Abstract

Background
Cardiovascular diseases (CVDs) and their risk factors are leading causes of morbidity and mortality worldwide, with physical inactivity and unhealthy dietary practices as key modifiable contributors. Sedentary employees, such as bank workers, are at high risk of CVD due to prolonged sedentary work nature and work-related stress. This study aimed to explore awareness, perceptions, and intervention preferences for CVD prevention among bank employees in urban Karachi, Pakistan.

Methods:
This exploratory qualitative study is part of the m-LIfE (mobile-based Lifestyle Intervention for Employees), a pilot cluster randomized controlled trial (NCT06981247) focused on developing and testing contextually relevant CVD prevention strategies (2025). Bank employees aged 20–65 years across 3 bank organizations (1 public and 2 private) were purposively selected. Employees with self-reported CVD were excluded. Data were collected from six focus group discussions (FGDs) and nine in-depth interviews (IDIs). IDIs were conducted with employees in leadership positions, using a semi-structured guide informed by the Health Belief Model.

Results: Four major themes emerged: (1) Awareness (Knowledge of specific behaviors/factors): Participants demonstrated moderate awareness of CVD risks and acknowledged banking as a high-risk profession due to prolonged sitting and job-related stress. However, a consistent gap was observed between knowledge and actual health behaviors, primarily due to time constraints and competing priorities. (2) Perceptions (Interpreting or expressing personal beliefs): Participants attributed CVD risk to urban lifestyles, poor dietary habits, and physical inactivity. Many cited dual-income household demands as barriers to healthy living. Occupational stress was widely reported, with participants highlighting performance pressure, job demands, customer-driven stress, long working hours, and a deadline-driven culture where customer needs were prioritized above employee well-being.

(3) Existing Workplace Initiatives: While banks occasionally organized health campaigns, typically in response to acute situations such as COVID-19, none addressed long-term strategies for promoting physical activity or healthy eating. (4) Preferences for CVD Risk Prevention Interventions: Participants preferred low-burden, context-sensitive interventions such as digital health applications featuring goal-setting, reminders, dietary guidance on calories, and real-time progress tracking. In-person sessions were preferred initially, followed by tech-based tools such as mobile apps and wearable devices. Paper-based approaches were largely dismissed. Structural suggestions included providing gym equipment at work, extending lunch breaks, and offering health-related incentives. 

Conclusion:
Bank employees are aware of CVD risks but face psychosocial and structural barriers to healthy behavior change. They prefer interventions that are low-effort, tech-enabled, and integrated into daily routines. Our findings highlight the need for behaviorally informed, context-tailored workplace interventions that enhance feasibility, motivation, and sustainability.