Date of Award


Degree Name

Doctor of Philosophy


Health Education

First Advisor

Wallace, Juliane


Heart failure prevalence is projected to rise in the United States over the ensuing decades. Typical health education should be focused on primary prevention strategies; however, for those stricken with the disease, health educators should determine appropriate secondary prevention strategies for individuals to live a healthy life. One such strategy, recently approved for coverage by the Centers for Medicare and Medicaid, is cardiac rehabilitation. The impetus for the policy change was the heart failure ACTION trial. The trial unfortunately did not include patients that lived too far from cardiac rehabilitation centers, thus putting rural heart failure patients at a disadvantage. The purpose of the current study was to delineate how rural heart failure patients were referred to cardiac rehabilitation from an inpatient setting, to determine what factors were associated with initiation of cardiac rehabilitation, and to gain insight into rural heart failure patients’ motivation to partake in exercise. A purposive sample of rural heart failure patients were used for the study. Patients were selected from a rural hospital based upon their ejection fraction, per Medicare requirements. Participants completed a demographic survey as well as surveys regarding motivation to partake in exercise; six weeks later, the researcher determined if the rural heart failure participants initiated outpatient cardiac rehabilitation. Cardiac rehabilitation diagnosis, increased distance to cardiac rehabilitation, transportation and assistance, higher income, Caucasian race, and higher levels of educational attainment were independently associated with cardiac rehabilitation initiation. Further, higher levels of perceived autonomous motivation, autonomy support, and competence were associated with cardiac rehabilitation initiation. Conversely, low levels of perceived amotivation scores were associated with cardiac rehabilitation initiation. Not all heart failure patients in the current study were managed by a cardiologist while hospitalized. Lastly, the impetus of attaining the cardiac rehabilitation order for a primary diagnosis of heart failure came from the inpatient exercise physiologists.




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