Cardiovascular diseases risk perception and communication among urban and rural residents in Ethiopia: A qualitative study

Abstract Background: The rise in non-communicable diseases (NCDs) burden, particularly, cardiovascular diseases (CVDs) in Ethiopia is driven by rapid urbanization, globalization, urban poverty, a shift in diet and physical inactivity. To tackle this, adoption of appropriate lifestyle and behaviour modifications are required. Such behavioural adoption in turn demands appropriate knowledge about the risk factors, and a reasonably perception of threat of CVDs. Objective: To explore CVDs risk perception, communication, and health seeking intentions of residents of rural and urban communities in Ethiopia.Methods: We conducted four focus group discussions (FGDs) and semi-structured risk communication interviews with residents of two communities (urban and rural) in Ethiopia. Two FGDs were conducted in each of the rural and urban communities with separate groups for men and women. The FGD participants were purposively selected with the help of local health extension workers. The FGDs were facilitated by a trained public health researcher, using a FGD guide, and risk communication cue cards. The textual data was analyzed using thematic analysis approach. Results: In general, awareness of CVDs and conceptualization of disease risk in both setting were low, and risk scores concepts were based on cultural beliefs and setting-specific knowledge, especially in the rural areas. Many participants had not perceived any threat, and indicated limited susceptibility to CVDs, despite their belief that the risk factors are common. Participants that indicated having a prior CVDs diagnosis, did not readily accept their diagnosis, or disclose their status to others, or seek medical care. Some urban participants thought that CVDs are untreatable owing to inaccessibility of care and the common belief that this ‘is the will of God’. Consequently, participants had often opted for traditional or ‘miraculous’ religious healing practices, and, therefore, did not rely on chronic disease management advice.Interviews using communication cue cards revealed that how and by whom a risk message was communicated was an important consideration for a message to be accepted, and to elicit subsequent health-seeking intention, and possible action(s).Conclusion: Supporting community-level collaborative learning about CVDs, and their risk factors can support optimal evaluation of personal risk and perception of the threat of CVDs.