STUDY PROTOCOL article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1542942
Adherence to outpatient cardiac rehabilitation and related factors in STEMI after PCI in China: a sequential explanatory mixed method study protocol
Provisionally accepted
- Affiliated Hospital of Jiangsu University, Zhenjiang, China
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Background: Acute myocardial infarction remains a major contributor to global morbidity and mortality. Cardiac rehabilitation is widely recognized as an essential component of the comprehensive medical management for patients with ST-elevation myocardial infarction, especially among those who have undergone percutaneous coronary intervention. Adherence to cardiac rehabilitation encompasses patient collaboration with a healthcare provider, active involvement in the treatment regimen, and persistence in practice, characterized by self-efficacy and relapse prevention. Outpatient cardiac rehabilitation constitutes the second phase of the continuum of care, bridging the inpatient and long-term maintenance stages. However, adherence to outpatient cardiac rehabilitation programs in China remains suboptimal. The factors influencing outpatient cardiac rehabilitation in patients with ST-elevation myocardial infarction after percutaneous coronary intervention have not yet been fully elucidated. Aims: To investigate the status and influencing factors of adherence to outpatient cardiac rehabilitation in patients with ST-elevation myocardial infarction after percutaneous coronary intervention one month after discharge in China and gain a deeper understanding of this phenomenon of interest. Methods: An explanatory sequential mixed-methods design will be employed to conduct this study with three phases. The first phase is a quantitative study with a cross-sectional design to assess the level of adherence to outpatient cardiac rehabilitation and related influences based on the Health Belief Model among 198 patients with ST-elevation myocardial infarction after percutaneous coronary intervention in two tertiary hospitals in Zhenjiang, Jiangsu Province, China. The second phase is followed by a qualitative study to explore the patients’ perceived facilitators and barriers to adherence to outpatient cardiac rehabilitation. Purposive sampling, semi-structured interviews, and conventional content analysis approaches will be used to collect and analyze the data. The final phase links to integrating the data and developing a targeted strategy to improve adherence to outpatient cardiac rehabilitation among patients with ST-elevation myocardial infarction after percutaneous coronary intervention. The nominal group technique and "weaving techniques" will be implemented in accordance with the results of the preceding two phases. Discussion: A targeted strategy to improve outpatient cardiac rehabilitation adherence would be designed considering the factors affecting adherence to outpatient cardiac rehabilitation in patients with ST-elevation myocardial infarction after percutaneous coronary intervention.
Keywords: adherence, Cardiac Rehabilitation, health belief model, acute myocardial infarction, Percutaneous Coronary Intervention, Mixed-methods study
Received: 15 Feb 2025; Accepted: 21 Jul 2025.
Copyright: © 2025 Zhang, Wang, Li, Wu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wenjie Zhang, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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