An act of courage: women's decision-making processes regarding outpatient cardiac rehabilitation attendance.

The purpose of this qualitative study was to describe the factors that affect women's attendance and adherence to a cardiac rehabilitation (CR) program after a myocardial infarction (MI). We used in-depth interviews and a health survey form to collect data. The purposive sample consisted of 40 women who had experienced a first MI within the previous 6 weeks to 12 months. Of those 40, 18 women were not offered the program, 8 declined it, and 14 attended. Using content analysis and constant comparison, we identified three distinct phases: "initial decision," "CR attendance," and "reevaluation." Four data clusters positively influenced the continuation of CR attendance: "Psychological Appraisal," "Program Components," "Staff Behaviors," and "Outcomes." When women encountered a fifth cluster--"Barriers"--they entered the reevaluation phase. Results of this study support specific interventions for each phase.