Barriers and facilitators of noncommunicable disease (NCD) prevention in Kerala: A qualitative study

CONTEXT: The burden of noncommunicable diseases (NCD) is increasing at an alarming rate, contributing to about 23% of the mortality in the rural and 30% of the total mortality in the urban population in India. Even with high health literacy in Kerala, the state has higher rates of NCD risk factors and lower diabetes and hypertension control rates. AIMS: The objectives were to qualitatively assess the facilitators and barriers of NCD prevention from the patients’ and health care providers’ perspectives and assess the perceptions of healthy lifestyle behaviors among NCD risk persons and patients. SETTINGS AND DESIGN: This was a qualitative study conducted in Thrissur district, Kerala, India. METHODS AND MATERIAL: Qualitative study was conducted using the grounded theory approach. A total of nine in-depth interviews and ten focus group discussions were conducted among health care providers and NCD risk persons and patients. The audio-recorded data were transcribed, coded, and thematically analyzed. STATISTICAL ANALYSIS: The data were transcribed and analyzed using the Framework approach to qualitative data analysis. RESULTS: The main themes identified were healthy lifestyle behaviors, facilitators, and barriers to NCD prevention. The main facilitators for NCD prevention were NCD screening, the national program for NCD, health education sessions, and yoga classes in school. Lack of time, laziness, unavailability of space for exercise, and safety issues were identified as barriers to physical activity. CONCLUSIONS: People are aware of the facilitators and barriers of NCD prevention. Availability of a favorable environment and behavior change is needed to combat the silent epidemic of NCDs.