Motivators, barriers to better heart health practices in Singapore

Among adults with potentially modifiable behavioural risk factors for cardiovascular diseases, the patterns of motivators and barriers to such modifications vary widely, often depending on age and social status, according to a recent Singapore study.

“Those with lower education in general felt less motivated to make behaviour changes for heart health, while the well-educated were not fully convinced of the effectiveness of their actions in improving heart health,” the researchers said.

“The well-educated also more keenly felt their past failures in behavioural change and lacked confidence in their ability to succeed. People aged 60 [years] and above with poor behaviours were especially resistant to change and will likely need sustained efforts to change their attitudes,” they added.

Researchers conducted a population-based survey including 1,000 participants (aged 21–75 years) whose behaviour-modifiable risk factors were assessed, as well as their motivators and barriers to adopting better heart health behaviours. More than two-thirds of participants had an intermediate educational level; a comparable proportion was in the workforce.

Exploratory factor analysis identified three main motivator factors: outcome expectations, external cues, and significant others. Meanwhile, four main barrier factors emerged: external circumstances; limited self-efficacy and competence; lack of perceived susceptibility, benefits, and intentions; and perceived lack of physical capability. [PLoS One 2022;17:e0262752]

The analysis of motivator and barrier patterns was then conducted using logistic regression analysis after classifying participants according to three major, modifiable cardiovascular risk factors: physical inactivity, smoking, and obesity. For instance, among the physically inactive, lower educational attainment (primary level and below) was a significant indicator of having low motivation for healthful heart behaviours (adjusted odds ratio [OR], 2.4, 95 percent confidence interval [CI], 1.4–4.2; p=0.001).

In comparison, the subgroup with intermediate-level (adjusted OR, 2.4, 95 percent CI, 1.1–4.9; p=0.022) or university-level (adjusted OR, 5.1, 95 percent CI, 2.1–12.5; p<0.001) education were more likely to have high barriers to such behaviours.

Among smokers, those aged 60–75 years reported significantly higher barriers than comparators aged 20–39 years (adjusted OR, 9.1, 95 percent CI, 2.6–32.3; p=0.001). The same was true for those with intermediate (adjusted OR, 5.0, 95 percent CI, 1.2–20.6; p=0.026) and university (adjusted OR, 7.4, 95 percent CI, 1.3–43.3; p=0.025) education.

Rather than report high barriers, obese participants experienced low motivation particularly those aged 60–75 years (vs 40–59 years: adjusted OR, 4.4, 95 percent CI, 1.1–17.2; p=0.035) and those with only primary level education (vs intermediate education: adjusted OR, 4.0, 95 percent CI, 1.2–14.1; p=0.028).

“The patterns seen in the Asian population segments with behavioural risks will inform the design of future intervention and communication strategies addressing specific motivators and barriers,” the researcher said.