Development, piloting and validation of the Recommending Cardiac Rehabilitation (ReCaRe) instrument

Knowledge, attitude, and practice of cardiac rehabilitation referral among healthcare professionals in China: A mediation model

Objective

Despite proven clinical benefits, cardiac rehabilitation referral rates remained insufficient and low globally. Healthcare professionals' knowledge and attitudes of cardiac rehabilitation may affect their referral behaviors, yet their interrelationships are rarely studied in China. This study aims to examine the cardiac rehabilitation referral rate among Chinese healthcare professionals and explore the associations among knowledge, attitude, and practice (KAP) of cardiac rehabilitation referral.

Methods

From July to August 2021, a cross-sectional study was conducted among 321 healthcare professionals from 40 hospitals in Hunan Province of China. The participants completed an online questionnaire to assess their KAP of cardiac rehabilitation referral. Mediation analysis was conducted using logistic regression analysis, Sobel test and Bootstrap method.

Results

About one-third of healthcare professionals never recommended cardiac rehabilitation to their patients. The correlation analysis showed that cardiac rehabilitation knowledge was positively correlated with cardiac rehabilitation referral attitude (r = 0.57, P < 0.001). There was a robust positive association between cardiac rehabilitation knowledge and cardiac rehabilitation referral practice, which was partially mediated by cardiac rehabilitation referral attitude, with the mediating effect accounting for 4.3 %.

Conclusion

The low cardiac rehabilitation referral rate among healthcare professionals indicates an urgent need to improve cardiac rehabilitation referral. Our mediation model suggests that enhancing cardiac rehabilitation knowledge and promoting positive attitudes through education and training may effectively promote cardiac rehabilitation referral. Furthermore, the findings underscore the necessity of establishing an organized cardiac rehabilitation system to facilitate structured cardiac rehabilitation implementation and improve patient outcomes.

Translation, Cultural Adaptation of the Portuguese Provider Attitudes toward Cardiac Rehabilitation and Referral (PACRR-P) Scale and Assessment of Its' Measurement Properties

BACKGROUND/OBJECTIVES

Access to cardiac rehabilitation (CR) is contingent upon physician referrals, yet these are often inadequate, particularly in low-resource settings. This multi-method study aimed to translate, culturally adapt, and validate the Portuguese version of the Provider Attitudes toward CR and Referral (PACRR-P) scale, as well as to identify key factors influencing CR referral in a Latin American context for the first time.

METHODS

The PACRR was translated into Brazilian Portuguese through a rigorous process involving independent translation, back-translation, and expert panel review to ensure face, content, and cross-cultural validity. A total of 44 Brazilian physicians completed the questionnaire, allowing for an assessment of internal consistency, criterion validity, and convergent validity.

RESULTS

The findings confirmed the face, content, and cultural validity of the 20 translated items, with a mean item clarity rating of 4.8/5. The final version included 17 of the original 19 PACRR-P items, with a Cronbach's alpha of 0.73. Referral rates were significantly associated with over one-third of the PACRR-P items, preliminarily supporting the scale's criterion validity, while correlations with the ReCaRe scores further supported its convergent validity. The most prominent barriers to referral were a lack of familiarity with CR site locations, absence of a standard referral form, and lack of automatic referral processes.

CONCLUSIONS

The PACRR's validity and reliability among Portuguese-speaking providers are preliminarily supported.

Development and validation of the Mental Health Promotion Scale

PURPOSE

This study aimed to develop and validate a scale that assesses adults' mental health promotion abilities.

DESIGN AND METHODS

This study was conducted in Istanbul from October 2016 to May 2018. Three rounds of the Delphi method were conducted to develop the scale.

FINDINGS

After the third Delphi round, the experts reached a consensus on 93 scale items. Forty-six items were excluded from the scale based on exploratory factor analysis (EFA) results. In the last EFA of the 47-item scale, a 12-factor construct was found with an eigenvalue >1 that explained 64.3% of total variance. The overall Cronbach's alpha of the scale was .93.

PRACTICE IMPLICATIONS

This scale can be used to assess adults' mental health promotion abilities.