Background <p>Cardiovascular diseases, a leading cause of death globally and in Hong Kong, lead to disability, mood changes, and increased healthcare burden. Lifestyle modifications can prevent these diseases. Health coaching, a client-centered approach, aids in behavior change. Despite its promise, cultural nuances in Hong Kong, like traditional diets and collectivist values, may influence health coaching effectiveness. Understanding these factors is crucial for tailored and effective cardiovascular disease prevention in the local Chinese population.</p> Methods <p>Eighteen participants were recruited from the We WATCH project, a health coaching program for cardiovascular disease prevention in middle-aged adults (35–59 years) at post-program. Purposive sampling was used regarding gender, age and lifestyle domains. Three semi-structured focused-group interviews were conducted. Interviews followed a guide focusing on lifestyle changes and health coaching experiences. Thematic analysis, based on Braun and Clarke’s approach, identified emergent themes.</p> Results <p>The study revealed challenges faced by middle-aged individuals in Hong Kong in adopting healthy habits due to various barriers. Comfort foods and inactivity hinder behavioral changes. The end of health coaching programs posed a barrier. Participants cited facilitators from health coaching for promoting healthy behaviors. Clients noted health coach characteristics impacting effectiveness. A mix of online and offline channels was preferred for health coaching modality in Hong Kong for a more versatile approach.</p> Conclusions <p>Psychological, behavioral, and cultural factors impact health decisions. Tailored health coaching in Hong Kong and similar cultures should consider unique cultural and environmental contexts (e.g., family-based health coaching, exploring indoor exercises).</p>