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To increase participation in cardiac rehabilitation among outpatients with heart disease in Thailand. Factors contributing to low participation are poorly understood. A scale is needed to identify barriers to participation in cardiac rehabilitation. This study aimed to evaluate the psychometric properties of the newly translated Cardiac Rehabilitation Barriers Scale Thai version to justify its use in the Thai population with cardiovascular diseases.
Methods
Psychometric testing was conducted using a cross-sectional survey of 200 outpatients at a Bangkok hospital eligible for the cardiac rehabilitation program from April 2023 to mid-April 2024. Construct validity was evaluated using principal axis factor analysis and first- and second-order confirmatory factor analysis. Cronbach’s alpha assessed the scale’s internal consistency.
Results
The average age of the total sample was 62.60±12.37 years. Principal axis factoring with Oblimin rotation and Kaiser normalization extracted four components (subscales) that explained 61.8% of the cumulative percentage of variance. These were labeled work and time conflicts, lack of perceived need factors, comorbidities, and logistical barriers. Values for the confirmatory factor analysis goodness of fit indices exceeded recommended minimum thresholds. The internal consistencies for the total scale and the four components were entirely acceptable.
Conclusion
The Cardiac Rehabilitation Barriers Scale Thai version has acceptable psychometric properties for Thai outpatients with cardiovascular diseases. It may be used to identify barriers to participating in cardiac rehabilitation, promote rehabilitation attendance, and improve patient care.
Cardiovascular diseases (CVDs) constitute a principal cause of mortality globally, with an alarming rise in prevalence [1]. In Thailand, coronary artery disease accounts for 11.5% of total deaths [2]. The burden of CVDs is unsparing among the Thai population, diminishing the quality of life and straining the healthcare system and national budget.
Cardiac rehabilitation (CR) is recognized as a multidisciplinary intervention and is recommended in evidence-based clinical guidelines as a secondary prevention strategy for individuals diagnosed with CVDs [3]. Effective CR aims to restore optimal cardiac function, reduce morbidity and mortality associated with cardiac conditions, enhance psychosocial well-being, and improve overall quality of life [4,5]. Organizations, such as the European Society of Cardiology [6], the American Heart Association [7], and the American College of Cardiology [8], advocate for the implementation of CR in treatment protocols, underscoring its efficacy in managing CVDs.
Despite substantial evidence supporting CR, participation rates in CR programs remain suboptimal [6]. Various factors at the individual, provider, and health system levels influence the uptake and adherence to CR [9]. However, the specific factors affecting participation among Thai individuals with CVDs are less understood. To improve the uptake and accessibility of CR in Thailand, a valid instrument to identify and measure potential barriers to CR would enhance understanding of the unique challenges encountered by Thai individuals with CVDs. The Cardiac Rehabilitation Barriers Scale (CRBS), developed in Canada and recently revised [10], has been translated into Thai and demonstrates promise in identifying barriers to CR for the Thai population. This follow-up study after translation into Thai aimed to assess the scale’s construct validity and internal consistency among Thai individuals diagnosed with CVD.
METHODS
Study design
The study was conducted in two stages. The initial phase involved translating the Cardiac Rehabilitation Barriers Scale Thai version (CRBS-T) (Supplementary Material S1), with results reported elsewhere [11]. This report focuses on the second phase, which examines the psychometric properties of the new CRBS-T to ascertain its construct validity and internal consistency.
Setting and sample
The participant pool was outpatients from the medical-surgical clinics and cardiac rehabilitation center at a large university-based tertiary care hospital in Bangkok, Thailand. These individuals were referred to the cardiac rehabilitation program because of their medical conditions, such as acute coronary syndrome, revascularization, and heart failure [12]. Programs are tailored to address individual rehabilitation needs. Inclusion criteria required participants to be aged 18 or older, able to read Thai on a self-administered survey, and willing to participate in the study. Exclusion criteria included outpatients documented by healthcare providers as having cognitive impairments or limited physical abilities from strokes or other impairments. The recruitment employed a convenience sampling method.
Based on an expected effect size of 0.20, a statistical power of 80%, 21 observable variables, four latent variables, and a significance level of 0.05, the required sample size was determined to range from 116 to 342 participants [13]. Consequently, the total sample size of 200 participants was deemed adequate for conducting factor analysis.
Instruments
A sociodemographic questionnaire collected data on participants’ age, sex, ethnicity, education, marital status, employment status, monthly family income, religion, health insurance, cardiac rehabilitation costs, distance to the cardiac rehabilitation center, and use of CR services.
Originally developed in English by Shanmugasegaram et al. [14], the CRBS is a widely used 21-item tool designed to assess the barriers to enrollment and participation in CR programs, spanning from the individual to the health system level [15,16]. The original CRBS consists of four subscales: perceived need for CR/healthcare factors (nine items), logistical factors (five items), work schedule/time conflicts (three items), and comorbidities/functional status (four items) [14]. Participants indicate their level of agreement on a 5-point Likert scale (1=strongly disagree to 5=Strongly agree), with higher scores reflecting more barriers to accessing the CR program. In 2024, the original CRBS was revised (CRBS-R) to enhance its applicability to hybrid CR across diverse settings [10].
The CRBS has been translated into at least 18 languages [17], with specific translations and validations conducted in Brazilian Portuguese [18], Korean [19], Turkish [20], Malay [21], Czech [22], Persian [23], Mandarin/Simplified Chinese [24], Greek [25], and Arabic [26]. The first translation of CRBS-T underwent cross-cultural validation [11], but its psychometric properties were not assessed until the current stage of this study.
Data collection
Data collection for this study occurred between April 2023 and mid-April 2024. Study participants were returning to the hospital’s outpatient clinics for follow-up care. The participants completed self-administered survey questionnaires after their appointments at either the medical-surgical clinics or the cardiac rehabilitation center.
Data analysis and psychometric testing
Data preparation
During data preparation, critical checks were conducted to ensure the dataset integrity, including the examination for data entry errors, missing data, and extreme outliers. Frequencies, percentages, patterns, and item distributions were calculated to analyze participant characteristics. Statistical analyses were conducted using IBM SPSS ver. 23 (IBM Corp.) and Mplus, ver. 7.1 (Scientific Software International).
Analysis confirmed that all surveys were complete, with no missing data. However, among the 248 participants, 48 individuals (19.35%) were identified as extreme outliers and were excluded from the factor analysis. Consequently, 200 participants were retained for both factor analysis and reliability analysis. The measurement properties of the instruments were assessed based on the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) taxonomy and guidelines [27].
Structural validity
Several statistical techniques were used to evaluate the instrument’s construct validity, including principal axis factor analysis (PAF) and first- and second-order confirmatory factor analysis (CFA). PAF was conducted to identify items related to each factor and to assess the alignment of the CRBS-T factors with the original English CRBS. Following PAF, CFA was performed to confirm the identified factors (subscales) and elucidate the relationships between them.
The suitability for conducting PAF was determined through the Kaiser-Meyer-Olkin (KMO) test for sampling adequacy, Bartlett’s sphericity test for correlation matrix adequacy, and the determinant for assessing heterogeneity and matrix singularity. PAF analysis was used to examine the factor structure, employing Oblimin rotation with Kaiser normalization. Factors were selected based on eigenvalues greater than 1.0 [28] and factor loadings of at least 0.40 [29]. The scree plot was analyzed to identify the “elbow” point where the eigenvalues leveled off. Items loading on multiple factors were interpreted according to the highest loading [30]. The internal consistency of the identified factors was assessed using Cronbach’s alpha, with coefficients at least 0.70 considered satisfactory. The significance level for all statistical tests was set at 0.05.
First-order CFA assessed the theoretical model identified through PAF to further explore construct validity by comparing it with the actual data. A simple factor structure was posited, indicating that each item could measure only one factor. The correlation structure of the data was tested against a hypothesized structure using goodness of fit indices. Second-order CFA assessed factor loadings applying a standard threshold of at least 0.70 for adequate loadings and evaluating the model’s fit indices. Model fit was deemed acceptable if the comparative fit index and Tucker–Lewis index were both ≥0.90, and the root mean square error of approximation was ≤0.08 [31,32]. Each factor exhibited factor loadings of at least 0.70 and fit indices meeting or exceeding acceptable thresholds.
Mann–Whitney U-tests were performed to assess the criterion validity of the CRBS-T, examining differences in mean scores between participants who attended CR programs and those who did not. The internal consistency of the CRBS-T was assessed to determine the degree of interrelatedness among the measurement items [27]. Cronbach’s alpha was used to assess the CRBS-T scale’s internal consistency [33], with values of at least 0.70 indicating sufficient internal consistency [34].
Ethical considerations
The study protocol received approval from the human research ethics committees of Faculty of Medicine Ramathibodi Hospital (COA.MURA2023/313). Ethical considerations, aligned with the principles outlined in the Helsinki Declaration, were prioritized throughout the research process. All participants gave written informed consent to participate in the study. Permission to use the CRBS was obtained from Shanmugasegaram et al. [14].
RESULTS
Characteristics of the participants
The sample consisted of 200 participants with a mean age of 62.60±12.37 years, range: 18–90 years) (Table 1). The demographic composition predominantly included Buddhist Thai males who were married, unemployed or retired, and reported a family income of at least 20,000 Thai baht (approximately US $600, contingent upon current exchange rates). Nearly half of the participants had a tertiary education. Over 80% were covered by Thailand’s universal health plan or were civil servants benefiting from medical benefits. Over three-fourths attended CR, although two-thirds resided at least 30 km from the nearest CR center. Financial implications varied, with approximately one-third positioned at either the lower or upper extremes of the cost range for individual CR sessions. Despite the geographical and financial barriers, the majority of participants attended CR.
Spearman’s rank correlation showed two significant demographic variables with weak relationships to CR attendance. Health insurance was positively related (rs=0.15, p=0.03), while the method of transportation was negatively related (rs=-0.20, p<0.01).
Construct validity
The scale’s structure was initially evaluated through PAF. The KMO yielded a value of .910, indicating that the sample size was appropriate for factor analysis. Furthermore, Bartlett’s test produced a significant result of 2,243.744 (p<0.05), suggesting robust correlations among variables. From PAF, the components with eigenvalues greater than 1.00 were extracted, revealing four components with eigenvalues ranging from 1.005 to 8.683, collectively accounting for 61.8% of the total variance (Table 2). The scree plot’s elbow appears to break at Factor 3, but the fourth eigenvalue is slightly above 1.0 (Fig. 1).
Factor loadings represent the degree of correspondence between each variable and the underlying factor, reflecting the correlation of each item with the respective component. Loadings with values of at least .40 indicate a more substantial representation of variables within the factor [35]. Table 2 displays the factor structure of the CRBS-T, presenting item loadings associated with each component.
The first- and second-order CFA results of CRBS-T revealed factor loadings of four components, ranging from .669 to .939 (Fig. 2). The CFA goodness of fit indices met or exceeded the recommended values [31]. Results of second-order CFA were used for the final interpretation of factors as subscales.
Internal consistency
The CRBS-T demonstrated a Cronbach’s alpha of .927, indicating acceptable internal consistency. Each scale component exhibited strong internal consistency, with alpha values ranging from .815 to .878. The component related to work and time conflicts showed the lowest alpha value of .815, whereas the logistical barriers component achieved the highest alpha value of .878 (Table 2).
Criterion validity
Criterion validity was assessed by comparing the total and subscale CRBS-T scores between participants who attended CR programs and those who did not. The results revealed that total scores were significantly higher among non-attendees, indicating they experienced more barriers to CR participation. Mean scores across the four components—lack of perceived need, logistical aspects, comorbidities, and work and time conflicts—were significantly higher among non-attendees than attendees (Table 3).
Table 3 shows the mean item, total, and CRBS-T factor scores. The most frequently reported barriers to participation were related to prior exercise. Other common barriers included distance, transportation difficulties, cost, and family responsibilities. Among these factors, logistical barriers emerged as the most critical impediments to CR uptake.
DISCUSSION
This study reports the psychometric properties of the newly translated CRBS-T. Results indicate that the scale’s construct validity and internal consistency are satisfactory for identifying and measuring potential barriers to CR among Thai people with CVDs.
The translated CRBS-T retains the 21 items and a four-component structure consistent with the original English version and most other translations [14,17,18]. We opted to retain the fourth component, notwithstanding its marginally low eigenvalue, preserving the original scale structure based on statistical and theoretical considerations. The four components are work and time conflicts, the lack of perceived factors, comorbidities, and logistical barriers. Although strong similarities exist with the English scale, the CRBS-T’s overall internal consistency, ordering/sequencing of the four components, and item loadings differ from the original [14]. This may be attributed to cross-cultural variability and variations between healthcare systems in Canada and Thailand, and local socio-cultural differences among Thai outpatients. The same reasons may account for differences between the CRBS-T and versions from Korea, Malaysia, and China [19,21,24,36].
Most validations of the translated CRBS scale, including those in Arabic [26] Czech [22], Greek [25], Malay [21], and Persian [23] retain the four components. However, the Brazilian Portuguese [18], Mandarin/Simplified Chinese versions [24], and Turkish [20], and identified five factors, while the Korean version identified six factors [19]. The four factors derived yielded from our analyses closely align with those identified in other translated CRBS versions, strengthening the scale’s validity of the factor structure. The CRBS-T exhibited acceptable internal consistency, with Cronbach’s alpha values consistent with or exceeding those reported in various translations, including the Czech (α=0.77), Greek (α=0.70), Korean (α=0.65–0.83), Malay (α=0.82), and Mandarin (α=0.67–0.82) versions.
The criterion validity of the scale is evidenced by the higher mean CRBS-T scores of outpatients who did not attend CR compared to those who did. However, it should be acknowledged that the number of non-attendees was disproportionately smaller than attendees. Recent studies indicate that CR non-attendees report significantly more perceived barriers across four domains: lack of awareness, logistic challenges, personal health limitations, and work/time conflicts [37]. Although CR programs are increasingly available in Thailand, the claim of not needing CR may stem from limited public awareness. Patients often report a lack of knowledge about CR and insufficient communication from CR staff, leading to gaps in patient education.
Logistical concerns, including cost and family responsibilities, mirror findings in other countries [38]. Despite Thailand’s universal health insurance covering CR sessions [39], out-of-pocket and indirect costs, such as transportation, remain substantial barriers to participation. Physical limitations, such as fatigue or pain, underscore the necessity for tailored CR programs to accommodate patients with multiple comorbidities and limited physical function. Work-related barriers, especially for working-age adults, highlight the need for more flexible CR delivery models, such as telerehabilitation options.
The factor structure from the second-order CFA indicates that the work and time conflicts subscale had the highest variance percentage. This perceived barrier may stem from the nature of the CR program in Bangkok, where outpatients can access the services only on weekdays. The lack of weekend options may prevent some outpatients from attending. This situation may differ from where the original English, Korean [19], Malay [21], and Mandarin [24] versions were developed.
The subscale addressing the lack of perceived need ranked second in variance. The majority of the Bangkok hospital outpatients were post-cardiac surgery, predominantly coronary artery bypass grafting, who may have perceived little or no need for CR after successful surgical outcomes [40]. They may also not have received professional encouragement from some healthcare providers to attend CR for similar reasons or because Thailand’s CR referral system is less implemented.
The subscale addressing comorbidity/health status of outpatients ranked third in variance. Outpatients who may wish to attend CR may be hesitant or prevented from doing so due to their health conditions. For those whose physical conditions suggest they would benefit from CR, further health assessments and emotional support from healthcare professionals may be necessary.
The subscale addressing the logistical factors subscale had the lowest variance percentage. This ranking diverges from the original English version [14,15]. CR in Thailand is still developing and requires more outpatient referrals; however, there are insufficient CR centers nationwide to meet demand. Travel distances from home to the CR center present significant transportation problems for Thai individuals with CVDs [11]. To address these issues, new CR delivery models, such as home-based CR or hybrid CR, warrant consideration, using various approaches, including telemedicine [10].
In response to a shift towards hybrid delivery in CR, the originator of the CRBS published a revised version in 2024, known as CRBS-R. Should Thailand adopt a hybrid service model, efforts should be initiated to validate a Thai adaptation of the CRSB-R to ensure its effectiveness and relevance in the local context.
Limitation
A convenience sample from one university-based tertiary care hospital in Thailand’s largest city may inhibit generalizability to other regions which may possess different infrastructural characteristics. Over 19% of the original sample was excluded because data did not meet statistical test assumptions, raising concerns about potential selection bias, as also might the overrepresentation of males in the sample. Differences in sociodemographic characteristics existed between CR attendees and non-attendees. While responses may also have varied between participants with acute coronary syndrome and chronic heart failure, these distinctions were not analyzed separately.
Future use of the CRBS-T in other regions in Thailand, including among rural populations with different CR programs should further examine the scale’s psychometric properties. Notably, this study was conducted before the latest revision of the CRBS; therefore, future translated studies should incorporate items addressing technology and hybrid CR models to mitigate the barriers to participation [10].
Conclusions
The CRBS-T demonstrates satisfactory psychometric properties for identifying and measuring potential barriers to cardiac rehabilitation among Thai people with CVDs. Future clinical research may use this scale to suggest targeted interventions aimed at increasing CR program attendance. By fostering attendance, individuals with CVDs are more likely to strengthen their cardiac functioning, well-being, and quality of life.
CONFLICTS OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING INFORMATION
Grant from the Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand (grant number: 02-2566).
AUTHOR CONTRIBUTION
Conceptualization: Kotcharoen R, Payngulume K. Methodology: Kotcharoen R, Payngulume K. Formal analysis: Kotcharoen R, Payngulume K, Chintapanyakun T. Funding acquisition: Kotcharoen R, Payngulume K. Project administration: Kotcharoen R, Payngulume K. Visualization: Kotcharoen R, Payngulume K. Writing – original draft: Kotcharoen R, Payngulume K. Writing – review and editing: Kotcharoen R, Payngulume K. Approval of final manuscript: all authors.
ACKNOWLEDGMENTS
We would like to express our special thanks to Dr.Robert Eley, Faculty of Medicine, The University of Queensland and Dr. Pennapa Unsanit. We thank all the study’s participants.
Scree plot from principal axis factor analysis of the Cardiac Rehabilitation Barriers Scale Thai version.
Fig. 2.
Second-order confirmatory factor analysis of the Cardiac Rehabilitation Barriers Scale (CRBS) Thai version.
Table 1.
Sociodemographic characteristics of participants
Characteristic
Value (N=200)
Age(yr)
<60
65 (32.5)
60–69
87 (43.5)
≥70
48 (24.0)
Sex
Male
133 (66.5)
Female
67 (33.5)
Ethnicity
Thai
196 (98.0)
Thai Chinese heritage
4 (2.0)
Educational level (yr)
<6
36 (18.0)
6–12
24 (12.0)
Tertiary or more than 12
140 (70.0)
Marital status
Married
147 (73.5)
Single, separated, divorced, and widowed
53 (26.5)
Employment status
Employed
78 (39.0)
Unemployed or retired
122 (61.0)
Family income a month (Thai baht)
<10,000
22 (11.0)
10,000–20,000
30 (15.0)
>20,000
148 (74.0)
Religion
Buddhist
186 (93.0)
Muslim
9 (4.5)
Christian
5 (2.5)
Health insurance
Universal health coverage
59 (29.5)
Civil servant medical benefits
105 (52.5)
Social security
12 (6.0)
Private insurance
9 (4.5)
Voluntary payment
15 (7.5)
CR cost per session (Thai baht)
<1,000
70 (35.0)
1,000–2,000
55 (27.5)
>2,000
75 (37.5)
Distance from home to CR (km)
<30
64 (32.0)
≥30
136 (68.0)
CR attendance
Attendance
154 (77.0)
Not attendance
46 (23.0)
Values are presented as number (%).
CR=cardiac rehabilitation.
Table 2.
Principle axis factor analysis with Oblimin rotation and Kaiser normalization, percentages of variance, factor eigenvalues, and internal reliabilities of the CRBS-T (N=200)
Scale item
Components (subscales) and factor oadings
F1
F2
F3
F4
1. I do not need cardiac rehabilitation
.557
2. I can manage on my own
.585
3. My doctor did not feel it was necessary
.537
4. Many people with heart problems do not go to cardiac rehabilitation and they are fine
.734
5. I prefer to take care of my health alone
.475
6. I already exercise at home or in my community
.604
7. I did not know about cardiac rehabilitation
.577
8. I think I was referred but the rehab program did not contact me
.634
9. It took too long to get referred and into the program
CRBS-T, Cardiac Rehabilitation Barriers Scale Thai version. F1, lack of perceived need factors; F2, logistical barriers; F3, comorbidities; F4, work and time conflicts.
a)Extraction method: principal axis factoring.
b)Internal reliability method.
Table 3.
Comparisons of the CRBS-T mean scores by cardiac rehabilitation participation status for four components and individual items (N=200)
CRBS-T components (subscales) and their respective items
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Evaluation of the Psychometric Properties of the Thai Version of the Cardiac Rehabilitation Barriers Scale
Fig. 1. Scree plot from principal axis factor analysis of the Cardiac Rehabilitation Barriers Scale Thai version.
Fig. 2. Second-order confirmatory factor analysis of the Cardiac Rehabilitation Barriers Scale (CRBS) Thai version.
Graphical abstract
Fig. 1.
Fig. 2.
Graphical abstract
Evaluation of the Psychometric Properties of the Thai Version of the Cardiac Rehabilitation Barriers Scale
Characteristic
Value (N=200)
Age(yr)
<60
65 (32.5)
60–69
87 (43.5)
≥70
48 (24.0)
Sex
Male
133 (66.5)
Female
67 (33.5)
Ethnicity
Thai
196 (98.0)
Thai Chinese heritage
4 (2.0)
Educational level (yr)
<6
36 (18.0)
6–12
24 (12.0)
Tertiary or more than 12
140 (70.0)
Marital status
Married
147 (73.5)
Single, separated, divorced, and widowed
53 (26.5)
Employment status
Employed
78 (39.0)
Unemployed or retired
122 (61.0)
Family income a month (Thai baht)
<10,000
22 (11.0)
10,000–20,000
30 (15.0)
>20,000
148 (74.0)
Religion
Buddhist
186 (93.0)
Muslim
9 (4.5)
Christian
5 (2.5)
Health insurance
Universal health coverage
59 (29.5)
Civil servant medical benefits
105 (52.5)
Social security
12 (6.0)
Private insurance
9 (4.5)
Voluntary payment
15 (7.5)
CR cost per session (Thai baht)
<1,000
70 (35.0)
1,000–2,000
55 (27.5)
>2,000
75 (37.5)
Distance from home to CR (km)
<30
64 (32.0)
≥30
136 (68.0)
CR attendance
Attendance
154 (77.0)
Not attendance
46 (23.0)
Scale item
Components (subscales) and factor oadings
F1
F2
F3
F4
1. I do not need cardiac rehabilitation
.557
2. I can manage on my own
.585
3. My doctor did not feel it was necessary
.537
4. Many people with heart problems do not go to cardiac rehabilitation and they are fine
.734
5. I prefer to take care of my health alone
.475
6. I already exercise at home or in my community
.604
7. I did not know about cardiac rehabilitation
.577
8. I think I was referred but the rehab program did not contact me
.634
9. It took too long to get referred and into the program
.487
10. Cost
.823
11. Transportation problems
.859
12. Distance
.767
13. Family responsibilities
.758
14. Severe weather
.639
15. I don’t have the energy
.868
16. I find exercise tiring or painful
.711
17. Other health problems prevent me from going
.626
18. I am too old
.754
19. Work responsibilities
.782
20. Time constraints
.908
21. Travel
.619
Initial eigenvaluesa)
Eigenvalue
8.683
2.061
1.218
1.005
Variance explained (%)
41.348
9.814
5.799
4.787
Total variance explained 61.8%
Cronbach’s alpha coefficients of the subscalesb)
.831
.878
.828
.815
Cronbach’s alpha coefficient: total CRBS-T=.927
CRBS-T components (subscales) and their respective items
Total (N=200)
CR attendees (n=154)
CR non-attendees (n=46)
Mann–Whitney U (Z)
p-valuea)
Lack of perceived need
2.36±0.72
2.29±0.69
2.62±0.74
-2.82
<0.01
Item 1
I do not need cardiac rehabilitation
2.07±1.00
1.98±0.99
2.37±0.97
-2.59
0.01
Item 2
I can manage on my own
2.02±1.02
2.00±1.04
2.07±0.98
-0.63
0.53
Item 3
My doctor did not feel it was necessary
2.54±1.15
2.46±1.13
2.83±1.18
-1.81
0.07
Item 4
Many people with heart problems do not go to cardiac rehabilitation and they are fine
2.06±1.00
2.03±1.03
2.17±0.90
-1.23
0.22
Item 5
I prefer to take care of my health alone
2.18±1.12
2.15±1.11
2.26±1.16
-0.55
0.58
Item 6
I already exercise at home or in my community
3.18±1.23
3.15±1.23
3.30±1.25
-0.80
0.42
Item 7
I did not know about cardiac rehabilitation
2.39±1.23
2.26±1.19
2.83±1.29
-2.69
<0.01
Item 8
I think I was referred but the rehab program did not contact me
2.37±1.10
2.26±1.02
2.74±1.29
-2.22
0.03
Item 9
It took too long to get referred and into the program
2.61±1.23
2.55±1.22
2.83±1.25
-1.37
0.17
Logistical barriers
2.78±0.99
2.67±0.94
3.14±1.08
-2.96
<0.01
Item 10
Cost
2.83±1.20
2.69±1.16
3.28±1.22
-2.92
<0.01
Item 11
Transportation problems
2.93±1.23
2.85±1.20
3.22±1.28
-1.83
0.07
Item 12
Distance
3.06±1.23
2.97±1.25
3.35±1.34
-1.83
0.07
Item 13
Family responsibilities
2.77±1.22
2.63±1.17
3.24±1.29
-2.87
<0.01
Item 14
Severe weather
2.32±1.05
2.23±0.98
2.61±1.20
-1.81
0.07
Comorbidities
2.14±0.88
2.07±0.86
2.38±0.91
2.14
0.03
Item 15
I don’t have the energy
2.10±1.05
2.01±1.02
2.37±1.12
-2.00
0.04
Item 16
I find exercise tiring or painful
2.12±1.05
2.05±1.03
2.37±1.06
-2.04
0.04
Item 17
Other health problems prevent me from going
2.20±1.08
2.12±1.06
2.43±1.13
-1.68
0.09
Item 18
I am too old
2.15±1.09
2.09±1.09
2.33±1.10
-1.39
0.17
Work/time conflicts
1.90±0.82
1.85±0.83
2.12±0.75
-2.40
0.02
Item 19
Work responsibilities
1.88±0.92
1.81±0.89
2.13±0.98
-2.17
0.03
Item 20
Time constraints
1.92±0.92
1.85±0.94
2.15±0.82
-2.52
0.01
Item 21
Travel
1.93±0.99
1.88±1.04
2.07±0.83
-1.86
0.06
Table 1. Sociodemographic characteristics of participants
Values are presented as number (%).
CR=cardiac rehabilitation.
Table 2. Principle axis factor analysis with Oblimin rotation and Kaiser normalization, percentages of variance, factor eigenvalues, and internal reliabilities of the CRBS-T (N=200)
CRBS-T, Cardiac Rehabilitation Barriers Scale Thai version. F1, lack of perceived need factors; F2, logistical barriers; F3, comorbidities; F4, work and time conflicts.
Extraction method: principal axis factoring.
Internal reliability method.
Table 3. Comparisons of the CRBS-T mean scores by cardiac rehabilitation participation status for four components and individual items (N=200)
