Table 4 Integration of quantitative and qualitative results

Domain 1 logistical factors

1…of distance

3.29 ± 1.565

Theme1 logistics factors

Distance

Confirmed by quantitative and qualitative results

Details: more than 40 minutes driving distance seems too far for participants

2…of cost

2.76 ± 1.425

Insufficient economic support

Confirmed by quantitative and qualitative results

However, the detail of cost is different. In quantitative result, the cost focus on gas, parking, but in qualitative result, the cost refers to grogram cost. The program cost was not covered by outpatient medical insurance.

3…of transportation problems

2.99 ± 1.503

Inconvenient traffic

Confirmed by quantitative and qualitative results.

Detail: living in rural areas without public transportation

8…severe weather

1.73 ± 0.888

In qualitative result, no people mentioned weather as a barrier

Parking difficulty

Detail: lack of parking space in hospital and it costs time to find the parking space

Domain 2 CR need

5…I did not know about cardiac rehab

1.61 ± 0.825

Theme2 Misunderstanding of CR

Not a big barrier. In qualitative part, all patients claimed they were referred and they have heard cardiac rehabilitation

6…I do not need cardiac rehab

1.82 ± 1.069

Doubt the effect of cardiac rehabilitation

Confirmed by quantitative and qualitative results.

In qualitative part, some participants said they just want to treat the disease, there is no need to do rehabilitation

7…I already exercise at home, or in my community

2.69 ± 1.509

Daily activities can replace rehabilitation

Confirmed by quantitative and qualitative results.

Detail: participant think they can go to the gym or some of them have treadmill at home. They think rehabilitation is the same as physical activities.

17… many people with heart problems do not go, and they are fine

1.66 ± 0.785

18… I can manage my heart problem on my own

1.68 ± 0.879

21…I prefer to take care of my health alone, not in a group

1.70 ± 0.896

Domain 3 Time conflicts

4…of family responsibilities

2.17 ± 1.299

Theme3 Low social support

Lack of family support Caregiver role conflict

In qualitative part, most participants claimed that take care of their grandchildren or family members is a barrier.

10…travel

1.74 ± 1.019

The center opens on daytime and just open from Monday to Friday, it is conflict with the working time

11…of time constraints

2.48 ± 1.496

12…of work responsibilities

2.43 ± 1.666

Work Conflict

In qualitative part, some younger patients claimed that they need return to work and there is no spare time to do the rehabilitation in the center

Domain4 Program and health system-level factors

16…my doctor did not feel it was necessary

1.54 ± 0.743

Theme4 Program and health system-level factors

19… I think I was referred, but the rehab program did not contact me

1.64 ± 0.842

20…it took too long to get referred and into the program

1.65 ± 0.818

Limited cardiac rehabilitation center

No CR center near their home

Covid-19 test

New information emerged in qualitative phase. It is a trouble to show the negative result every time when enter the hospital

Domain5 Comorbidities/ Functional status

13…I do not have the energy

1.99 ± 1.171

No information emerged in this domain in the qualitative phase

14…other health problems prevent me from going

1.75 ± 0.938

9…I find exercise tiring or painful

2.00 ± 1.208

15…I am too old

1.86 ± 1.141

Theme5 Impression on healthcare team

New information emerged in qualitative phase

Referred by physicians or cardiologists is better than referred by nurses

Theme 6 Psychological distress

Escaping

New information emerged in qualitative phase

Anger and Hostility

New information emerged in qualitative phase

Pessimism

New information emerged in qualitative phase