Illuminating Stakeholder Perspectives at the Intersection of Air Quality Health Risk Communication and Cardiac Rehabilitation.

There is ample evidence of adverse cardiovascular health outcomes associated with exposure to air pollution and cardiac rehabilitation patients are at increased risk for future adverse health events related to air quality. Risk communication and health messaging about recommended behaviors to reduce exposure to air pollution can be integrated into existing care routines and structures. How this can be achieved most appropriately and effectively is not well understood. A focus group design is used to investigate cardiovascular patient and provider experiences, attitudes and beliefs about the risks of air pollution, related health risk messaging and factors that may influence integrating that topic into patient care and communication. Three discussions were hosted, one with cardiac patients, a second with non-physician cardiac rehabilitation providers and a third with physicians who treat cardiac patients. A within-case thematic inductive analysis of each discussion is used to understand the nature of communication, logistics, guidance and overall substance of the cardiac rehabilitation educational experience. Results suggest that air pollution may be an unrecognized risk factor for cardiac patients and cardiac rehabilitation is a prime setting for communicating air pollution health risk messaging. However, to effectively integrate air quality health risk messaging into cardiac rehabilitation, it is critical to account for the existing knowledge-base and behaviors of both providers and patients.