Table 2.

Examples of Bangladeshi patients’ perceptions, structural and material barriers, and reinforcing factors affecting acceptance of a behavioural priority in diabetes education—“People with diabetes should take regular sustained low-intensity physical exercise”

	Implications for health education and health policy
Perceptions
Loss of body sweat, such as occurs during physical labour, is good for health	Recommendations for physical exercise should focus on the potential for producing sweat in ways other than physical labour
Prayers (namaz) are a form of physical exercise	Educators should be aware of the perceived association of prayer with exercise
Sport and organised physical exercise have no cultural meaning and are inappropriate for women and older men. Sports clothing and footwear are “not appropriate for our community”	Non-sporting activities that do not require special clothing or footwear may be more acceptable than pressure to become involved in sport
Walking is an acceptable form of exercise, but fast walking is inappropriate, especially for women and those of high social status	Promotion of walking and other indigenous activities may allow activity level to be increased in a culturally acceptable way, at least for males
Women should generally remain within the home, dress modestly, and remain demure. Young children should remain with their mother or grandmother at all times	Activities that can be done discretely and in private (such as home exercise videos) may be more acceptable to women
Structural and material factors
Walking in the street is considered unsafe, particularly for women and elderly people, because of fear of crime and harassment	Effective local and national policies on crime and racial harassment, and community policing in particular, are required on health as well as social grounds
Opportunities for exercise in daily living often go unrecognised	Health promotion campaigns should encourage walking to school and shops rather than using motor transport
Reinforcing factors
Advice from educators and health professionals is held in high regard	Even though physical exercise is not part of the culture, it should be encouraged in individual doctor-patient encounters
Approval or disapproval by family seems to strongly influence lifestyle choices	Involvement of key family members in education for exercise is likely to improve its success