“It’s Just a Matter of Doing It”: Women Veterans’ Experiences with Changing Behavior for Cardiovascular Risk Reduction

Background: Cardiovascular disease (CVD) is the leading cause of death among women in the U.S., and prevalence rates are even higher among women Veterans. While behavioral interventions, such as improving diet and increasing exercise, are widely recommended to reduce CVD risk, implementing and sustaining such lifestyle changes can be challenging. Objective: We characterized women Veterans’ experiences making lifestyle changes to reduce their CVD risk, including self-reported barriers and strategies that facilitated success. Design: A quality improvement initiative to increase women Veterans’ engagement and retention in evidence-based health care for CVD risk reduction (the CV Toolkit) was implemented across five VA primary care sites June 2017–March 2020. We conducted semi-structured interviews with a sub-sample of women Veterans and used directed content analysis to identify themes. Participants: Women Veterans with at least one primary care visit and exposure to at least one component of the CV Toolkit (N = 1609) were invited to complete a mailed survey; among survey completers (n = 253), 48 participated in a 30-min interview about their experiences. Main Measures: We assessed lifestyle change type, barriers, and experiences implementing these changes. Key Results: Women Veterans reported making changes to diet, exercise, smoking, sleep, mental health, and medication adherence. Barriers included physical health, mental health, transportation, work schedule, care-giving responsibilities, limited access to resources/information, the COVID-19 pandemic, and personal attributes. Strategies that helped women Veterans be successful included the following: taking an incremental approach; setting small, achievable goals; and implementing targeted provider recommendations. Women also reported achieving success through self-education, finding a compelling motivation, and practicing mindfulness techniques. Conclusions: Women Veterans expressed considerable self-awareness regarding strategies that helped them successfully implement lifestyle changes to reduce CVD risk. Providers can leverage women Veterans’ self-awareness to develop personalized, realistic lifestyle change strategies that promote adherence and long-term improvements to cardiovascular health.