Factors Contributing to Access and Adherence to Primary Health Care and Cardiac Rehabilitation for Patients with Obesity: An Overview of a Post Doctoral Program of Research

Abstract

Engagement in primary health care and adherence to cardiac rehabilitation is associated with reduced mortality and morbidity. These benefits are extended to high-risk populations such as those with obesity. However, obesity is associated with avoidance of primary health care and lower rates of adherence to cardiac rehabilitation. A post-doctoral program of research including two separate, yet thematically related studies was completed over two years, one year in a primary health care environment and one year in a cardiac rehabilitation environment for the purpose of identifying factors that contribute to participation in health promoting and secondary prevention behaviours for patients with obesity. The first study used a qualitative methodology and included 11 interviews with patients from a primary health care program. Interviews were coded using thematic analysis to identify key themes related to engagement in primary health care. The second study was a retrospective analysis of a data collected from 12 003 patients enrolled in a cardiac rehabilitation program between 1995-2010. Sequential logistic regression was conducted to examine the extent to which socio-demographic, psychological, anthropometric, fitness and clinical factors account for the higher likelihood of non-adherence to on-site treatment in CR. Results from both studies show that patients with obesity do not believe that their needs are being met in primary health care and are at greater risk of non-adher.