{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:58:42Z","timestamp":1791622722799,"version":"4.3.4"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Santander","award":["2145987"],"award-info":[{"award-number":["2145987"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a five-point Likert scale) was administered to patients treated between February and July, 2019, in three CR centers in Colombia. A random subsample of 50 participants was invited to a focus group, along with an accompanying relative. Physiotherapists from the programs were invited to an interview, with a similar interview guide. Audio-recordings were transcribed and analyzed using interpretive description. A total of 210 patients completed the survey, and 9 patients, together with 3 of their relatives and 3 physiotherapists, were interviewed. The greatest barriers identified were costs (mean = 2.8 \u00b1 1.6), distance (2.6 \u00b1 1.6) and transportation (2.5 \u00b1 1.6); the logistical subscale was highest. Six themes were identified, pertaining to well-being, life roles, weather, financial factors, healthcare professionals and health system factors. The main facilitators were encouragement from physiotherapists, relatives and other patients. The development of hybrid programs where patients transition from supervised to unsupervised sessions when appropriate should be considered, if health insurers were to reimburse them. Programs should consider the implications regarding policies of family inclusion.<\/jats:p>","DOI":"10.3390\/ijerph19041911","type":"journal-article","created":{"date-parts":[[2022,2,8]],"date-time":"2022-02-08T23:37:48Z","timestamp":1644363468000},"page":"1911","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Examining Facilitators and Barriers to Cardiac Rehabilitation Adherence in a Low-Resource Setting in Latin America from Multiple Perspectives"],"prefix":"10.3390","volume":"19","author":[{"given":"Diana Marcela","family":"Rangel-Cubillos","sequence":"first","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Vanessa","family":"Vega-Silva","sequence":"additional","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yully Fernanda","family":"Corzo-Vargas","sequence":"additional","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Camila","family":"Molano-Tordecilla","sequence":"additional","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yesica Paola","family":"Pe\u00f1uela-Ar\u00e9valo","sequence":"additional","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen Mayerly","family":"Lagos-Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana Marcela","family":"J\u00e1come-Hort\u00faa","sequence":"additional","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Juliana","family":"Villamizar-Jaimes","sequence":"additional","affiliation":[{"name":"Rehabilitation Center, Research and Development Department, Bucaramanga 680003, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"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, ON M3J 1P3, Canada"},{"name":"KITE-Toronto Rehab Institute, & Director of Cardiac Rehabilitation Research, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M4G 1R7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0009-0005","authenticated-orcid":false,"given":"Hugo Celso","family":"Dutra de Souza","sequence":"additional","affiliation":[{"name":"Laboratory of Physiology and Cardiovascular Physioterapy, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14049-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Angarita-Fonseca","sequence":"additional","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"},{"name":"Universit\u00e9 du Qu\u00e9bec en Abitibi-T\u00e9miscamingue, Rouyn Noranda, QC J9X 5E4, Canada"},{"name":"Centre de Recherche du Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Montreal, QC H2X 0A9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"S\u00e1nchez-Delgado","sequence":"additional","affiliation":[{"name":"Universidad de Santander, Facultad de Ciencias M\u00e9dicas y de la Salud, Bucaramanga 680003, Colombia"},{"name":"Laboratory of Physiology and Cardiovascular Physioterapy, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeir\u00e3o Preto 14049-900, Brazil"},{"name":"Grupo de Investigaci\u00f3n Ser Cultura y Movimiento, Universidad Santo Tom\u00e1s-Bucaramanga, Santander 680001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e146","DOI":"10.1161\/CIR.0000000000000485","article-title":"American Heart Association Statistics Committee and Stroke Statistics Subcommittee. 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