Environmental Determinants of Cardiovascular Diseases Risk Factors: A Qualitative Directed Content Analysis

Abstract

Background:Cardiovascular diseases (CVDs) are the number one cause of death in the world. In most analyses of health problems, environment plays a significant and modifiable role in causing the problem either directly or indirectly through behavior.Objectives:This study aims to understand the patients and healthcare providers’ experiences about the environmental determinants of CVD risk factors based on the Precede Model.Patients and Methods:This qualitative study conducted over six months in 2012 at Diabetes Units of Health Centers associated with Alborz University of Medical Sciences and Health Services which is located in Karaj, Iran. The data were collected based on individual semi-structured interviews with 50 patients and 12 healthcare providers. Data analysis was performed simultaneous with data collection using the content analysis directed method.Results:Lack of behaviors like stress control, healthy eating and physical activity were the roots of the risk factors for CVD. The environmental factor is one of the barriers for conducting these behaviors. The environmental barriers included of structural environment including “availability and accessibility of health resources”, “new skills”, and “law and policies” which are located in enabling category and social environment including “social support”, “motivation to comply” and “consequences of behavior” which are located in reinforcing category. The most barriers to performing health behaviors were often structural.Conclusions:The environmental factors were barriers for doing healthy behaviors. These factors need to be considered to design health promotion interventions. Policymakers should not only focus on patients’ education but also should provide specific facilities to enhance economic, social and cultural status.

Physical Activity and Healthy Eating Promotion among Adults with Cardiovascular Metabolic Risk Factors: An Application of Intervention Mapping Framework

“…88/20% of the 15 -64 year age group consumes less than 5 unit fruits or vegetables daily, furthermore, 38/97% of people had low PA weekly (20). Findings from the qualitative part of this study, which had already been published (21,22), have proved that unhealthy eating and physical inactivity were behaviors, which predict CVMRFs. Findings of the qualitative part show that personal determinants are the predisposing category (knowledge, attitude, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self efficacy), and among them, the determinants of perceived barriers and self efficacy for doing PA and HE were more important than other determinants.…”

Living Within Limits: Unpleasant Experiences From the Perspective of Patients After Cardiac Surgery, a Content Analysis Study

“…A similar result was obtained in Sabzmakan et al's study. In this study, conflicts between patients' diet regimens and their families' diet regimens, and the patients becoming tired of the taste of their diet regimens were perceived as barriers to behavioral change in patients (31). Furthermore, a lack of information after CABG (10) and at discharge was reported in other studies (10,32).…”

“…Repeatedly telling patients that they need further treatment and methods of care is not enough, and may cause patients to feel a reduced sense of wellbeing and a feeling of loss of personal control over their health (43), and trust in their efficiency and ability to perform self-care. Depending on the implementation of the desired behavior (31,44), health experts can emphasize the patient's ability and efficiency.…”

Cardiac autonomic modulation related to prayer may contribute to the reduced cardiovascular mortality associated with religiosity/spirituality

“…Psychosocial stressors such as depression and chronic stress can lead dysregulation of autonomic nervous system function, endothelial dysfunction, and persistent hypothalamic pituitary adrenal axis activation in patients with cardiovascular disease or even previously cardiac healthy individuals [6][7][8][9]. In these people, behavioral factors and involvement in health promotion activities have also been implicated among the mechanisms responsible for the higher rate of cardiovascular mortality [10,11]. In the INTER-HEART study, psychosocial stressors including depression, locus of control and perceived stress (defined as tension or anxiety due to external influences) were independently associated with increased risk of acute myocardial infarction, suggesting that approaches aimed at changing these factors should be developed [12,13].…”