Development and preliminary testing of the Cardiac Rehabilitation Enrolment Obstacles (CREO) scale: implications for service development

Eur J Cardiovasc Nurs. 2008 Jun;7(2):96-102. doi: 10.1016/j.ejcnurse.2007.09.002. Epub 2007 Oct 18.


Background: In spite of the benefit in participating in cardiac rehabilitation (CR) programs, low participation rates are well documented. Participation rates are potentially lower in people who have undergone percutaneous coronary interventions (PCI). Assessment of the barriers to CR participation in PCI patients could provide vital information for the development of alternate strategies for coronary risk factor modification.

Aim: The aim of this study was to develop and evaluate the psychometric properties of a scale to assess obstacles to cardiac rehabilitation enrolment in patients following PCI.

Methods: Item generation for the 15 items of this scale was based on a comprehensive review of the literature and data collected from telephone interviews of CR coordinators related to cardiac rehabilitation enrolment obstacles (CREO). Content validity of the scale was undertaken using a reference group comprising of clinicians and patients. Construct validity was undertaken using a factor analysis. Data for the CREO scale was collected from December 2004 to March 2005 from 114 PCI patients recruited from a cardiology database in a Sydney metropolitan hospital.

Results: Factor analysis revealed a two-factor structure: patient-related obstacles and health service-related obstacles, which accounted for 58% of cumulative explained variance. The scale showed good internal consistency (Cronbach's alpha=0.89) and satisfactory divergent validity.

Conclusion: This scale can be used as a useful tool for the early identification of patients who would not normally enrol into CR and offer them alternate strategies for health-related lifestyle modification.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Angioplasty, Balloon, Coronary
  • Factor Analysis, Statistical
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility / organization & administration*
  • Heart Diseases* / psychology
  • Heart Diseases* / rehabilitation
  • Hospitals, Urban
  • Humans
  • Male
  • Middle Aged
  • National Health Programs
  • Needs Assessment
  • New South Wales
  • Nursing Assessment / methods*
  • Nursing Evaluation Research
  • Patient Acceptance of Health Care / psychology*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Patient Education as Topic
  • Psychometrics
  • Surveys and Questionnaires / standards*
  • Universal Health Insurance