Women's Perceived Barriers and Catalysts to Completing Phase II Cardiac Rehabilitation: A Qualitative Study

Abstract

Cardiovascular disease remains the leading cause of mortality among women in the United States, yet women continue to be underrepresented in Phase II cardiac rehabilitation (CR2), a critical component of secondary prevention following cardiac events. Although participation in CR2 is associated with significant reductions in morbidity, mortality, and rehospitalization, women are less likely than men to be referred, enroll, and complete these programs. While barriers to enrollment are well documented, less is known about women’s experiences once engaged in CR2 and the factors that support sustained participation.The purpose of this manuscript-style dissertation was to examine women’s engagement in CR2 across the rehabilitation continuum, with particular emphasis on perceived barriers and catalysts to program completion. Guided by the Transtheoretical Model of behavior change, this work integrates three complementary studies: an examination of referral pathways and care transitions into CR2, a synthesis of gender differences in social support related to CR2 participation, and a qualitative phenomenological study exploring women’s lived experiences of completing CR2. In the qualitative study, semi-structured interviews were conducted with women who completed at least 25 CR2 sessions. Findings revealed that barriers and catalysts coexisted throughout the rehabilitation process, with program completion reflecting persistence rather than the absence of challenge. Women described an internal transformation over time characterized by shifts from fear and uncertainty toward confidence, self-efficacy, and internal motivation. Relational catalysts, including family support, staff encouragement, peer connection, and the experience of tangible progress, consistently facilitated progression through stages of change and sustained engagement. Collectively, these findings extend existing CR2 literature by elucidating the emotional, relational, and experiential mechanisms underlying women’s behavior change. This work underscores the importance of gender-responsive, patient-centered approaches that strengthen relational support and address transitional vulnerabilities to enhance CR2 engagement and completion among women.