How can i think of stroke when i don’t even have money to eat?: barriers to primary stroke prevention among Nigerian suburban community-dwelling adults

Stroke remains a leading cause of morbidity and mortality globally, with the greatest burden being borne by low- and middle-income countries such as Nigeria. Despite the high prevalence of modifiable risk factors, primary prevention strategies remain poorly implemented, and contextual barriers to prevention are underexplored. This study explored barriers to primary stroke prevention among high-risk adults in Nnewi, Anambra State, Southeastern Nigeria. A qualitative exploratory design was adopted, utilising in-depth interviews and focus group discussions among ten adults previously identified as at high risk of stroke in an earlier profiling study. Participants were recruited from Nnewi, a suburban industrial town in Anambra State, Nigeria. Data collection continued until thematic saturation was achieved. Transcripts were analysed using the General Inductive Approach to identify recurrent categories and themes. Participants aged between 38 and 67 years, and were predominantly male with varied educational and occupational backgrounds. Seven themes emerged: low risk perception and poor screening, misconceptions about stroke risk, faith and informal cultural prevention practices, poverty and access barriers, work and time constraints, difficulty sustaining lifestyle change, and family and gender role influences. Most participants reported that their present health status reduced the need for further screening and believed that their past normal body test createda sense of security regardingn their health. Our participants also reported not deeming the risk screening as necessary, and prioritized other household needs over health screening. Stress and familiar responsibilities were reported as unequally distributed, and yet they were unwilling to eliminate some stressors due to cultural expectations. Stroke prevention in Nigeria is hindered by an interplay of misconceptions, cultural practices, poor health attitudes, and financial constraints. This study points to the urgent need for context-sensitive interventions that integrate cultural and religious considerations, improve community awareness, and address affordability barriers. Policy makers should strengthen primary health care, expand insurance coverage, and invest in culturally-tailored health education.