title: Facilitators and barriers to NCD prevention in Pakistanis-invincibility or inevitability: a qualitative research study.
abstract: BACKGROUND
  Non-communicable diseases (NCD) are the leading causes of death globally. In Pakistan, they are among the top ten causes of mortality, especially in the productive age group (30-69 years). Evidence suggests that health perceptions and beliefs strongly influence the health behavior of an individual. We performed focus group interviews to delineate the same so as to design the user interface of a non-invasive stroke risk monitoring device.
  
  
  METHODS
  It was a qualitative study, designed to explore how health perceptions and beliefs influence behavior for NCD prevention. Four focus group discussions (FGD) were conducted with 30 stable participants who had diabetes mellitus, ischemic heart disease, blood pressure, and stroke. The data was collected using a semi-structured interview guide designed to explore participants' perceptions of their illnesses, self-management behaviors and factors affecting them. The interviews were transcribed and content analysis was done using steps of content analysis by Morse and Niehaus [10].
  
  
  RESULTS
  Medication adherence, self-monitoring of blood sugars and blood pressures, and medical help seeking were the commonly performed self-management behaviors by the participants. Personal experience of illness, familial inheritance of disease, education and fear of premature death when life responsibilities were unfulfilled, emerged as strong facilitators of self-management behaviors. A sense of personal invincibility, Fatalism or inevitability, lack of personal threat realization, limited knowledge, inadequate health education, health care and financial constraints appeared as key barriers to the self-management of chronic disease in participants.
  
  
  CONCLUSIONS
  Behavioural interventional messaging will have to engender a sense of personal vulnerability and yet empower self-efficacy solutions at the individual level to deal with both invincibility and inevitability barriers to adoption of healthy behavior.
authors.affiliation: Stroke Service Research Nurse, Aga Khan University, Karachi, Pakistan.
authors.forename: Ambreen
authors.initials: A
authors.lastname: Gowani
authors.affiliation: Technology Development, Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan.
authors.forename: Hafiz Imtiaz
authors.initials: HI
authors.lastname: Ahmed
authors.affiliation: Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health), Aga Khan University, Karachi, Pakistan.
authors.forename: Wardah
authors.initials: W
authors.lastname: Khalid
authors.affiliation: eHealth Innovation, Global, Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan.
authors.forename: Abdul
authors.initials: A
authors.lastname: Muqeet
authors.affiliation: Tech4Life Enterprises, Karachi, Pakistan.
authors.forename: Saad
authors.initials: S
authors.lastname: Abdullah
authors.affiliation: Tech4Life Enterprises, Canada, and Technical Advisor-Evidence, Capacity and Policy mHealth Alliance, United Nations Foundation, Washington, USA.
authors.forename: Shariq
authors.initials: S
authors.lastname: Khoja
authors.affiliation: Section of Neurology, Department of Medicine, Stroke Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center and the National Institute of Neurologic Disorders and Stroke, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan. Ayeesha.kamal@aku.edu.
authors.forename: Ayeesha Kamran
authors.initials: AK
authors.lastname: Kamal
mesh_terms: D003920:Diabetes Mellitus / Q000517:prevention & control; D017144:Focus Groups; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000517:prevention & control; D010154:Pakistan; D011315:Preventive Medicine; D036301:Qualitative Research; D020521:Stroke / Q000517:prevention & control
keywords: Lower and middle income countries; Non-communicable diseases; Qualitative study; Self-management