Developing strategies to increase engagement with Cardiac Rehabilitation in Northern Ireland using Experience Based Co-Design

Student thesis: Doctoral ThesisDoctor of Philosophy


Introduction: Cardiac Rehabilitation (CR) is a multidisciplinary intervention offered to patients who have been diagnosed with cardiovascular disease (CVD) it focuses on risk factor reduction through education, exercise and psychological support and has been proven to reduce mortality and enhance patients’ quality of life. Uptake of CR is poor, with >50% of eligible patients choosing not to attend. There is urgent need to improve the acceptability of CR to enhance patient outcomes, but previous attempts to increase engagement with CR have had limited success.

Aim: To identify and explore the barriers for uptake of CR in NI and subsequently develop strategies with staff and patients which could improve engagement with CR.

Methods: Using Experience Based Co-Design (EBCD) three iterative studies were conducted. Study one, Suitable interventions/concepts were identified through a literature review. Study two, local patient and staff experiences were explored through focus groups and interviews in a qualitative study and results used to inform the co-design process. Study three, findings were presented in a virtually delivered co-design workshop. Participants developed strategies to improve engagement with CR.

Results: The co-design workshops produced three strategies that help address and support findings from the PhD; A CR infomercial for use in clinical settings to improve understanding of CR, a regional webpage to improve information sharing, and a brief intervention (CABIN) to provide psychological support to patients in the acute stage of recovery.

Conclusion: The project provides real-world evidence and co-produced strategies to overcome a persistent clinical issue, intended to enhance patient outcomes. It has produced discreet outcomes designed for clinical impact. Findings evidence the complex nature of CR delivery and the barriers faced by patients, as well as solutions to overcome these. The project demonstrated how EBCD could be adapted to accommodate the demands of specific population and be delivered within a virtual environment.

Thesis is embargoed until 31 July 2025.

Date of AwardJul 2023
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SponsorsSouth Eastern Health & Social Care Trust & Northern Ireland Public Health Agency
SupervisorDonna Fitzsimons (Supervisor), Judy Bradley (Supervisor) & Patrick Donnelly (Supervisor)


  • Experience based co-design
  • nursing
  • cardiac rehabilitation

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