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Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally and in Sweden. Effective primary prevention requires not only clinical risk assessment but also person-centred communication to promote a healthy lifestyle. Nurses play a key role in structured preventive dialogues, such as those in the Västerbotten Intervention Programme (VIP), one of the world’s largest prevention programmes. However, little is known about how nurses experience and navigate risk communication in real-world primary care. This study aimed to explore nurses’ experiences with cardiovascular risk communication and lifestyle counselling during preventive dialogues in primary care.

Methods: Semistructured interviews were conducted with 11 nurses delivering VIP health dialogues across primary care centres in Västerbotten County between December 2024 and April 2025. The interviews were audio-recorded and transcribed verbatim. Data were analysed via qualitative content analysis, identifying meaning units, codes, categories, and an overarching theme. Reporting followed COREQ.

Results: The analysis generated two main categories. The first, Meeting the person professionally while taking a step back, captured how nurses described exploring each patient’s unique situation, needs, motivations, and attitudes. The second, Continuously adapting approaches in self-management support, captured nurses’ accounts of using flexible strategies, such as gradual goal setting, visual tools, and practical daily habit suggestions, to support patients in understanding and working with lifestyle change. Together, these categories formed the overarching theme Shifting between leading and following, illustrating how nurses experienced balancing individualised adaptation with professional guidance while navigating structural and contextual challenges.

Conclusions: Nurses described translating cardiovascular risk into person-centred, relational dialogue by flexibly combining structure, responsiveness, and motivational strategies. Understanding preventive dialogues as interactive, person-centred processes, supported by the sensitive use of visualisation tools, may inform the continued development of cardiovascular prevention in primary care and warrants further evaluation.