Facilitators and Barriers to Adherence to Home-Based Cardiac Rehabilitation Exercise in Patients with Chronic Heart Failure: A Qualitative Study.

BACKGROUND

Chronic heart failure (CHF) is a major global health burden. Home-based cardiac rehabilitation (HBCR) is an effective alternative to center-based programs but suffers from low patient adherence, with influencing factors within the Chinese context being underexplored.

OBJECTIVE

To explore perceived facilitators and barriers to HBCR exercise adherence among Chinese patients with CHF using the Information-Motivation-Behavioral Skills (IMB) model.

METHODS

A descriptive phenomenological qualitative study was conducted at a tertiary hospital in Guangzhou, China. Semi-structured interviews were performed with 22 CHF patients (NYHA I-III). Data were analyzed using Colaizzi's seven-step method, and themes were mapped onto the IMB model.

FINDINGS: Three IMB dimensions emerged: Information (lack of exercise knowledge; rehabilitation misconceptions); Motivation (perceived benefits, need for professional guidance, social support, poor physical perception, inertia, habit-driven motivation); Behavioral skills (active planning, self-regulation, symptom monitoring). Notably, family support - particularly from adult children - was a culturally specific facilitator, while equating daily labor with structured exercise was a unique barrier.

CONCLUSION

Adherence to HBCR is shaped by interlinked information, motivational, and behavioral skill deficits. Clinically, providers should (a) correct culturally rooted misconceptions using plain-language education, (b) involve family members as active supporters, (c) provide post-discharge cues to action via digital platforms, and (d) teach concrete self-regulation skills. These actionable strategies can improve long-term adherence in Chinese CHF patients.