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

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.