Barolia R, Higginbottom G, Duggleby W, Clark AM (2019) Critical Challenges of Economic and Social Issues in Secondary Prevention of Cardiovascular Disease. J Fam Med Dis Prev 5:105.


© 2019 Barolia R, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ORIGINAL RESEARCH | OPEN ACCESS DOI: 10.23937/2469-5793/1510105

Critical Challenges of Economic and Social Issues in Secondary Prevention of Cardiovascular Disease

Rubina Barolia*, Gina Higginbottom, Wendy Duggleby and Alexander M Clark

Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Canada



What we eat may cause Cardiovascular Disease (CVD), and a healthy diet is a key factor in the prevention of CVD. Promoting healthy diet is challenging, particularly for people with low Socioeconomic Status (SES), because poverty is linked with many risk behaviours such as smoking, unhealthy eating, and obesity. Multiple factors make healthy eating very challenging. Underpinned by critical realism, this study explores the factors that inform Pakistani people of low socio-economic status SES in making decisions on food choices after diagnosis with CVD.

Methods and results

The study was carried out at two Cardiac facilities of Karachi, Pakistan, in which 24 participants (male and female from different ethnic backgrounds), who had received health education, were selected to elicit the facilitators and barriers to healthy diet. The thematic analysis, using an interpretive descriptive approach, the study identified revealed seven major themes: (a) The meaning of food and healthy diet: A social dimension; (b) Poverty and a healthy diet: Not a matter of choice; simply to satisfy hunger; (c) Health promotion is a political issue: Survival is difficult because of political unrest in Karachi (c) Hope for recovery and family support: motivation for dietary change; (d) Family support and family relationships affect diet change (e) Self-control and self-determination; and (f) Culture and family values promote or hinder dietary change.


The cardiovascular risk and disease outcomes for the people of low SES are likely to further escalate if individual and structural barriers are not reduced, using multifactorial approaches.