{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:44:28Z","timestamp":1791229468958,"version":"4.1.0"},"reference-count":40,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T00:00:00Z","timestamp":1743897600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/ijerph22040574","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T07:41:51Z","timestamp":1744270911000},"page":"574","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Barriers and Facilitators of Cardiac Rehabilitation in a Middle-Income Country: A Qualitative Study from China"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1352-8599","authenticated-orcid":false,"given":"Ying","family":"Zou","sequence":"first","affiliation":[{"name":"Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0419-4407","authenticated-orcid":false,"given":"Sarah","family":"Janus","sequence":"additional","affiliation":[{"name":"Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5968-3120","authenticated-orcid":false,"given":"Jiamin","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands"},{"name":"Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands"},{"name":"Academy of Medical Engineering and Translational Medicine, Medical School, Tianjin University, Tianjin 300072, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karel","family":"Zuidema","sequence":"additional","affiliation":[{"name":"Center for Accounting, Auditing & Control, Nyenrode Business University, 3621BG Breukelen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6484-0349","authenticated-orcid":false,"given":"Huibert","family":"Burger","sequence":"additional","affiliation":[{"name":"Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9973-3746","authenticated-orcid":false,"given":"Kees","family":"Ahaus","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy and Management, Erasmus University Rotterdam, 3062PA Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhigang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin 300300, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4991-9507","authenticated-orcid":false,"given":"Sytse","family":"Zuidema","sequence":"additional","affiliation":[{"name":"Department of Primary and Long-Term Care, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.46234\/ccdcw2021.087","article-title":"Cardiovascular Disease Mortality\u2014China, 2019","volume":"3","author":"Liu","year":"2021","journal-title":"China CDC Wkly."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/s41569-018-0119-4","article-title":"Epidemiology of cardiovascular disease in China: Current features and implications","volume":"16","author":"Zhao","year":"2019","journal-title":"Nat. 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