Health Care Administrators\u27 Attitudes Toward Cardiac Rehabilitation in North and South America and the Development of a Scale to Assess Them

BACKGROUND: Cardiac rehabilitation (CR) is insufficiently available; even less so in low-resource settings. Health care administrators (HAs) are responsible for ensuring CR programs are offered and resourced. This study compared HA CR attitudes in North and South America, the contextual factors associated with these attitudes, and developed a scale/survey to assess them with global applicability. METHODS: Data were retrospectively analysed from three cross-sectional studies: in (1) 195 HAs from Canada (i.e., North America), (2) 44 HAs from seven South American countries, and (3) 43 HAs from Brazil (all South America). Contextual and perceptual/attitudinal items (five-point Likert scale, with higher scores indicating more positive attitudes) were compared by region. Psychometric properties of items were tested. A literature review was performed, and items generated for content validation by experts. RESULTS: The most negative CR attitudes related to government funding models (mean=2.46±1.14/5), and that patients have responsibility for their disease management (3.03±1.25). North American HAs rated their institutions\u27 perceptions of the importance of CR (p\u3c0.001) and quality of the local program (p\u3c0.001) higher than their South American counterparts, but rated the utility of CR in lowering length of stay (p\u3c0.001), promoting behaviour change (p\u3c0.05) and the need for more government funding (p\u3c0.05) lower, among others. Total attitude scores were positively associated with CR knowledge/awareness in both cohorts (all p\u3c0.01). North American HAs more often perceived CR should be funded by hospitals (p\u3c0.001) than South Americans. A 39-item HA CR Attitudes (HACRA-R) scale was developed. CONCLUSIONS: Health care administrators\u27 perceptions vary by context, which could impact CR resourcing