Why won’t they engage? Factors that influence chronic heart failure rehabilitation engagement

Katie Palmer1,2, Dr Kelly-Ann Bowles1, Professor Rebecca Lane3, A/Professor Julia Morphet1,2

1Monash University, 2Monash Health, 3Victoria University

Background: Chronic Heart Failure (CHF) is an ever-growing pandemic with a rising economic burden and a heavy personal cost. Despite a large evidence base proving the positive effect of rehabilitation programs engagement levels for CHF remain critically low. It is important to understand what the influencers of rehabilitation engagement are from the perspective of people with CHF themselves. The aim of this research was to describe the factors influencing engagement in CHF rehabilitation programs from the perspective of people with CHF, across metropolitan and rural settings.

Methods: Twelve people with a diagnosis of CHF, along with six family members, were interviewed. The interviews were analysed qualitatively, using realist thematic analysis, reporting the meaning, experiences and realities of the participants regarding rehabilitation and engagement.

Results: The participants’ responses showed four main influencing themes impacting on engagement: health literacy, the broken system, community, and experience. These themes were often overlapping and interwoven throughout the individuals experience, disease journey and ample healthcare interactions. Health literacy included the influence of communication, the source of the information and the language used. The broken system included issues around access, responsibilities, and being lost in the system. Community was made up of interactions with family, medical professionals and rehabilitation clinicians, and others with CHF. Experience included previous attitudes to exercise, rehabilitation experiences and the fluidity of health.

Conclusion: Health professionals need to recognise the individualized and often interwoven factors that influence rehabilitation engagement, in order to address them. Foremost is improving health literacy, including the benefits of rehabilitation. Health services need to continually revolutionise their delivery methods, maximising flexibility of the service to allow it be tailored to the individuals need.


Katie Palmer is a physiotherapist with a decade of experience working across the continuum of care, specialising in cardiorespiratory physiotherapy, particularly community rehabilitation in the cardiac field. She is currently completing her PhD with Monash University, investigating engagement in Chronic Heart Failure and strategies to improve both referral and uptake.

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