Missing from Cardiac Rehabilitation: Intersectional Inequalities Among Ethnically Diverse Women in the UK.

Abstract

Background: Cardiovascular disease remains the leading cause of morbidity and mortality among women in the United Kingdom. Despite national priorities to reduce health inequalities, women and ethnic minority groups remain underrepresented in cardiac rehabilitation. Limited qualitative evidence informs how intersecting social identities influence engagement, constraining NHS efforts to deliver equitable, person centred care.

Aims: To explore how gender, ethnicity, culture, religion, immigration status and socioeconomic position intersect to shape access to and participation in cardiac care and rehabilitation among ethnically diverse women in the UK.

Methods: A qualitative study using four focus groups with 19 women from diverse ethnic backgrounds. Groups were conducted in community settings and online to enhance inclusivity. Data were analysed using reflexive thematic analysis informed by intersectionality theory. Rigour was strengthened through independent coding, reflexive dialogue and comprehensive audit trail documentation.

Results: Four themes were generated. ‘My health is being failed by the system’ described delayed diagnosis, perceived dismissal and fragmented pathways. ‘I care for others more than myself’ reflected gendered caregiving expectations limiting self-prioritisation. ‘We do NOT talk about health’ captured stigma and culturally embedded silence surrounding illness. ‘Reimagining CR as a community hub’ articulated preferences for culturally safe, locally delivered and relationship-centred models of support. Women from minority ethnic backgrounds described compounded structural barriers shaped by racism, discrimination, immigration insecurity and financial strain. Cultural health secrecy emerged as both a protective mechanism and a barrier to timely engagement.

Conclusion: Findings highlight the need for intersectional, equity-driven and culturally responsive cardiac rehabilitation within NHS services. Reducing inequities requires co-designed, community-informed models of care that centre the lived experiences of marginalised women and address the structural barriers affecting access and engagement.