A study looked at the perceived barriers to implementing lifestyle changes for preventing heart disease among different socio-demographic populations.
Cardiovascular disease (CVD) remains a leading cause of morbidity and death in many countries. It is well-studied that a healthy lifestyle leads to a 67-72% lower risk of developing heart failure and that 80% of CVD cases can be prevented by eliminating modifiable risk factors. The challenge, however, is the ability to implement and maintain the lifestyle changes necessary to lower risk.
A number of different barriers may contribute to the inability to implement the lifestyle changes necessary, from structural limitations in resources (e.g. time and finances) to personal challenges (e.g. habits and preferences). The specific barriers each individual is faced with may differ across population groups. Diversity in barriers among individuals could mean that targeted approaches to promoting lifestyle changes for preventing heart disease may be beneficial.
Researchers in Denmark published a study in BMC Cardiovascular Disorders that investigated the associations between perceived barriers to lifestyle changes and socio-demographic and health characteristics. The study invited a random sample of Danish-speaking people between 40 to 60 years old by email to visit a website and answer a questionnaire.
The respondents were given a hypothetical scenario of being at increased CVD risk and a hypothetical medical treatment for prevention, which they could either accept or reject and then indicate their preference for lifestyle changes or medication. In addition to health-related questions, such as physical activity, smoking, and history of heart disease, the questionnaire also asked about socio-demographic characteristics, such as gender, age, income, and education. The questionnaire included three types of lifestyle changes for respondents to consider: 30 minutes of daily exercise, eating a low-fat diet, and smoking cessation. Respondents were given two to three specific barriers to implementing and maintaining these changes for a year and were asked to indicate if these barriers applied to them.
Lack of Time was the Most Frequently Reported Barrier
A total of 962 Danish respondents were included in the study results. When considering a lifestyle change of incorporating 30 minutes of daily exercise, 45% of the respondents indicated at least one of the predefined barriers as being applicable to them. The lack of time was the most frequently reported followed by not being accustomed to exercise and the cost of participating in exercise programs.
The study found that respondents in the workforce with higher income and education level cited a lack of time as a barrier more frequently whereas respondents with lower income, lower level of physical activity, higher BMI, or lower self-reported health status perceived being unaccustomed to exercise as a barrier.
With regards to a low-fat diet, 30% of respondents identified at least one of the barriers as a challenge. Of these respondents, 30% indicated not liking low-fat foods, taking longer to prepare and cost of low-fat foods as being barriers. Those with higher BMI reported the increased time to preparing low-fat foods as a barrier, and those with higher BMI and those who were unemployed reported cost as a barrier. Finally, 62% of smokers reported at least one of the two predefined barriers as being a challenge to smoking cessation. About half of these respondents stated previous failure to quitting as a barrier and a smaller percentage identified “partner still smokes” as being a barrier.
A limitation of this study was the limited number of predefined barriers presented to respondents. This could have underestimated the overall number of barriers people perceive when attempting to make lifestyle changes for preventing heart disease. The questionnaire did include a free text option for respondents to use, but the analysis didn’t show any other major barriers that weren’t already reflected. Nonetheless, the group included in the study was fairly representative of the general population with regards to socio-demographic characteristics, and the high participation rate and thoroughly tested questionnaire were strengths to the study’s findings.
Social Inequality Influences Perceived Barriers
The responses from this study show that structural factors, such as being out of the workforce and lower income, have an influence on perceived barriers to lifestyle changes for preventing heart disease. Those who were unemployed and with lower income identified the cost of low-fat foods and the cost of using fitness centres the major barriers to lifestyle changes. Personal challenges associated with habits, preferences, attitudes, experience and family support were also important determinants. At least 10% of the study’s respondents indicated not liking low-fat food, not being used to exercise, or having partners who also smoke as barriers to these lifestyle changes.
The study’s overall results demonstrate the challenges that social inequality poses to the perceived ability to implement lifestyle changes and stay healthy. These perceptions are influenced by the health and socio-demographic factors of each individual, as the perceived barriers were varied among different social groups in the population. The study suggests that promoting lifestyle changes through targeted and individualized methods directed at high-risk groups, in addition to general public campaigns, may be worth considering.
Written by Maggie Leung, PharmD
Reference: Nielsen, J. B., Leppin, A., Gyrd-Hansen, D. E., Jarbøl, D. E., Søndergaard, J., & Larsen, P. V. (2017). Barriers to lifestyle changes for prevention of cardiovascular disease – a survey among 40–60-year old Danes. BMC Cardiovascular Disorders, 17(1). doi:10.1186/s12872-017-0677-0