Reframing the dilemma of poor attendance at cardiac rehabilitation: an exploration of ambivalence and the decisional balance
Article first published online: 12 FEB 2009
© 2009 The Authors. Journal compilation © 2009 Blackwell Publishing Ltd
Journal of Clinical Nursing
Volume 18, Issue 13, pages 1842–1849, July 2009
How to Cite
Everett, B., Salamonson, Y., Zecchin, R. and Davidson, P. M. (2009), Reframing the dilemma of poor attendance at cardiac rehabilitation: an exploration of ambivalence and the decisional balance. Journal of Clinical Nursing, 18: 1842–1849. doi: 10.1111/j.1365-2702.2008.02612.x
- Issue published online: 5 JUN 2009
- Article first published online: 12 FEB 2009
- Accepted for publication: 4 August 2008
- cardiac rehabilitation;
- decisional balance;
Aim. To discuss the problem of poor attendance at cardiac rehabilitation from the alternative perspective of patient ambivalence.
Background. Evidence supports the benefits of cardiac rehabilitation as a means for secondary prevention of coronary heart disease, yet current literature continues to document poor attendance at these programmes. Whilst extrinsic factors, such as transportation and lack of physician support have been identified as barriers, patients who choose not to attend these programmes are often described as lacking motivation or being non-compliant. However, it is possible that non-attendance is the result of ambivalence – the experience of simultaneously wanting to and yet not wanting to, or the ‘I want to, but I don’t want to’ dilemma.
Design. Discussion paper.
Method. This discussion paper draws on the literature of ambivalence and decision-making theory to reframe the issue of poor attendance at cardiac rehabilitation.
Conclusions: This paper has demonstrated that the problem of poor attendance may be explained from the perspective of patient ambivalence and that using strategies such as the decisional balance may assist these individuals in exploring their ambivalence to engage in secondary prevention programmes.
Relevance to clinical practice. Understanding the dynamics of ambivalence provides an alternative to thinking of patients as lacking motivation, being non-compliant, or even resistant. Helping patients to explore and resolve their ambivalence may be all that is needed to help them make a decision and move forward.