Rejuvenating rehab protocol: using experience based co-design to improve engagement with cardiac rehabilitation

Background: Cardiovascular disease is the world’s biggest killer and while we know that cardiac rehabilitation reduces mortality and morbidity, it has poor uptake and attendance. Outcomes are sub-optimal with a 1 in 5 risk of major adverse cardiac event within the first year. There is an urgent need to make rehabilitation and prevention of future heart disease more acceptable, more accessible and more appealing to those who traditionally avoid participation; more than half of eligible patients choose not to attend. Unfortunately methods to achieve that objective have proved elusive. This study aims to take the innovative approach of Experience Based Co-Design (EBCD) to involve patients and staff as co-designers of innovative approaches to delivering CR may be an opportunity to greatly improve participation in this life-saving programme.

Aim: To explore the current challenges of Cardiac Rehabilitation and using EBCD develop innovative approaches that maximise patient engagement.

Methods: There is evidence that patient participation in design has a positive effect on subsequent use of resources. Those patients who do not attend the current CR programme hold the key to understanding the aspects of CR which are unappealing or inaccessible. It is through exploration of their experience that the most tangible evidence for change can potentially be revealed. EBCD will be used along with latest evidence to develop innovative approaches to CR.
1.Structured Literature Review - to evaluate existing approaches to CR delivery and to identify which intervention strategies are most effective and why.
2.Focus groups and interviews. There are 4 main groups of participants; each will discuss their experiences of the current provision of CR and include ideas for change. The study will be conducted in each of the 5 Health and Social Care Trusts. Figures given are per Trust.
Group A – Staff (Focus group) n=5
Group B – Patients who have attended most or all CR classes (Focus group) n=10
Group C – Patients who dropped out of CR (Interview) n=10
Group D – Patients who did not attend any CR classes (Interview) n=10
3.Co-Design Workshop. This is a session with participants from Groups A-D, patient representatives, Cardiologists, CR programme leads, Local Cardiac Charities and University supervisors. The workshop will include anonymised quotations and video footage of patient’s experiences portrayed by an actor designed to trigger discussion and responses within the workshop. The goal of the workshop is to co-design innovative approaches which are viable solutions for non-attendance to CR.

Outcome: Innovative methods of delivering CR will be identified and will proceed to further testing beyond this study. The study will provide evidence of the benefit of using EBCD and working with patients and staff directly to develop their service.