How do the public, health care professionals, and policy makers view unhealthy behaviours in the context of socioeconomic deprivation? A qualitative study.

Problem

Our recent systematic review suggests there are interactions between combinations of unhealthy behaviours (e.g., smoking, high alcohol intake, low physical activity, high sedentary time, poor diet, poor sleep, and low social participation levels) and socioeconomic deprivation for adverse health outcomes. This supports targeting health behaviour resources towards more deprived populations where risks are highest. Examining how key stakeholders, who regularly contend with both unhealthy behaviours and the effects of socioeconomic deprivation, perceive health behaviour risks is crucial to understanding the barriers and facilitators to addressing a wide range of unhealthy behaviours in the context of socioeconomic deprivation.

Approach

This was a qualitative study with data collected from two groups of participants: 1) 25 members of the public in four focus groups and 2) 18 in-depth interviews of professionals, including six community links workers, one practice nurse, one community pharmacist, four GPs, three public health professionals, and three policy makers. Audio data was transcribed, anonymised, and analysed via reflexive thematic analysis.

Findings

Both members of the public and professionals used broad definitions of unhealthy behaviours and often perceived combinations of unhealthy behaviours and socioeconomic circumstances as inextricable. All participants described myriad deep and intricate links between difficult socioeconomic circumstances and a wide range of unhealthy behaviours often via an overwhelming lack of choice and reduced individual agency. Both public and professional participants felt nihilism and fatalism, in relation to desire or opportunities to live healthy lives, were prevalent in more deprived communities. Health care professionals also recognised the importance, even duty, to instil hope in individuals that healthy behaviour change is achievable despite the most arduous circumstances. Community resources, including peer support and local champions ‘who walked the walk’ were seen as overcoming barriers to healthy living, such as access and stigma, in more deprived communities. Empowering both individuals and communities via deeper enquiry into their specific barriers was seen as successful in driving healthy change. At population and policy level, there was even less of a distinction between health behaviours and socioeconomic conditions and current policies were perceived as curtailed and narrowed by legislation and funding, which remains siloed, with existing policies only focussing on single unhealthy behaviours.

Consequences

Appreciation of the underlying socioeconomic barriers to healthy ways of living does not mean diminished hope for healthy behavioural change in individuals affected by socioeconomic deprivation. However, perceptions captured here drastically diminish the role of individual-level responsibility for healthy choices. Key stakeholders see co-designed and well-funded community level resources as best placed to support individuals trying to make healthy behavioural change in difficult socioeconomic circumstances. Innovative policy, planning, and legislation is required to incorporate wider approaches that can tackle upstream determinants of numerous unhealthy behaviours simultaneously.