title: Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community.
abstract: BACKGROUND
  Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice.
  
  
  OBJECTIVE
  This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients' viewpoint.
  
  
  METHODS
  We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories.
  
  
  RESULTS
  Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness.
  
  
  CONCLUSIONS
  This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices.
authors.affiliation: Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; natalia.oli@gu.se.
authors.forename: Natalia
authors.initials: N
authors.lastname: Oli
authors.affiliation: Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Vaidya
authors.affiliation: Patan Academy of Health Sciences, Lalitpur, Nepal.
authors.forename: Madhusudan
authors.initials: M
authors.lastname: Subedi
authors.affiliation: Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health NHV, Gothenburg, Sweden.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Krettek
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control / Q000523:psychology; D003920:Diabetes Mellitus / Q000523:psychology; D004032:Diet / Q000009:adverse effects; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000523:psychology; D006801:Humans; D006973:Hypertension / Q000523:psychology; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D036301:Qualitative Research
keywords: Nepal; cardiovascular disease; health behavior; health promotion; perceptions; qualitative research