Diet Modification in Saudi Women Living With Cardiovascular Disease: A Qualitative Study of Barriers and Motivators

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality worldwide and a major contributor to reduced quality of life. The disproportionately high risk of CVD faced by Saudi women compared with Saudi men is driven by rising rates of obesity, physical inactivity, and lifestyle-related risk factors. Despite the importance of dietary modification in secondary prevention, adherence to a heart-healthy diet remains challenging for many Saudi women due to gendered caregiving responsibilities, limited autonomy in food choices, and sociocultural expectations to prioritize family needs over their health. PURPOSE: This study was designed to explore the barriers and motivators related to healthy diet adherence among Saudi women living with CVD, with a particular analytical focus on how gendered household roles and sociocultural expectations shape dietary behaviors. METHODS: A qualitative descriptive design was employed, involving individual semistructured interviews with 19 Saudi women. Thematic analysis was conducted in accordance with Braun and Clarke's six-phase approach. RESULTS: The factors identified in the analysis were grouped into four themes: individual, social, institutional, and environmental. Gender roles, particularly the responsibilities of women as primary caregivers and meal preparers, consistently shaped the ability of the participants to adhere to healthy diets. Disease severity and family support were identified as key motivators, while the identified barriers included prioritizing family preferences over personal health, lack of tailored dietary counseling, and limited access to healthy food options. CONCLUSIONS: The findings underscore the multifaceted challenges Saudi women face in adhering to heart-healthy diets, particularly those rooted in gendered caregiving roles, social obligations, institutional gaps in dietary support, and environmental barriers to food access. Effective dietary interventions must go beyond individual education and be purposefully embedded within culturally sensitive, gender-responsive strategies that address these broader structural and contextual constraints.