Barriers and facilitators to the adoption of healthy lifestyles for cardiovascular disease prevention in Sub-Saharan Africa: a mixed method systematic review of evidence

Abstract Background Sub-Saharan Africa (SSA) has been witnessing a persistent increase in the burden of cardiovascular diseases (CVD), such as stroke and heart disease, over several decades. A key driver of this burden has been the poor adoption of healthy lifestyles such as physical activity. The goal of this systematic review was to critically appraise and synthesize evidence on the barriers and facilitators to adopting healthy lifestyles for CVD prevention in SSA. Methods We searched PubMed, African Journals Online, Google Scholar, Medline, and Web of Science from January to March 2024 for both quantitative and qualitative studies that assessed barriers and/or facilitators to the adoption of at least one preventative measure for CVD prevention. The socioecological model was used to categorize barriers and facilitators into four levels: intrapersonal, interpersonal, institutional, and community. The Critical Appraisal Skills Program (CASP) checklist was used to determine the quality of qualitative studies, while the AXIS checklist was used to assess the quality of cross-sectional studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to estimate the certainty of the evidence. Results There were a total of 25 studies included in this review. At the intrapersonal level, barriers included perceived self-efficacy, limited knowledge and awareness, personal attitudes and behaviours, and poverty, while health literacy and awareness served as facilitators. At the interpersonal level, social norms and limited social support were the main barriers, while social support and having positive role models were facilitators. At the institutional level, accessibility and affordability of preventive healthcare services, as well as healthcare provider characteristics, were barriers, while trust in healthcare providers, affordability of care, reputation, and approachability of healthcare providers, quality of patient-provider relationships, and quantity and quality of patient education were facilitators. Lastly, at the community level, the physical, social, and economic characteristics of the community acted as either facilitators or barriers. Conclusions A complex interplay of multiple barriers and facilitators influences the adoption of healthy lifestyles in SSA. While individual factors, such as knowledge and motivation, are crucial, they are often overshadowed by deeply rooted socioeconomic disparities, limited access to healthcare and resources, and cultural norms. A multi-sectoral approach that empowers individuals, strengthens community support systems, improves access to affordable, healthy options, and implements supportive policies could address these barriers.