Exploring Public, Practitioner and Policymaker Perspectives of Unhealthy Lifestyle Factors in the Context of Socioeconomic Deprivation: A Qualitative Study

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Expectations Pub Date : 2024-10-24 DOI:10.1111/hex.70069

Hamish M. E. Foster, Frances S. Mair, Catherine A. O'Donnell

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引用次数: 0

Abstract

Introduction

Unhealthy lifestyle factors, such as smoking, high alcohol intake, poor diet and physical inactivity, are key risk factors for premature mortality. How unhealthy lifestyle factors are viewed in the wider context of socioeconomic deprivation is rarely considered. Understanding key stakeholder views on lifestyle factors in the context of deprivation is critical to intervention development and reducing harm in more deprived populations. The aim of this study was to explore public, healthcare professional and policymaker views around unhealthy lifestyle factors in the context of deprivation. The aim was broad to facilitate iterative development of ideas, as the views of this wide range of stakeholders are rarely captured.

Methods

Twenty-five adult members of the public in Scotland took part in four focus groups between August 2022 and June 2023. Eighteen semi-structured interviews were conducted with professionals: 12 primary-care practitioners and 6 public-health practitioners and policymakers. Reflexive thematic analysis was undertaken.

Results

Four main themes were developed: (1) Evolving complexity of lifestyle factors – the number of lifestyle factors that adversely impact health has grown, with increasingly complex interactions, (2) Social determinants of lifestyle – numerous links were made between socioeconomic conditions and unhealthy lifestyle factors by all participants, (3) Poverty as a fundamental social determinant – poverty was identified as a core factor for unhealthy lifestyle factors, and (4) Agency versus structure in relation to lifestyle – individual agency to address lifestyle factors was limited by structural constraints. Among professionals, understanding the challenging social determinants of unhealthy lifestyle factors was countered by a desire to support healthy change in those affected by deprivation.

Conclusion

Public and professional views around lifestyle highlight an evolving understanding of the new and growing number of lifestyle factors as well as the increasingly complex interplay between lifestyle factors. Views of the social determinants of lifestyle and structural limits to agency strengthen arguments for reduced emphasis on individual-level responsibility for unhealthy lifestyle factors and for deeper integration of social determinants into lifestyle interventions. In addition to addressing poverty and socioeconomic inequalities directly, innovative policy, planning and legislation that incorporate wider approaches could tackle upstream determinants of numerous unhealthy lifestyle factors simultaneously.

Patient or Public Contribution

Members of the public who participated in this study have made contributions by sharing their views and perspectives. The National Health Service Research Scotland Primary Care Patient and Public Involvement (NRS PPI) Group contributed to the development of this work. The NRS PPI Group was consulted as part of the preparatory work for H. M. E. F.'s doctoral thesis funding application. The findings of the qualitative work were presented to them, and they informed the interpretation of those findings and related work presented at conferences and public engagement events.

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探索社会经济贫困背景下公众、从业者和决策者对不健康生活方式因素的看法：定性研究。

导言：不健康的生活方式，如吸烟、高酒精摄入量、不良饮食和缺乏运动，是导致过早死亡的主要风险因素。在社会经济贫困的大背景下，人们如何看待不健康的生活方式因素却很少被考虑。了解主要利益相关者对贫困背景下生活方式因素的看法，对于制定干预措施和减少贫困人口的伤害至关重要。本研究旨在探讨公众、医疗保健专业人员和政策制定者对贫困背景下不健康生活方式因素的看法。这项研究的目的很广泛，目的是促进想法的迭代发展，因为这种广泛的利益相关者的意见很少被采纳：2022 年 8 月至 2023 年 6 月期间，苏格兰 25 名成年公众参加了四个焦点小组。与专业人士进行了 18 次半结构化访谈：12 名初级保健从业人员和 6 名公共卫生从业人员及政策制定者。对访谈结果进行了反思性专题分析：形成了四个主要专题：(1) 生活方式因素不断演变的复杂性 - 对健康产生不利影响的生活方式因素越来越多，相互作用也越来越复杂；(2) 生活方式的社会决定因素 - 所有参与者都将社会经济条件与不健康的生活方式因素联系在一起；(3) 贫穷是基本的社会决定因素 - 贫穷被认为是不健康的生活方式因素的核心因素；(4) 与生活方式有关的机构与结构 - 解决生活方式因素的个人机构受到结构限制。在专业人员中，理解不健康生活方式因素的社会决定因素具有挑战性的同时，也希望支持那些受贫困影响的人健康地改变生活方式：公众和专业人士对生活方式的看法凸显了他们对生活方式因素数量不断增加的新认识，以及生活方式因素之间日益复杂的相互作用。关于生活方式的社会决定因素和结构性限制因素的观点，加强了减少强调个人对不健康生活方式因素的责任，以及将社会决定因素更深入地纳入生活方式干预措施的论点。除了直接解决贫困和社会经济不平等问题外，纳入更广泛方法的创新政策、规划和立法可以同时解决众多不健康生活方式因素的上游决定因素：参与本研究的公众成员通过分享他们的观点和看法做出了贡献。苏格兰国家健康服务研究中心初级医疗患者和公众参与小组（NRS PPI）为本研究的发展做出了贡献。在 H. M. E. F. 申请博士论文资助的准备工作中，曾咨询过 NRS PPI 小组的意见。定性工作的结果已提交给他们，他们为这些结果的解释以及在会议和公众参与活动中介绍的相关工作提供了信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.