Barriers to the Implementation of Phase I Cardiac Rehabilitation from the Perspective of Medical Staff Based on Normalisation Process Theory: A Qualitative Study

Abstract

Background/Objectives: Based on the Normalisation Process Theory (NPT), this study aims to systematically analyze the barriers to knowledge translation of Phase I cardiac rehabilitation (CR) from the perspective of medical staff. Methods: Purposive sampling and snowball sampling were used to recruit 12 members of the cardiac rehabilitation multidisciplinary team for one-on-one in-depth interviews. Colaizzi’s seven-step phenomenological analysis method was employed to organize and summarize the interview data. Results: Four categories of barriers based on the NPT framework were identified: (1) Coherence barriers: low perceived value and benefits of CR among various stakeholders (insufficient explicit efficacy of CR, ambiguous cost-effectiveness); (2) Cognitive participation barriers: insufficient engagement and commitment of medical staff (decision-making inertia, role identity conflicts, risk perception conflicts); (3) Collective action barriers: low organizational resource readiness (leadership conflicts, fragmented referral systems, human resource shortages, lack of continuing education mechanisms for CR); (4) Reflexive monitoring barriers: low contextual compatibility (inadequate policy support, insufficient compatibility in evidence application). Conclusions: The NPT-based analysis reveals barriers in coherence, cognitive participation, collective action, and reflexive monitoring regarding Phase I CR knowledge translation from the perspective of medical staff. Enhancing medical staff’s perceived value of CR, improving organizational resource readiness, and creating highly compatible contexts may systematically promote the normalization of Phase I CR into routine practice.