Background
 
Cardiovascular disease (CVD), a major worldwide public health issue, is of significant concern to the government of Saudi Arabia due to its negative impact on morbidity, mortality, and healthcare budgets. Two systematic reviews, published in the course of the development of this study, confirmed and highlighted the high prevalence of CVD risks in Saudi women. However, few studies focused on how cardiovascular risk is affected by health beliefs, in conjunction with sociodemographic variables. This study used the Health Belief Model to identify and compare Saudi women’s perceived health beliefs (susceptibility, severity, benefits and barriers) against their calculated Framingham Risk Score to ascertain their risk for a future cardiovascular event.

Aim

This study sought to understand the influence of health beliefs and socio-demographic variables on the high prevalence of cardiovascular risks in Saudi Women, compared to their actual calculated risks using their Framingham Risk Scores.


Method

A cross-sectional study design was conducted to include women attending the primary care clinics at King Saud University Medical City, in Riyadh, Saudi Arabia. A non-random convenience sample was selected of adult women without pre-existing CVD. Health belief and sociodemographic data were collected and Framingham Risk Scores (FRS) calculated.

Results

This study, which involved 503 female participants, suggests that based on their surveyed health beliefs, subjects significantly underestimated their actual risks of CVD, as measured by their individually calculated Framingham Risk Scores. Of the studied group, 43.4% had high calculated CVD risks, though had a low perception of susceptibility. Compounding this, while 63.5% understood the severity of CVD, 75.2% had a low to moderate perception of benefits of healthy behaviours i.e. physical activity and healthy diet. 86.7% did not know how to perform CVD risk-reducing exercises, and 65.9 % disagreed that they had access to exercise facilities. Pearson correlations supported these findings suggesting a weak linear relationship between the FRS and each health belief subscales (perceived: severity, benefits, and barriers). There was a significant relationship between the FRS across the income, marital status, education, occupation and work status categories (p<= 0.001) in Chi-Square tests. Significant differences were found in comparing; perceived benefits of healthy behaviours with marital status, perceived severity and benefits with the level of education, perceived severity and benefits with occupation, and perceived severity and benefits in relation to financial income. Of the sample group, 75% were over the age of 45, and 68% declared their occupation as housewives, and 50% were educated at a level below High School.


Conclusion

This study is the first in Saudi Arabia to examine the correlation between health beliefs, calculated CVD risks, and extended socioeconomic and sociodemographic variables. It has significant implications for the public health policies and investment decisions needed to reduce the prevalence of CVD in the country. This study highlights how the social determinants of health are a vital element affecting CVD risk and health beliefs. Focusing policies on the low educational and income level population is required to prevent CVD. Moreover, financial allocations for health in Saudi Arabia should move towards preventive programs that are designed to raise the awareness of health risks. Education regarding the risks lies at the heart of the problem since if the level of perceived susceptibility are low then that will only serve to undermine the whole motivation for them to address exercise routines and diet. Risk awareness on its own would not necessarily lead to changes in behaviour. Any increase in understanding of risk would have to be accompanied with the knowledge of what exercises are appropriate, along with an appreciation of what healthier diets are and how they can be affordable.