Objectives To explore (1) the extent to which a multicomponent intervention addressed determinants of the desired behaviours (ie, adherence to cardiac rehabilitation (CR) and cardiovascular medications), (2) the associated mechanism(s) of action and (3) how future interventions might be better designed to meet the needs of this patient population.
Design A qualitative evaluation embedded within a multicentre randomised trial, involving purposive semistructured interviews.
Setting Nine cardiac centres in Ontario, Canada.
Participants Potential participants were stratified according to the trial’s primary outcomes of engagement and adherence, resulting in three groups: (1) engaged, adherence outcome positive, (2) engaged, adherence outcome negative and (3) did not engage, adherence outcome negative. Participants who did not engage but had positive adherence outcomes were excluded. Individual domains of the Theoretical Domains Framework were applied as deductive codes and findings were analysed using a framework approach.
Results Thirty-one participants were interviewed. Participants who were engaged with positive adherence outcomes attributed their success to the intervention’s ability to activate determinants including behavioural regulation and knowledge, which encouraged an increase in self-monitoring behaviour and awareness of available supports, as well as reinforcement and social influences. The behaviour of those with negative adherence outcomes was driven by beliefs about consequences, emotions and identity. As currently designed, the intervention failed to target these determinants for this subset of participants, resulting in partial engagement and poor adherence outcomes.
Conclusion The intervention facilitated CR adherence through reinforcement, behavioural regulation, the provision of knowledge and social influence. To reach a broader and more diverse population, future iterations of the intervention should target aberrant beliefs about consequences, memory and decision-making and emotion.
Trial registration number ClinicalTrials.gov registry; NCT02382731
- qualitative research
- myocardial infarction
- health services administration & management
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Contributors LD contributed to the study design, data analysis and interpretation of the results and drafted the manuscript. KR and MS contributed to data analysis and interpretation of the results. J-DS, JP, NMI and HW contributed to the interpretation of the results. NMI contributed to the study design and interpretation of the results. All authors read, contributed to, and approved the final manuscript.
Funding Funding support was available through Ontario Ministry of Health and Long Term Care (MOHLTC) Health System Research Capacity Award grant number 06683 and the Canadian Institutes of Health Research’s Strategy for Patient Oriented Research, through the Ontario Strategy for Patient Oriented Research Support Unit.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Patient consent for publication Not required.
Ethics approval This study received ethics approval from the Research Ethics Boards at Women’s College Hospital (REB number 2017-0135-E). Informed consent was obtained from all participants.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available. An aggregate summary of the data generated during this study is included in this published article. Individual data transcripts cannot be shared publicly due to confidentiality.
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