title: Effective heart disease prevention: lessons from a qualitative study of user perspectives in Bangladeshi, Indian and Pakistani communities.
abstract: OBJECTIVE
  Coronary heart disease (CHD) has a high mortality, incidence and prevalence among Indian, Pakistani and Bangladeshi communities in the UK, indicating the need for effective heart disease prevention initiatives for these communities. This paper considers how service user perspectives can be used to develop effective, culturally focused CHD prevention interventions for these target groups by addressing identified barriers, including deeply held cultural beliefs.
  
  
  METHODS
  A qualitative research study, using a longitudinal action research approach.
  
  
  METHODS
  This was a community-based study in Edinburgh. Six focus group discussions--two for each community--were organized with participants from these communities at the beginning of the project. A further six focus group discussions for the same communities were organized six months later.
  
  
  RESULTS
  Over the period examined, participants reported varying changes in levels of knowledge relating to the nature, causes and symptoms of CHD. Some participants reported taking slight to significant steps to reduce or prevent heart disease, while others did not. The project was viewed as helpful in increasing knowledge about CHD and preventive measures and encouraging healthier lifestyles. However, persistent barriers to change were also identified, requiring changes to the project that involved not only matching intervention materials and messages to observable, superficial characteristics of the target population, but more fundamental changes that address the cultural, social, historical, environmental and psychological forces that influence health behaviour.
  
  
  CONCLUSIONS
  CHD prevention initiatives need to identify and respond to deep-rooted influences on health-behaviour in 'at-risk' groups, in addition to superficial characteristics of the target populations. It is important for specific prevention initiatives to be linked into wider CHD frameworks to ensure transferability of learning and integration within wider service provision.
authors.affiliation: School of the Built Environment, Heriot-Watt University, Edinburgh EH14 4AS, UK. g.netto@sbe.hw.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Netto
authors.forename: L
authors.initials: L
authors.lastname: McCloughan
authors.forename: A
authors.initials: A
authors.lastname: Bhatnagar
mesh_terms: D001211:Asia, Western / Q000208:ethnology; D003327:Coronary Disease / Q000208:ethnology* / Q000517:prevention & control*; D018864:Cultural Diversity; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D008297:Male; D015397:Program Evaluation; D036301:Qualitative Research; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012606:Scotland