Identification of knowledge, behavior and health application needs for cardiovascular disease prevention in young women: An interview and focus group discussion study in Makassar city

Abstract

BACKGROUND:

Cardiovascular disease (CVD) is the leading cause of death in women. Therefore, this study aimed to identify the level of knowledge, behavior, and needs of young women related to health applications in CVD prevention in Makassar City.

MATERIALS AND METHODS:

A qualitative method was used with a phenomenological design. Data were collected through in-depth interviews and Focus Group Discussion (FGD) of young women aged 17 to 25 years who live in Makassar City. Subsequently, data analysis was carried out using NVivo 12 Plus software.

RESULTS:

The results showed that most informants had a basic understanding of CVD risk factors, such as genetic history, lifestyle, and hormonal conditions. However, the majority still engaged in risky behavior, including a lack of physical activity and unhealthy diets. An information gap was also found regarding CVD, with the majority of informants not having received adequate education through conventional or digital media. Informants proposed key features in the CVD prevention applications, such as nutritional calculations, physical activity monitoring, disease risk detection, and the provision of interactive educational materials.

CONCLUSION:

This study identified gaps in education and preventive behavior among young women. The results showed need for a more comprehensive policy, including a digital technology-based method as a medium for health education. In line with the analysis, integration of digital technology-based health education was proven effective strategy in encouraging behavioral change and improving cardiovascular health among young women.

Introduction

Cardiovascular disease (CVD) is the leading cause of death among women worldwide. In the previous two decades to 2021, the global prevalence of the disease continues to increase[1] specifically in countries such as China, Indonesia, and India.[2] According to WHO reports, CVD accounted for approximately 32% of all deaths in women globally in 2019 as the gap increases.[3] A study conducted in India found a fairly high incidence of CVD among Muslim women in Southern India.[4] Another report from Iran found that more than half of the adult population had one or more risk factors, with higher prevalence in women compared to men.[5] Based on data from the 2018 nationwide Indonesian cross-sectional study, the prevalence of CVD diagnosis was slightly higher in women than in men.[6] A study conducted on premenopausal women in Canada showed that 70.4% of informants were unaware that CVD was the leading cause of death among women. There was also a lack of awareness regarding sex-specific risks, perceived factors, and exercise habits, which required health education efforts for more effective prevention.[7] Due to the importance of gender differences in health habits, mitigating efforts must be established to reduce the prevalence of this disease in the community, specifically in women, by controlling modifiable risk factors.[5]

The results of a study conducted by Bradley et al.,[8] in the United States who developed a prototype online cardiovascular risk assessment tool designed for young women found that only 10.5% of young women identified CVD as the leading cause of death. The development of easy-to-use tools such as cardiovascular risk assessments for young women can increase engagement and understanding of the disease. Recent interviews with young women and health practitioners have shown various barriers to adopting heart-healthy behavior. Therefore, there is need to develop effective interventions that can promote healthy lifestyles among young women. In this context, the Indonesian Heart Association (IHA) has issued guidelines for the management of CVD prevention in women[9] to provide information on the management and prevention of CVD. However, these guidelines have not been fully understood by the general community, specifically in primary health services.

The role of mobile health applications in increasing awareness of cardiovascular health poses a significant concern, specifically among women.[8] To address this issue, digital technology such as mobile health (mHealth) has been proven effective in disseminating information, promoting healthy behavior, and facilitating early detection of CVD by targeting vulnerable population. Health applications can empower users with knowledge and resources that lead to improved outcomes and increased awareness.[10] Therefore, it is necessary to develop a technology-based educational media, such as mHealth technology as a primary prevention educational media in controlling CVD. The implementation of secondary prevention by using mHealth technology has been widely applied in the older adult age group in CVD self-management and improving overall cardiovascular health. Specifically, mHealth shows the potential to positively influence behavioral changes and clinical outcomes,[11,12,13] suggesting need for further development in young women.

Significant gaps in awareness and knowledge of CVD among women exist across countries. Therefore, interventions are needed to improve awareness and knowledge, with a focus on education on risk factors and prevention methods.[14] A previous study suggested that heart-healthy lifestyles, including exercise, maintaining healthy weight, a balanced diet, and smoking cessation, are essential to reduce the risk of CVD.[15] As the next generation and future leaders, young women need greater awareness and knowledge to protect against chronic diseases that can reduce their quality of life.[14] However, this age group is often less aware of chronic diseases with barriers such as lower perceived risk.[16] The risk of CVD is increasing among young women, specifically those living in urban areas. This trend poses a significant concern due to the increase in cardiometabolic risk factors such as obesity, diabetes, physical inactivity, and hypertension.[17]

As one of the largest cities in Eastern Indonesia, Makassar City has high prevalence rate of CVD. Based on the screening data for Non-Communicable Diseases (NCD) of the Makassar City Health Office in 2022, there were 514 (1.1%) patients with Heart Disease, 158 (0.3%) had Stroke, 40,276 (84.9%) had Hypertension, 8,646 Diabetes Mellitus (18.2%), and 1874 Obesity (4.0%). The data show that there are several individuals with CVD in Makassar City, suggesting significant attention to creating educational media for early health education. Therefore, this study aimed to identify the level of knowledge, behavior, and needs of young women related to health applications in CVD prevention in Makassar City.

Materials and Methods

Study design and setting

This study was conducted in April-June 2024 using a qualitative method with a phenomenological design. The experiment was performed to identify the perception of benefits and barriers in creating healthy behavior such as physical activity and diets for young women in preventing CVD. Data were collected through in-depth interview with young women as informants. Additionally, Focus Group Discussion was conducted to analyze need, features, and functions expected in the developed applications.

A Social Cognitive Theory (SCT) method was used to facilitate an understanding of healthy behavior because of the interaction between individuals and the environment.[18] SCT has been used to determine the driving factors of health behavior such as physical activity as well as diet patterns. An understanding of these factors adequately can enable the design of health interventions that lead to better behavioral changes.[19,20,21] The themes in this study include knowledge about CVD, prevention-related behaviors, and other environmental factors influencing behavioral changes. Additionally, the investigation is carried out on the use of health applications in preventing CVD, exploring information desired by young women. The conceptual model of the study is modified from the SCT theoretical framework, as shown in Figure 1.

Figure 1.

Conceptual model of study

Study participants and sampling

Informants are young women 17 to 25 years old, classified as late adolescents according to the Ministry of Health of Indonesia who have been domiciled for more than 2 years in the study area, namely Makassar City. Selection was carried out based on knowledge and understanding of study problems using purposive sampling method. Moreover, a total of six informants were selected for in-depth interview and nine for FGD.

Data collection tool and technique

This study used qualitative descriptive data obtained from in-depth interview and FGD. The guideline instruments used for interview and FGD were developed by the first author after discussing with the study members. Data collection was carried out using qualitative tools and instruments. These consisted of interview guidelines comprising main questions on knowledge, perceptions of benefits, and obstacles in creating healthy behavior such as physical activity and healthy diets in preventing CVD. Additionally, FGD discussion guides were applied to explore information related to using health applications and the features or functions expected by informants to increase awareness, physical activity, and diet patterns.

The interview in this study was semi-structured, face-to-face interviews and lasted for approximately 25-60 minutes in one room. The purpose of this in-depth interview was to determine the knowledge and behavior of young women in preventing CVD. Subsequently, the FGD was conducted in a room guided directly by the first author for approximately 1 hour. The purpose of the FGD was to identify the use of health applications in young women and analyze the features needed. During interview and FGD process, a recording device, notebook, and digital camera were used to record images. A tape recorder was also used for voice, while informed consent was provided through a request format for willingness to become an informant.

Ethical consideration

This study referred to the Declaration of Helsinki and received approval from the Research Ethics Committee of the Faculty of Public Health, Hasanuddin University with the ethical approval recommendation number No. 977/UN4.14.1/TP. 01.02/2024. Before conducting interview, the study objectives were explained and then asked for willingness to become an informant by filling out the informed consent.

Data analysis

Data analysis was performed from the start of this study using qualitative methods. This was followed by reading and thorough analysis of all data collected, including interview transcription, credibility test, and re-checks. Subsequently, the data were processed and prepared for analysis by scanning the materials, interview transcripts, and FGD, followed by source triangulation based on informant statement quotes. Thematic analysis was then conducted by first rereading the transcripts, coding the data into semantic units, grouping codes into main themes and subthemes, followed by reviewing themes to ensure their relevance to the study objectives.[22] Applications used in qualitative data analysis included the Nvivo ver. 12 plus.

Results

Identification of knowledge and behavior of young women in preventing CVD

The purpose of identifying knowledge and behavior of young women in preventing CVD is to provide an initial picture as a consideration in developing relevant content in applications. The informants consisted of six young women who were included in interview, with their characteristics shown in Table 1.

Table 1.

Characteristics of in-depth interview participants

Informant code		Age		Occupation		Ethnicity		Family history of disease/risk factors for CVD
W1		18		Student		Bugis		Yes
W2		18		Student		Makassar		Yes
W3		20		College student		Makassar		No
W4		19		College student		Makassar		No
W5		18		Student		Bugis		Yes
W6		22		College student		Bugis		Yes

As shown in Table 1, six young women became informants in this study with college student and student status from Bugis and Makassar Tribes. The ages ranged from 18 to 22 years. A total of four informants had a family history or CVD risk, while two had no history.

Knowledge and behavior were identified through interview guidelines containing seven questions. The answers were processed using thematic analysis in NVivo 12 plus software. Meanwhile, the thematic analysis results found three themes consisting of 10 subthemes, as shown in Table 2.

Table 2.

Themes and subthemes from thematic analysis results of in-depth interview questions

Interview questions		Subtheme		Theme
1. Is there a history of CVD in the family? 2. How is knowledge about risk factors? 3. How about the perception of CVD risk related to yourself or young women in general?		1. Genetics 2. Concomitant diseases 3. Lifestyle 4. Age 5. Gender		1. Understanding the causes and risk factors of CVD
4. Do you feel vulnerable to this disease? 5. How to live a healthy lifestyle including physical activity and diet patterns?		1. Risk behavior 2. Healthy behavior		2. Behavior of young women
6. What are the motivating factors in living a healthy lifestyle? 7. What forms of information and resources are needed to maintain cardiovascular health?		1. Past experiences 2. Awareness of the importance of health 3. Support system		3. Enabling factors

Table 2 shows the formation of subthemes from informants’ answers to interview questions given. Answers to questions 1-3 form 5 subthemes for the theme “understanding the causes and risk factors for CVD”. Answers to questions 4-5 form 2 subthemes for the theme “behavior of young women” and answers to questions 6-7 form 2 subthemes for the theme “Enabling factors”. The results of data processing with Nvivo software present mind maps, showing idea graphs from subthemes that form themes. Additionally, t.he results of the thematic analysis are shown in the description [Figure 2].

Figure 2.

Mind maps related to the theme of knowledge and behavior of young women in preventing CVD

• Understanding the causes and risk factors of CVD

  This theme is formed by five subthemes composed of informants’ answers about whether there is a history of CVD in the family, knowledge of risk factors, and their perceptions. Based on the answers, informants understood the causes of CVD, leading to the genetic subtheme. Informants explained the causes of the disease and predominantly argued that there were comorbidities such as hypertension, stroke, and cholesterol. There was also an expression of risk factors such as lifestyle, old age, and gender specifically in women due to hormonal changes and menopause. This result comes from the results of triangulation of sources based on the following informant statement quotes:

  • “.yes, namely my father. the risk factors may be high blood pressure, cholesterol, due to smoking, and an inactive lifestyle, such as not exercising regularly. Heart disease can also be inherited from parents who experience it, due to genetic factors” (W1).

  • “.yes, my grandmother. heart disease can occur at ages like ours, specifically when health is not maintained” (W2).

  • “.My father had a mild stroke. My father has a history of hypertension, cholesterol, and kidney problems, hence there may be complications that affect his brain nerves” (W3).

  • “.There is also a family history, such as a stroke in my late father. Risk factors can be caused by age, high blood pressure or hypertension, high cholesterol, smoking, and obesity. Women are also at risk of this disease, often ignoring symptoms, and women experience a period called menopause” (W4).

  • “.risk factors can come from smoking, consuming foods that contain high levels of fat, salt, and excessive sugar, and lack of physical activity. Women who have entered menopause are at high risk” (W5).

  • “…several factors, such as biological or lifestyle factors, also contribute, for example, changes in women’s hormones after menopause” (W6).

• Young women’s behavior

  This theme is formed by two subthemes composed of informants’ answers about perceived vulnerability to CVD and how to live healthy lifestyle, including physical activity and diet patterns. Based on these answers, informants often show risky behavior such as lack of physical activity, not maintaining food consumption, rarely eating breakfast, and usually staying up late causing vulnerability to CVD. Some informants show healthy behavior such as not buying snacks carelessly, exercising, limiting consumption of fatty and salty foods, increasing vegetable consumption, and drinking enough water. This result is based on the results of triangulation of sources based on the following quotes from informants’ statements:

  • “.I underestimated this disease; maybe it was considered a disease of the elderly or men, even though women are also susceptible to heart disease. so I am more aware that this heart risk can happen to me, specifically if I do not maintain my health and exercise” (W1).

  • “.So far, there is no prevention. I am the type of person who doesn’t like to buy snacks outside.staying up late is a common habit among students.don’t exercise regularly.never diet.rarely eat breakfast.” (W2).

  • “.do not diet, do not exercise regularly” (W3).

  • “.I do not change my healthy lifestyle, do sports activities, and also avoid foods that can trigger diseases such as cardiovascular and other diseases. I personally think I should drink more water, consume foods that are not high in sugar and salt, and avoid fats in food. Moreover, now there are many viral snacks that are high in salt or sugar, and I also try to eat vegetables.” (W5).

  • “.I am aware that my lifestyle is unhealthy, and I rarely exercise or drink water.several times I have tried to implement a healthy lifestyle, such as exercising even though it is not a heavy exercise.” (W6).

• Enabling factors

  This theme is formed by three subthemes composed of informants’ answers about motivating factors in living healthy lifestyle and the form of information/resources needed to maintain cardiovascular health. From these answers, enabling factors are formed, namely supporting factors that can facilitate changes in risky behavior to healthy behavior, including past experiences and informants learning from family history of CVD. These include causes and risk factors increasing the awareness of health, particularly regarding the danger of CVD which is a chronic disease and can cause death at any time. There is also a support system, such as friends and the environment, with expectation of applications to provide relevant information and health consultations. This result comes from the results of triangulation of sources based on the following quotes from informants’ statements:

  • “.because this heart disease runs in my family, so I am at greater risk of getting heart disease.so I am more aware that this heart risk can happen to me, specifically if I don’t take care of my health.the main factor that motivates me is my father’s health, to avoid the same situation, so I have to keep my body fit and healthy so I can enjoy a longer life without complications.” (W1).

  • “.to improve lifestyle, specifically as a student, staying up late is one of the common habits. Well, that needs to be reduced because disease can come from that.heart disease is a chronic disease that can suddenly take someone’s life. I understand better after getting counseling from a doctor.consultation services are really needed.the application can be accessed at home.” (W2).

  • “.because there is a hereditary factor from my father, but God willing I want to maintain my lifestyle to avoid this disease. To maintain health, if fat is also not good to look at, so maintaining appearance is important. well, starting from school there is an influence from cellphones and television” (W3).

  • “.but still feel vulnerable because there are members of my family who suffer from this disease. from internal and external factors, internal comes from myself and external from friends. For example, when my friends exercise, I will join” (W4).

  • “.from the environment, if I see many friends who exercise or reduce sugar consumption, maybe I can follow their habits, exercise diligently, and not consume sweet drinks” (W5).

  • “.Because I feel unhealthy because maybe I stay at home too much and lack physical activity, so I think if I don’t exercise, I will get sick.maybe a small counseling can be carried out” (W6).

Identification of the use of health applications in young women and analysis of the features needed in CVD prevention applications.

The purpose of identifying the use of health applications in young women and analyzing the features needed in CVD prevention applications is to provide information regarding their usage patterns and preferences. In this study, nine young women informants were included in focus group discussion, with their characteristics shown in Table 3.

Table 3.

Characteristics of focus group discussion participants

Participant code		Age		Last education		Occupation
P1		19 years		Senior High School		College student
P2		20 years		Senior High School		College student
P3		19 years		Senior High School		College student
P4		19 years		Senior High School		College student
P5		19 years		Senior High School		College student
P6		20 years		Senior High School		College student
P7		19 years		Senior High School		College student
P8		20 years		Senior High School		College student
P9		20 years		Senior High School		College student

Table 3 presents the characteristics of FGD informants consisting of nine young women who have lived in Makassar City for more than 2 years. The ages ranged from 19 to 20 years with the last education being senior high school with a work status as a college student. Furthermore, the use of health applications and need analysis were identified through FGD. Answers were processed using thematic analysis in NVivo 12 plus software. The results of the thematic analysis found two themes consisting of nine subthemes, as shown in Table 4.

Table 4.

Themes and subthemes from the thematic analysis of FGD questions

FGD Questions		Subtheme		Theme
1. Have you ever heard of CVD? 2. Have you ever used a health app before?		1. Not yet exposed to CVD information 2. Types of health applications that have been used 3. Functions of health applications that have been used		Education gap and technology potential
3. What features would you expect if there was a CVD prevention app for women? 4. What are your views on CVD prevention?		1. Nutritional calculations 2. Activity tracking 3. Educational media 4. Educational materials 5. Dietary regulation 6. Disease risk detection		Features needed

Table 4 shows the formation of subthemes from informants’ answers to interview questions given. Answers to questions 1-2 form 3 subthemes for the theme “education gap and technology potential”. Answers to questions 1-1 form 6 subthemes for the theme “features needed”. The results of data processing with NVivo software present mind maps, which show idea graphs from subthemes that form the main theme. The thematic analysis results help determine the use of health applications and feature need analysis from CVD prevention applications, as shown in Figure 3. The results of the thematic analysis are described in the following description:

Figure 3.

Mind maps related to the theme of the use of health applications in young women and analysis of features needed in CVD prevention applications

• Education gap and technology potential

  This theme is formed by three subthemes composed of informant answers to questions about having heard of CVD and previous use of health applications. Based on the answers, informants have not received information related to CVD, either from the media, health education programs, or other sources. This shows an educational gap that must be addressed through more effective communication strategies, including conventional and digital media. Informants have used health applications that show the potential of technology as a tool for disseminating health information. This result is based on the results of triangulation of sources in line with the following informant statements:

  • “.never., I’ve never heard of it either” (P1, P3, P4, P5, P6).

  • “.Once, there was an application to calculate this, calculate BMI. only through the website” (P5).

  • “.me too, fitness applications., how to train muscles” (P3).

  • “.me too, flow applications to calculate menstrual schedules. menstrual schedules” (P2, P6).

  • “.slim fit., weight, height., like recommended foods” (P4).

• Features needed in CVD prevention applications

  This theme is formed by six subthemes composed of informant answers to questions about features expected when there is a CVD prevention application for women and views on CVD prevention. Based on these answers, participants expect six core features in CVD prevention applications including nutritional calculations, activity tracking, educational media, educational materials, diet management and disease risk detection, and heart rate calculations. This result is based on the results of triangulation of sources in line with the following informant statements:

  • “.What is expected is a nutritional application that can calculate calories to avoid excessive consumption of food” (P6).

  • “.maybe more about the calories of the activities that we have done that day” (P5).

  • “.The application functions as education because it is often forgotten, specifically in the menus that rarely fill in educational menus” (P1).

  • “.Specifically, in fitness applications, such as adding features to detect heart rate when we run or walk” (P3).

  • “.ee animation., movement., educational poster” (P9, P4).

From the two themes found, the integration between formal education and application-based technology can be a holistic method to improve CVD prevention behavior. Therefore, a more inclusive application is needed specifically targeting women and focusing on CVD prevention education.

Discussion

This study offers a new contribution to CVD prevention efforts by providing information on digital health education based on user need, specifically young women. The result shows the education gap that can be bridged by identifying user need related to accessible and engaging digital health applications for young women. This study focuses on need for early education and primary prevention before entering the high-risk group.

Knowledge and behavior of young women in preventing CVD

This study shows that although most young women have a basic understanding of CVD risk factors, there is still a gap in applications of preventive behavior. Several informants have basic knowledge related to general CVD risk factors such as comorbidities such as hypertension, stroke, cholesterol, and genetic history. Informants also know several risk factors including lifestyle, old age, and gender, particularly in women. This is because hormonal changes and menopause are risk factors for CVD, while behavior like inactivity, poor food consumption, rarely eating breakfast, and often staying up late, further contribute to vulnerability. Gooding et al.[23,24] stated that many young women do not understand the risk factors of the disease. The results showed that perceptions of age, gender, and social norms contributed to low awareness of heart disease among young women. This can limit heart health behavior, showing need for effective health education to increase awareness.

Factors motivating young women are informants learning from a family history of CVD, which increases awareness. This study is in line with Garg et al.[25] that individuals with a family history of cardiometabolic diseases tend to have a higher perception, thereby influencing health-related decisions and behavior.

Several informants in this study have support systems including friends and the environment as well as expect the applications that can provide information related to CVD. This study shows the importance of enabling factors in shaping healthy behavior, such as past experiences, and awareness of the importance of health, including social support from family and friends. Nordin et al.[26] stated that low emotional support was associated with an increased risk of CVD lifestyle factors, such as smoking, alcohol consumption, and lack of physical activity. Individuals with low emotional support are also at higher risk for CVD morbidity and mortality while showing subclinical atherosclerosis. Strong social support plays an important role in helping individuals adopt healthy behavior, particularly physical activity, and a better diet.

The use of health applications in young women and analysis of features needed in CVD prevention applications

FGD with young women in this study shows a lack of information about CVD from the media or educational programs. This shows an educational gap that should be addressed with more effective communication strategies through conventional and digital media. Informants expect six main features in CVD prevention applications, such as nutritional calculations, activity tracking, educational media, educational materials, diet management, and CVD risk detection. In response to this, informants propose interactive and attractive health application features. Joseph et al.[27] proved that digital technology-based health applications, such as Smart Walk, were effective in increasing physical activity and cardiovascular health awareness in young women at risk of metabolic disease. Additionally, applications such as HeartBeat that focus on monitoring diet, physical activity, and psychosocial factors have increased healthy lifestyle changes in women at high risk of CVD.[28]

Digital technology-based applications in prevention and control of CVD risk specifically applied to women have been developed in several countries. This includes SMARTWOMAN^TM[29] to control cardiovascular risk factors, diet tracking,[30] monitor dietary compliance, and blood pressure. TRAINGLE[31] aims to monitor cardiometabolic risk behavior, while FitBit[32] is designed to determine physical activity, 10-year risk of CVD, lipid levels, and fasting blood sugar. Several applications for prevention and control of the disease in women focus on managing risk factors such as medical conditions, health behavior (physical activity and diet), as well as psychosocial characteristics of patients. However, applications that emphasize early education to increase awareness are still limited,[8,33] suggesting need to motivate young women to adopt heart-healthy habits and prevent CVD.[34] Promoting early identification and treatment of cardiovascular risk factors can prevent disease and save the lives of young women.[35]

Based on the results, this study presents novelty in providing information about need for developing digital technology-based health applications specifically designed for young women in CVD prevention. Through a qualitative method with interview and FGD, the result identifies gaps in education and risk behavior in young women as well as information on applications feature need, such as nutritional calculations, physical activity tracking, disease risk detection, and interactive education. This study emphasizes the importance of early education and primary prevention through mHealth technology tailored to local need.

Health education interventions by providing more engaging educational content such as animations, short videos, or infographics can be used to increase appeal in improving health behavior.[36,37,38] These interventions are adjusted to enhance awareness of women-specific risk factors, such as early menopause and pregnancy complications.[39,40] Healthcare providers should systematically evaluate women at risk for coronary heart disease as well as provide gender-sensitive and age-specific education.[41] Integrating health applications with conventional systems should be conducted to support long-term monitoring and provide more engaging educational content to increase awareness of CVD, particularly among women.

This study has the main advantage of a qualitative method that allows for an in-depth exploration of young women’s knowledge, behavior, and need to be related to health applications for CVD prevention. Comprehensive data collection methods through in-depth interview and FGD produce rich data with various informants perspectives as well as offer relevant and contextual insights. The results are applicable due to the successful identification of the features expected in CVD prevention applications, serving as the basis for developing digital technology-based health applications.

Limitations and recommendations

This study had limitations, as the experiment was conducted in only Makassar City, producing the results that did not fully show conditions in other regions. The number of informants was limited, thereby the results may not be representative of the wider population. This study only showed young women, which suggested variation to other age groups. Moreover, further investigations are expected to develop and test a prototype of health applications based on the identified features to measure effectiveness in increasing awareness, behavior, and CVD prevention in young women. A mixed method should also combine qualitative and quantitative data to obtain more comprehensive results. Additionally, a larger number of informants should be included, covering a wider area to increase the generalizability of the results. It is also important to explore the social, cultural, and economic factors influencing young women’s health behavior to produce more effective and sustainable education strategies.

Conclusion

In conclusion, this study identified gaps in education and preventive behavior among young women. This suggested need for more comprehensive policies, including a digital technology-based method as a medium for health education. The development of health applications that provided interactive features such as physical activity monitoring, nutritional calculations, disease risk detection, and interesting educational materials was expected to improve CVD prevention behavior. Supporting the integration of health applications with primary health care services is essential to ensure continuous health monitoring. Additionally, targeting early prevention and building awareness through interactive education could play an important role in reducing CVD risk among young women.

Conflicts of interest

There are no conflicts of interest to declare.

Abbreviations

CVD: Cardiovascular Disease; FGD: Focus Group Discussion; IHA: Indonesian Heart Association; mHealth: Mobile Health; NCD: Non-Communicable Diseases; SCT: Social Cognitive Theory.

AI policy

This research does not involve the use of artificial intelligence (AI) in any aspect of data analysis, processing, or decision-making. All methodologies employed in this study are based on conventional techniques that align with existing scientific standards.

Funding Statement

This research was supported by the Indonesia Center for Education Financial Services (PUSLAPDIK Indonesia), Center for Higher Education Funding (BPPT), and Indonesia Endowment Funds for Education (LPDP) No. 01111/J5.2.3./BPI.06/9/2022.