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An Act of Courage: Women's Decision-Making Processes Regarding Outpatient Cardiac Rehabilitation Attendance


  • Jean C. McSweeney PhD RN,

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    • Jean C. McSweeney is an associate professor at the University of Arkansas for Medical Sciences, College of Nursing.

  • Patricia B. Crane PhD RN

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    • Patricia B. Crane is a research project director at the University of Arkansas for Medical Sciences, College of Nursing.

College of Nursing, 4301 W. Markham Street, Slot 784, Little Rock, AR 72205 or e-mail


The purpose of this qualitative study was to describe the factors that affect women's attendance and adherence to a cardiac rehabilitation (CR) program after a myocardial infarction (MI). We used in-depth interviews and a health survey form to collect data. The purposive sample consisted of 40 women who had experienced a first MI within the previous 6 weeks to 12 months. Of those 40, 18 women were not offered the program, 8 declined it, and 14 attended. Using content analysis and constant comparison, we identified three distinct phases: “initial decision,” “CR attendance,” and “reevaluation.” Four data clusters positively influenced the continuation of CR attendance: “Psychological Appraisal,” “Program Components,” “Staff Behaviors,” and “Outcomes.” When women encountered a fifth cluster—“Barriers”—they entered the reevaluation phase. Results of this study support specific interventions for each phase.