Review Improving uptake of cardiac rehabilitation: Using theoretical modelling to design an intervention Sultan M. Mosleh ⁎ , Alice Kiger, Neil Campbell Centre of Academic Primary Care, University of Aberdeen, Westburn Road, Aberdeen, AB25 2AY, Scotland Received 13 August 2008; received in revised form 4 December 2008; accepted 8 February 2009 Available online 19 March 2009 Abstract Background: Attendance rates at cardiac rehabilitation remain low with typically fewer than 35% of eligible patients attending. Much of the poor attendance stems from invited patients failing to attend. Aim: To design a theoretically based intervention to improve attendance at cardiac rehabilitation. Methods: Our methods followed recommendations that have been developed from the Medical Research Council (MRC) framework for the design of complex interventions. We conducted three processes that progressed simultaneously: 1) literature review for evidence on epidemiology, behavioural theory, and efficacy of interventions; 2) expert meetings on behavioural theory and to select target points for intervention; and 3) development and theoretical modelling of the intervention. Result: Our final interventions were a theoretically worded invitation letter and leaflet based on the Theory of Planned Behaviour and the Common Sense Model of Illness, designed to: a) motivate patients through professional recommendation; b) provide simple information on the contents of cardiac rehabilitation emphasising ease for participants; c) reassure participants that the programme is tailored to their personal needs in a safe supervised environment; and d) reinforce the benefits of attending cardiac rehabilitation. Conclusion: A theoretically worded letter and leaflet could be an inexpensive intervention to improve attendance at cardiac rehabilitation. The letters and leaflets will now be evaluated in a randomised trial. © 2009 European Society of Cardiology. Published by Elsevier B.V. All rights reserved. Keywords: Cardiac rehabilitation; Complex intervention; Health psychology Contents 1. Introduction ............................................................ 162 2. Methods ............................................................. 162 2.1. Identify predictors of cardiac rehabilitation ........................................ 162 2.2. Identifying relevant behavioural theory .......................................... 162 2.3. Conceptualising the intervention ............................................. 162 3. Results .............................................................. 163 3.1. Background and context .................................................. 163 3.1.1. Target population ................................................. 163 3.1.2. Cardiac rehabilitation benefits .......................................... 163 3.1.3. Attendance rates ................................................. 163 3.1.4. Factors associated with non-attendance ..................................... 163 European Journal of Cardiovascular Nursing 8 (2009) 161 – 168 www.elsevier.com/locate/ejcnurse ⁎ Corresponding author. Tel.: +44 0 1224551965; fax: +44 0 1224 550683. E-mail address: s.m.mosleh@abdn.ac.uk (S. Mosleh). 1474-5151/$ - see front matter © 2009 European Society of Cardiology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.ejcnurse.2009.02.004