Multilevel obstacles to heart-healthy living in the context of Ischemic heart disease: A qualitative study

Bardia Amidi, Narges Naderi, Javad Yoosefi Lebni, Arash Amin

Abstract

Ischemic heart disease (IHD) is a major contributor to global morbidity and mortality. Lifestyle modifications play a central role in preventing and management of IHD, yet patients face barriers to engaging in healthy behaviors. This study explored these barriers among IHD patients in Lorestan Province, Iran.

Introduction

Ischemic heart disease (IHD) is the most common form of cardiovascular disease [1]. IHD is one of the critical public health concerns of our time, becoming a leading cause of morbidity and mortality in nations worldwide [2]. Iran’s national age-standardized IHD disability-adjusted life years (DALYs) decreased by 33.7% from 1990 to 2019.

Methods

The present study was conducted on IHD patients and key informants in Lorestan province in western Iran in 2025, using a qualitative approach and conventional content analysis. Lorestan Province was chosen as the study setting because of its unique socio-cultural and environmental characteristics that can potentially affect lifestyle behaviors.

Results

This study included 31 patients with IHD (Table 1), two cardiology residents, three cardiology ward nurses, and three cardiologists as key informants (Table 2). Following the data analysis, four categories, seventeen subcategories, and 413 primary codes were identified and extracted (Table 3).

Discussion

This study sought to explore the barriers that IHD patients face in adopting a healthier lifestyles through a qualitative approach. The key barriers identified through this study include socio-cultural barriers, economic barriers, individual barriers, and healthcare-medical barriers.

Conclusion

This study examined the barriers to IHD patients’ adoption of healthier lifestyles and categorized them into four broad categories, including socio-cultural barriers, economic barriers, individual barriers, and healthcare-medical barriers.

Citation: Amidi B, Naderi N, Yoosefi Lebni J, Amin A (2025) Multilevel obstacles to heart-healthy living in the context of Ischemic heart disease: A qualitative study. PLoS One 20(12): e0338298. https://doi.org/10.1371/journal.pone.0338298

Editor: Tahir Turk,, Dow University of Health Sciences, PAKISTAN

Received: July 27, 2025; Accepted: November 19, 2025; Published: December 9, 2025

Copyright: © 2025 Amidi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data supporting the findings of this study are available from the Research Committee of Lorestan University of Medical Sciences upon reasonable request (contact:[email protected]) or from the corresponding author (email: [email protected]). Full interview transcripts are not publicly available. This is to protect participant confidentiality. Appropriately de-identified excerpts relevant to the study findings may be shared with qualified researchers upon request and approval by the Ethics Committee.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.