Table 3 Barriers and enablers to current exercise rehabilitation programmes [80,81,82,83,84,85]
Theme | Barriers | Enablers |
|---|---|---|
Referral to programme | Oversight of patient’s eligibility. | Good relationship between health care practitioner and the patient allows the patient to have understanding of the relevance, importance and benefits of referral to the programme. Automated referral system. |
Geographical Factors | Long travel times. Difficulties in accessing transport, especially in rural areas where there is limited public transport available. High costs associated with travel. | Nearby facilities with short travel times. Good support from family and friends who offer assistance with transport. |
Psychosocial Factors | Negative health attitude, low level of motivation, underlying mental health issues. Lack of support from friends and family. Lower socioeconomic status resulting in financial strain hence unwilling to take time off work. Patients overwhelmed with information during their hospital stay, contributing to an overall sense of helplessness and low motivation. Linguistic and cultural differences. Unclear of benefits of the programme, poor understanding or disbelief in the positive outcomes. Feeling of embarrassment taking part in such a programme. Patient illness. | Motivation to improve health and feel better. Encouragement from others. Programmes offering psychological support. |
Supervised Programme | Lack of staff. Lack of resources. Higher costs (compared to home based). Timings of the programme restricted to weekday working hours. | Presences of programme facilitator during exercise acts as a motivator and reassures patients. Patients held accountable to attend. Group programmes allow participants to interact and share experiences. |
Home Based Programme | Reduced intensity of programme. Less support available to patients from health care professionals. Reduced patient adherence and progression. Reduced patient accountability. | Increased flexibility. No transport issues. Potentially lower costs (compared to supervised). |