Development, piloting and validation of the Recommending Cardiac Rehabilitation (ReCaRe) instrument

Heart Lung. 2019 Sep-Oct;48(5):405-413. doi: 10.1016/j.hrtlng.2019.04.008. Epub 2019 May 14.


Background: Health practitioners' values, attitudes and beliefs largely determine their referrals to cardiac rehabilitation (CR).

Objective: To develop and test the Recommending Cardiac Rehabilitation scale (ReCaRe), designed to assess health professionals attitudes, values and beliefs to CR referral.

Methods: ReCaRe was appraised for: content validity (Delphi method, expert panel); interpretability and face validity (interview, health professionals); factor structure and internal consistency (survey, health professionals); and test-retest reliability (survey, health professionals). Normative scores were collated.

Results: ReCaRe initially comprised 75 items. Initially, a Content Validity Index (CVI) was calculated for ratings of item relevance (CVI range; 0.27-1.0), which resulted in the removal of 19 items. After preliminary validation and psychometric testing, 34 items were factor-analysed (n = 24) providing a 17-item, four-factor scale: perceived severity and susceptibility (α = 0.93, κ = 0.37); perceived service accessibility (α = 0.91, κ = 0.67); perceived benefit (α = 0.97, κ = 0.47); perceived barriers and attitudes (α = 0.82, κ = 0.49). ReCaRe normative scores (n = 75) are reported.

Conclusions: This psychometric analysis found ReCaRe to demonstrate good face validity, internal consistency and fair to substantial test-retest reliability. The next step is to validate these initial findings on a larger sample size to confirm whether ReCaRe can enable identification of factors impacting CR referral.

Keywords: Cardiac rehabilitation; Psychometrics; Referral; Scale development.

Publication types

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

MeSH terms

  • Attitude of Health Personnel*
  • Cardiac Rehabilitation / methods*
  • Delphi Technique
  • Female
  • Humans
  • Male
  • Middle Aged
  • Program Development*
  • Psychometrics / methods*
  • Reproducibility of Results
  • Surveys and Questionnaires