Table 2.

Thematic Analysis of Qualitative Data and Modifications to the Patient Education Program

Theme	Related Quotes	Modifications to the PEP
1) Targeted impact message: Opening impact message was too direct and an “attack.”	“Why particularly South Asian people? The people, other than Asians, use oils, even they smoke, even they are busy with their works and stuff and do not exercise regularly. But why basically for Asian people?” (Female, 27 years)	Original narration: “Heart attack is the number one killer of Asian Indians and Pakistanis.”
	“You are being too hard on Indians. “This is like it’s nailed towards Indians” (Female, 24 years).	Modified narration: “Heart attack is the number one killer of people all around the world. Studies show that Asian Indians and Pakistanis are more likely to have heart attacks than people from other communities.”
	“Why is this video especially for Indians and Pakistanis? In the USA, I have seen many. Heart disease is a common disease.” (Male, 56 years)
2) Community heterogeneity: Images and messages not speaking to the whole community.	“Some people might think that only women are more susceptible to heart attack, by putting a man in the picture it shows both are susceptible, balancing I mean.” (Female, 26 years)	Original opening picture: see Figure 1
	“The picture shows a mother daughter relationship, but not everybody who knows someone who had a heart attack has a mother. (Female, 32 years)	Modified opening picture: see Figure 2
	“I don’t see any connection here between narration and the picture.” (Female, 68 years)
3) Stress and explanatory models of CHD: Community’s belief that stress causes CHD should not be negated. Community’s explanatory model should be incorporated into messages.	“Few things missing in this video. Even if heart disease does not run in your family, even then you could get it if you are facing some sorrow or a big problem in life.” (Female, 70 years).	Original narration: “Many people believe that sudden shock or bad news can cause a heart attack. It may look like a heart attack happens suddenly, but the truth is that heart attacks are caused by blood vessels getting clogged, slowly over many years.”
	“You say that stress and tension do not cause heart attack, but doctors in India say don’t take stress or tension or probably you could have a heart attack. Why this conflicting recommendation? What’s the true relationship?” (27 years old female)”	Modified narration: “Many people know someone who had a heart attack suddenly after getting bad news or having a lot of stress. It may look like a heart attack happens suddenly. But bad news or stress by themselves do not cause a heart attack. If someone already has clogged blood vessels in their heart, stress can make this worse.”
	“You should add some information on controlling stress as part of prevention (Female, 38 years).
4) Perceived behavioral control: PEP was effective at changing perceptions and beliefs, but PEP should also address structural barriers to screening.	“I like the awareness towards prevention. Being a young healthy person, I never thought about it. Even youngsters should get checked regularly and talk to your doctor about heart disease. I always thought this cholesterol and diabetes could only happen to older people. It was new to me.” (Male, 29 years)	Original PEP: Did not address structural barriers to screening.
	“Insurance is a problem. Those who don’t have it cannot get too many tests done. Getting check-up is very hard for us.” (Female, 38 years)	Modified PEP: Provides information on federally qualified health centers where people that are underinsured or uninsured can get screened.