Mechanisms and drivers of social inequality in phase II cardiac rehabilitation attendance: A convergent mixed methods study

Abstract Aim The aim of this study was to explore the extent to which the qualitative and quantitative data converge and explain mechanisms and drivers of social inequality in cardiac rehabilitation attendance. Background Social inequality in cardiac rehabilitation attendance has been a recognized problem for many years. However, to date the mechanisms driving these inequalities are still not fully understood. Design The study was designed as a convergent mixed methods study. Methods From March 2015—March 2016, patients hospitalized with acute coronary syndrome to two Danish regional hospitals were included in a quantitative prospective observational study ( N = 302). Qualitative interview informants ( N = 24) were sampled from the quantitative study population and half brought a close relative ( N = 12) for dyadic interviews. Interviews were conducted from August 2015 to February 2016. Integrated analyses were conducted in joint displays by merging the quantitative and qualitative findings. Results Qualitative and quantitative findings primarily confirmed and expanded each other; however, discordant results were also evident. Integrated analyses identified socially differentiated lifestyles, health beliefs, travel barriers and self‐efficacy as potential drivers of social inequality in cardiac rehabilitation. Conclusion Our study adds empirical evidence regarding how a mixed methods study can be used to obtain an understanding of complex healthcare problems. The study provides new knowledge concerning the mechanisms driving social inequality in cardiac rehabilitation attendance. To prevent social inequality, cardiac rehabilitation should be accommodated to patients with a history of unhealthy behaviour and low self‐efficacy. In addition, the rehabilitation programme should be offered in locations not requiring a long commute.