The goal of this qualitative study is to learn about the barriers and enablers to cardiac rehabilitation, experience by South Asian service users based in the UK who have experienced an acute cardiac event and been referred for CR. This may allow NHS programmes to make adaptations to their services to enhance uptake, adherence and completion for this ethnic population. The main questions it aims to answer are:

• What are the barriers and enablers to uptake, adherence or completion of CR experienced by service users with South Asian heritage?
• What adaptations to the CR service could be implemented to overcome identified barriers, enhance enablers and result in increased uptake, adherence or completion to CR?

Participants will be invited to participate in a semi-structured interview and/or a focus group to explore lived experiences that can answer the research questions.

This study aims to explore contemporary barriers and enablers to uptake, adherence or completion of cardiac rehabilitation experienced by service users with South Asian heritage, and develop culturally relevant programme adaptations to overcome the identified barriers. Cardiac rehabilitation (CR) a highly evidenced exercise-based intervention offered to eligible patients who have experienced a cardiac event however South Asian service users are less likely to uptake, adhere to or complete CR. This may be because cultural acceptability of CR components (assessment, exercise and education sessions) are not fully considered or tailored for this ethnic population. This study will explore what barriers and enablers are experienced by South Asian service users, with a focus on cultural and psychosocial factors, and develop culturally relevant programme adaptations to increase uptake, adherence and completion. The study will also explore healthcare professionals (HCPs) perceptions of barriers and enablers to CR experienced by service users with South Asian heritage. Participants will include adult (≥ 18 years) service users who have a South Asian heritage and have been referred to University Hospitals of Leicester CR after a cardiac event. Participants will also include healthcare professions and key stakeholders involved in CR and health inequalities. Participants will be invited to a community-based interview (1 hour) and/or a workshop (3 hours) to provide their experiences of barriers and enablers to CR and help develop culturally appropriate service adaptations to overcome these barriers and enhance enablers, resulting increased uptake, adherence or completion of CR. The study is funded by the Wellcome Trust as part of the Leicestershire Health Inequalities Improvement Programme as the University of Leicester.

Inclusion Criteria:

Service Users

• Adult aged ≥18 years
• Has capacity to give consent
• Been referred to UHL NHS Trust cardiac rehabilitation service
• Has experienced an acute cardiac event which is eligible for CR provided by UHL CR service
• Identifies their ethnicity as South Asian i.e. ancestral origins in India, Pakistan, Bangladesh, Afghanistan, Bhutan, Maldives, Nepal and Sri Lanka (Indian sub-continent).
• Workshop only: be able to communicate in spoken English

CR Healthcare Professionals

• Adult aged ≥18 years
• Has capacity to give consent
• HCP involved in delivering direct patient care, who works within UHL NHS Trust CR service

Key Stakeholders

• Adult aged ≥18 years
• Has capacity to give consent
• Individuals who have a direct involvement with South Asian communities, tackling health inequalities, NHS commissioning or service development, or CR policy/guideline development

Exclusion Criteria:

Service Users

• Child aged <18 years
• Unable to give consent
• Have not been referred to UHL NHS Trust CR services
• Been referred to CR due to heart failure and will conduct CR within a community-provided breathlessness pathway
• Does not self-identify as South Asian
• Workshop only: unable to speak or understand spoken English

CR Healthcare Professionals

• Child aged <18 years
• Unable to give consent
• Not a CR team member involved in delivering direct patient care, who works within UHL NHS Trust CR service

Key Stakeholders

• Child aged <18 years
• Unable to give consent
• Not an individual who have a direct influence on South Asian communities, tackling health inequalities, NHS commissioning or service development, or CR policy/guideline development
• Unable to attend workshop in person

• adults referred to cardiac rehabilitation with South Asian heritage
• cardiac rehabilitation (CR) healthcare professionals working at University of Leicester Hospitals CR service
• key stakeholders