiac rehabilitation (CR). Physician barriers to referral have been scantly investigated outside of high-income settings, and not qualitatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>This study investigated cardiac specialists\u2019 perceptions of barriers and facilitators to patient CR participation in a low-resource setting, with a focus on referral.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this qualitative study, focus groups were conducted with conventional content analysis. Thirteen of 14 eligible cardiac specialists working in Yazd, Iran, participated in 1 or both focus groups (n\u2009=\u20099 and n\u2009=\u200910, respectively). The recording of the first focus group was transcribed into a word file verbatim, and the accuracy of the content of all field notes and the transcripts was approved by the research team, which was then analyzed inductively. Following a similar process, saturation was achieved with the second focus group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Four themes emerged: \u201cphysician factors,\u201d \u201ccenter factors,\u201d \u201cpatient factors,\u201d and \u201ccultural factors.\u201d Regarding \u201cphysician factors,\u201d most participants mentioned shortage of time. Regarding \u201ccenter factors,\u201d most participants mentioned poor physician-patient-center coordination. In \u201cpatient factors,\u201d the subcategories that arose were socioeconomic challenges and clinical condition of the patients. \u201cCultural factors\u201d related to lack of belief in behavioral\/preventive medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Barriers to CR referral and participation were multilevel, as in high-resource settings. However, relative recency of the introduction of CR in these settings seemed to cause great lack of awareness. Cultural beliefs may differ, and communication from CR programs to referring providers was a particular challenge in this setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1179572720936648","type":"journal-article","created":{"date-parts":[[2020,8,25]],"date-time":"2020-08-25T14:28:49Z","timestamp":1598365729000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Cardiac Specialists\u2019 Perspectives on Barriers to Cardiac Rehabilitation Referral and Participation in a Low-Resource Setting"],"prefix":"10.1177","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5084-2770","authenticated-orcid":false,"given":"Mahdieh","family":"Ghanbari-Firoozabadi","sequence":"first","affiliation":[{"name":"Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masoud","family":"Mirzaei","sequence":"additional","affiliation":[{"name":"Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khadijeh","family":"Nasiriani","sequence":"additional","affiliation":[{"name":"Mother and Newborn Health Research Center, School of Nursing & Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mozhgan","family":"Hemati","sequence":"additional","affiliation":[{"name":"Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamal","family":"Entezari","sequence":"additional","affiliation":[{"name":"Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammadreza","family":"Vafaeinasab","sequence":"additional","affiliation":[{"name":"Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7063-3610","authenticated-orcid":false,"given":"Sherry L","family":"Grace","sequence":"additional","affiliation":[{"name":"Faculty of Health, York University, Toronto, Ontario, Canada"},{"name":"KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasan","family":"Jafary","sequence":"additional","affiliation":[{"name":"Health Policy and Management Research Center, Department of Health Care Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seyed Mahmood","family":"Sadrbafghi","sequence":"additional","affiliation":[{"name":"Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,8,25]]},"reference":[{"key":"bibr1-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2018.09.511."},{"key":"bibr2-1179572720936648","first-page":"304","volume":"17","author":"Forouzanfar MH","year":"2014","journal-title":"Arch Iran Med"},{"key":"bibr3-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318235eb4d"},{"key":"bibr4-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2018.11.013"},{"key":"bibr5-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.10.044."},{"key":"bibr6-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312809"},{"key":"bibr7-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.01.004."},{"key":"bibr8-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314520783"},{"key":"bibr9-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2013.11.007"},{"key":"bibr10-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2016.01.036"},{"key":"bibr11-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2016.09.004"},{"key":"bibr12-1179572720936648","first-page":"100406","volume":"24","author":"Ghanbari M","year":"2019","journal-title":"Int J Cardiol Hear Vasc"},{"key":"bibr13-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22126"},{"key":"bibr14-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000233"},{"key":"bibr15-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.ihj.2018.04.011."},{"key":"bibr16-1179572720936648","doi-asserted-by":"publisher","DOI":"10.5812\/icrj.4370"},{"key":"bibr17-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2003.10.001."},{"key":"bibr18-1179572720936648","unstructured":"Krueger RA. Designing and conducting focus group interviews. https:\/\/www.eiu.edu\/ihec\/Krueger-FocusGroupInterviews.pdf. Published October 2002."},{"key":"bibr19-1179572720936648","first-page":"105","volume-title":"Handbook of Qualitative Research","volume":"1994","author":"Guba EG"},{"key":"bibr20-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1177\/1525822X16639015."},{"key":"bibr21-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1177\/2047487316630085"},{"key":"bibr22-1179572720936648","doi-asserted-by":"publisher","DOI":"10.2147\/VHRM.S48213"},{"key":"bibr23-1179572720936648","first-page":"187","volume":"6","author":"Moradi B","year":"2011","journal-title":"J Tehran Heart Cent"},{"key":"bibr24-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1177\/1741826711409326."},{"key":"bibr25-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2013.01.007."},{"key":"bibr26-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000203"},{"key":"bibr27-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000166."},{"key":"bibr28-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1097\/HCR.0000000000000087."},{"key":"bibr29-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2015.02.006."},{"key":"bibr30-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2013.11.001"},{"key":"bibr31-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD000259.pub3"},{"key":"bibr32-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.112.967539"},{"key":"bibr33-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2018.07.001."},{"key":"bibr34-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1177\/0269215511410579"},{"key":"bibr35-1179572720936648","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2019.09.006."},{"key":"bibr36-1179572720936648","volume":"2","author":"Santiago de","year":"2019","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Rehabilitation Process and Outcome"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1179572720936648","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1179572720936648","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1179572720936648","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:42:34Z","timestamp":1777693354000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1179572720936648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":36,"alternative-id":["10.1177\/1179572720936648"],"URL":"https:\/\/doi.org\/10.1177\/1179572720936648","relation":{},"ISSN":["1179-5727","1179-5727"],"issn-type":[{"value":"1179-5727","type":"print"},{"value":"1179-5727","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1]]},"article-number":"1179572720936648"}}