Table 8 Summary of clinical messages from key themes

Emotions Depression, anxiety, stress, poor motivation, lack of confidence, embarrassment.

Patients with depression are less likely to take up both the offer of lifestyle change support and complete any programmes. Depression is linked with obesity and poor health outcomes. Other more subtle emotional barriers may also deter patients from changing lifestyles.

Psychological & spiritual beliefs Beliefs about role of health behaviours and extent of physical recovery

Patients who do not consider that lifestyles influence health or that they can manage their risks are less likely to take up the offer of lifestyle change support. Providing patients with evidence on how lifestyles reduce risks may encourage patients to re-think their beliefs.

Information & communication Lack of knowledge and misperceptions about purpose of healthy lifestyles, poor understanding of communication about risks and diet

Lack of knowledge about the role of lifestyles in managing cardiovascular risk may deter patients from taking up lifestyle support. Poor knowledge may engender misperceptions and so improving knowledge may challenge beliefs.

Friends & family support Close social support appears to impact on attempts to change and maintain healthy lifestyles.

Good support from family and friends can facilitate uptake of lifestyle behaviour change. Encouraging partners to attend Health Checks and annual reviews may increase uptake of lifestyle change programmes.

Transport & cost Difficulties with access to specific centres to undertake rehabilitation. Costs associated with transport and daily costs of living

Transport and cost issues are a significant barrier for patients. Referral to lifestyle support should be coupled with questioning about accessibility and affordability. Referral to social services may help.