title: Situated influences on perceived barriers to health behavior change: cultural identity and context in Kazakhstan.
abstract: The objective of this study was to identify the perceived barriers to lifestyle changes citizens of Kazakhstan suffering from cardiovascular disease and type II diabetes were experiencing.
  
  
  
  14 focus groups were conducted with patients across two regions of Kazakhstan. Topics of discussion included accessing medical care, communicating with health care providers, and following doctor's recommendations. The text of the discussions were analysed for trends and themes across the different groups.
  
  
  
  Patients identified a series of external and internal barriers to lifestyle changes, including the environment, a dependency on health care providers, a health care system they feel powerless to change, and a low level of self-efficacy. Most notable, however, was a constructed ethnic identity whose boundaries included unhealthy behaviors, specifically diet and untimely access of health care. This identity both was blamed as a cause for the patient's condition and seen as an unchangeable barrier to health behavior change.
  
  
  
  Current provider efforts to encourage lifestyle changes to manage disease are not taking into account the broader issue of ethnic identity, namely negotiating a fragile and previously suppressed identity that mostly exists alongside other ethnicities. Therefore, maintaining distinctiveness may be a greater need than modifying health behaviors. Efforts towards healthier lifestyles for the public must include not only messages regarding health but also constructions of a Kazakh identity that allows for such lifestyles to fit within the identity framework.
authors.affiliation: a Liberal Arts Department, St Louis College of Pharmacy , St Louis , USA.
authors.forename: Brett J
authors.initials: BJ
authors.lastname: Craig
authors.affiliation: b School of International and Public Affairs, Columbia University , New York , USA.
authors.forename: Aizhan
authors.initials: A
authors.lastname: Kapysheva
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000523:psychology; D003144:Communication Barriers; D003467:Cultural Deprivation; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006297:Health Services Accessibility; D006801:Humans; D007623:Kazakhstan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012933:Social Identification; D012938:Social Perception
keywords: Identity; Kazakhstan; behavior change; healthy lifestyle; perceived barriers; post-Soviet