Background: As developing countries shift to an increasing prevalence of cardiovascular risk factors and diseases (CVD), prevention efforts, both primary and secondary, become a public health priority. Designing effective methods requires a clear understanding of local beliefs and practices regarding health risks and behaviors.

Methods: A mixed gender and age team deployed a rapid assessment protocol (participant observation and interviews) over three days. Interviews from 25 residents of Carriacou, Grenada included leaders and community members representing a range of demographic characteristics (gender, age, employment).

Results: Residents expressed general uncertainty about their actual health. While acknowledging that certain conditions e.g. diabetes, hypertension were prevalent, heredity was viewed as being more strongly associated with CVD. Not being able to work or carry out one’s daily activities often drove health care seeking behavior such as evaluation, care or initiating lifestyle changes. Health improvement activities when practiced were fragmented and did not involve an overall lifestyle change. Physical activity was implicitly valued but not universally practiced; it declined with age and increasing work and other commitments.

Conclusions: While public health programs benefit from understanding community attitudes and beliefs, research to inform program development is often not undertaken or if undertaken not effectively utilized to make needed program modifications. Key to our conclusions was their perspective on health as illness oriented and reactive, strongly associated with heredity rather than preventive and associated with behavior change. A preventive focus informed by local practices is fundamental to designing effective and sustainable primary and secondary prevention programs and particularly useful in developing countries.