title: 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.
  
  
  OBJECTIVE
  This study aims to understand the patients and healthcare providers' experiences about the environmental determinants of CVD risk factors based on the Precede Model.
  
  
  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.
authors.affiliation: Department of Health Education & Promotion, Alborz University of Medical Sciences, Karaj, IR Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Sabzmakan
authors.affiliation: Department of Nursing, Tarbiat Modares University, Tehran, IR Iran.
authors.forename: Eesa
authors.initials: E
authors.lastname: Mohammadi
authors.affiliation: Department of Health Education, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Morowatisharifabad
authors.affiliation: Department of Nutritionist, Qazvin University of Medical Sciences, Qazvin, IR Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Afaghi
authors.affiliation: Department of Surgery, Alborz University of Medical Sciences, Karaj, IR Iran ; Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, IR Iran.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Naseri
authors.affiliation: Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Mirzaei
keywords: Cardiovascular; Environment; Precede Model; Qualitative Research; Risk Factors