Exploring the attitudes, beliefs, barriers, and facilitators to the uptake of and adherence to exercise and physical activity among Saudi women diagnosed with coronary artery disease: a qualitative study

Abstract

Introduction: Coronary artery disease (CAD) is the leading cause of death among women in Saudi Arabia. However, women often underestimate their CAD risk. Physical activity (PA) is an integral part of secondary prevention of CAD. PA is known to lower mortality rates and improve the quality-of-life among individuals with established CAD. PA levels vary between different ethnicities and genders. In Saudi Arabia, the percentage of women meeting the PA recommendation is as low as 10%. Despite the low prevalence rate among Saudi women in general, little is known about their PA habits post-diagnosis of CAD. Aim: To explore attitudes, beliefs, barriers, and facilitators to the uptake of and adherence to exercise and PA among Saudi women diagnosed with CAD. Methods: A descriptive qualitative study was undertaken. Thirty-two semi-structured interviews were conducted between June 2024 and November 2024, sixteen with Saudi women diagnosed with CAD and sixteen with healthcare professionals. The theoretical domain framework informed the data collection and data analysis, which was undertaken using framework analysis. The findings were fed into the COM-B model and the behavioural change wheel (BCW) to identify a potential intervention to promote PA uptake and adherence among Saudi women post-CAD diagnosis. Findings: Nine themes and subthemes were identified from both datasets. Religious and sociocultural influences were highlighted as a main theme as women reported familial and social obligations take priority over being physically active, and discussed the effect of the lack of exercise during their upbringings on their ability to uptake and adhere to exercise and PA. Other themes discussed knowledge gap, social and professional support and the perceived barriers and facilitators to being physically active. Conclusion: This study has provided an insight into the experience of Saudi women diagnosed with CAD with exercise and PA. Identified facilitators and barriers were used to develop a potential PA-promoting intervention to improve overall health and well-being, which was visually illustrated in a logic model featuring the intervention’s key ingredients, based on the findings of the application of the COM-B model and BCW.