Healthcare Administrator Cardiac Rehabilitation Attitudes Scale 
(by healthcare administrators, we are referring to those in charge of planning, directing, and coordinating health services; see PACRR for scale assessing attitudes in healthcare providers or clinicians)

There are now numerous publications where healthcare administrator attitudes toward CR are assessed (see below; see also: https://globalcardiacrehab.com/Validated-CR-Surveys). Given healthcare administrators are often responsible for resourcing CR appropriately, knowing their attitudes and where they could be improved is key.


We have recently more formally developed a HACRA-R scale, at the link below. I would be delighted if you wanted to use it in your research. Kindly email me to let me know. I would also be delighted to share any outputs of your work with the HACRA on this website, and/or to collaborate with you to attempt to mitigate identified issues that block CR use.

If you use the scale, ensure this citation appears on surveys, publications and presentations: Chaves, G.S.S., Ghisi, G.L.M.G., Britto, R.R., Servio, T.C., Cribbie, R., Pack, Q., & Grace S.L. (2020). Healthcare administrators’ cardiac rehabilitation attitudes (HACRA) in North and South America, & the development of a scale to assess them. Heart, Lung & Circulation;29(7):e111-120. July.

PROPOSED SCALE (to be psychometrically tested): HACRA-R

SCORING: From left to right, response options are scored from 5 to 1, such that higher scores reflect more positive CR attitudes.


If you wish to translate the scale to another language: Please reach out as there may be others working on translations or available translations to which I could point you. If not, there are best practices for translation, cross-cultural adaptation and validation that should be used; I could point you to some resources if requested. Ultimately, I could post your translation to this website as well, giving you credit if you are agreeable, in case others wish to use it.


Grace SL, Scarcello S, Newton J, O'Neill B, Kingsbury K, Rivera T, & Chessex C. How do hospital administrators perceive cardiac rehabilitation in a publicly-funded health care system? BMC Health Serv Res 2013 Mar 28;13:120. doi: 10.1186/1472-6963-13-120.

Ghisi GLM, Britto R, Servio TC, Anchique Santos C, Fernandez R, Rivas-Estany E, Santibanez C, Gonzalez G, Burdiat G, Lopez-Jimenez F., Herdy AH & Grace SL. Perceptions of Cardiology Administrators About Cardiac Rehabilitation in South America and the Caribbean. J Cardiopulm Rehabil Prev 2017 Jul;37(4):268-273.

Servio, T.C., Ghisi, G.L.M., da Silva, L.P., Silva, L.D.N., Lima, M.M.O., Gomes, D.A., Britto, R.R., & Grace, S.L. (2019). Barriers to cardiac rehabilitation delivery in a low-resource setting from the perspective of healthcare administrators, rehabilitation providers and cardiac patients. BMC Health Services Research;19: September. https://rdcu.be/bP9VR

Soares, M., Ponciano, I., Britto, R., Silva, L., Silva, E., Espinosa, O., Spíndola, R., Cobbuci, M., Gattas, L., & Sérvio, T. (2023). Identificação de facilitadores e barreiras para reabilitação cardíaca na cidade de Juiz de Fora - Minas Gerais. Seven; capitulo27. 10.56238/ciemedsaudetrans-027.