Understanding Behavioural Determinants of Cardiovascular Disease and Stroke Prevention Among Culturally and Linguistically Diverse Communities: A Qualitative Descriptive Study.

Background: Cardiovascular disease (CVD) and stroke disproportionately affect culturally and linguistically diverse (CALD) communities. In Australia, CALD describes communities that differ from the dominant population by language, ethnicity and/or cultural beliefs and practices. CALD status often intersects with social disadvantage, including lower socioeconomic position, experiences of discrimination and reduced access to culturally safe health services, contributing to inequities in cardiovascular risk and outcomes. Understanding how these factors influence engagement in CVD and stroke prevention activities is essential for developing culturally responsive education and behaviour change programmes. Aims: This study explored: (i) the experiences of four CALD communities with risk factors for, or history of, CVD or stroke; (ii) their perceptions and prior experiences of CVD and stroke prevention education and (iii) preferences for the content, timing, format and delivery of future prevention programmes. Methods: Focus groups were conducted face-to-face and via videoconference, audio-recorded and transcribed verbatim. Data were analysed in NVivo using deductive thematic analysis. Themes were mapped to the COM-B model. Results: Nine focus groups involving 38 participants from Arabic-, Dari-, Chinese- and Vietnamese-speaking communities with risk factors for, or a history of, CVD or stroke were conducted. Nine key themes were identified. Participants described a perceived inevitability of disease, uncertainty about risk factors and the impact of physical limitations on prevention (psychological and physical capability). Engagement was influenced by the need for culturally tailored, accessible education (physical opportunity) and preferences for group-based, community-led support (social opportunity). Motivation and sustained engagement were influenced by cultural food practices, fear of adverse health consequences and inconsistent self-management. Conclusion: Engagement in CVD and stroke prevention among CALD communities is influenced by social and structural factors beyond individual knowledge or motivation. Findings highlight the importance of culturally tailored, codesigned prevention approaches delivered through trusted community settings and supported by social and healthsystem partnerships to promote more equitable prevention.