Perceptions on healthy eating, physical activity and lifestyle advice: opportunities for adapting lifestyle interventions to individuals with low socioeconomic status

BMC Public Health

Reint Jan Renes⁴  Agnes Meershoek³  Marleen A van Baak²  Edith J M Feskens¹  Dorit Teuscher²  Andrea J Bukman¹ 

[1] Division of Human Nutrition, Wageningen University, P.O Box 8129, 6700 EV Wageningen, The Netherlands;Department of Human Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre+, P.O Box 616, 6200 MD, Maastricht, The Netherlands;Department of Health, Ethics and Society, CAPHRI, Maastricht University Medical Centre+, P.O Box 616, 6200 MD, Maastricht, The Netherlands;Division of Strategic Communication, Wageningen University, P.O box 8130, 6700 EW, Wageningen, The Netherlands

关键词: Focus groups;    Healthy eating;    Physical activity;    Perceptions on lifestyle;    Socioeconomic status;   

Others  :  1126396
DOI  :  10.1186/1471-2458-14-1036

 received in 2014-06-26, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

Individuals with low socioeconomic status (SES) are generally less well reached through lifestyle interventions than individuals with higher SES. The aim of this study was to identify opportunities for adapting lifestyle interventions in such a way that they are more appealing for individuals with low SES. To this end, the study provides insight into perspectives of groups with different socioeconomic positions regarding their current eating and physical activity behaviour; triggers for lifestyle change; and ways to support lifestyle change.

Methods

Data were gathered in semi-structured focus group interviews among low SES (four groups) and high SES (five groups) adults. The group size varied between four and nine participants. The main themes discussed were perceptions and experiences of healthy eating, physical activity and lifestyle advice. Interviews were transcribed verbatim and a thematic approach was used to analyse the data.

Results

In general, three key topics were identified, namely: current lifestyle is logical for participants given their personal situation; lifestyle change is prompted by feedback from their body; and support for lifestyle change should include individually tailored advice and could profit from involving others. The perceptions of the low SES participants were generally comparable to the perceptions shared by the high SES participants. Some perceptions were, however, especially shared in the low SES groups. Low SES participants indicated that their current eating behaviour was sometimes affected by cost concerns. They seemed to be especially motivated to change their lifestyle when they experienced health complaints, but were rather hesitant to change their lifestyle for preventive purposes. Regarding support for lifestyle change, low SES participants preferred to receive advice in a group rather than on their own. For physical activities, groups should preferably consist of persons of the same age, gender or physical condition.

Conclusions

To motivate individuals with low SES to change their lifestyle, it may be useful to (visually) raise their awareness of their current weight or health status. Lifestyle interventions targeting individuals with low SES should take possible cost concerns into account and should harness the supportive effect of (peer) groups.

【 授权许可】

   
2014 Bukman et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Mackenbach JP, Stirbu I, Roskam AJR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE: Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008, 358:2468-2481.
• [2]Stringhini S, Sabia S, Shipley M, Brunner E, Nabi H, Kivimaki M, Singh-Manoux A: Association of socioeconomic position with health behaviors and mortality. J Am Med Assoc 2010, 303:1159-1166.
• [3]Darmon N, Drewnowski A: Does social class predict diet quality? Am J Clin Nutr 2008, 87:1107-1117.
• [4]Lallukka T, Laaksonen M, Rahkonen O, Roos E, Lahelma E: Multiple socio-economic circumstances and healthy food habits. Eur J Clin Nutr 2007, 61:701-710.
• [5]Gidlow C, Johnston LH, Crone D, Ellis N, James D: A systematic review of the relationship between socio-economic position and physical activity. Health Educ J 2006, 65:338-367.
• [6]Beenackers MA, Kamphuis CBM, Giskes K, Brug J, Kunst AE, Burdorf A, van Lenthe FJ: Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act 2012, 9:116. BioMed Central Full Text
• [7]Demarest S, Van Oyen H, Roskam AJ, Cox B, Regidor E, Mackenbach JP, Kunst AE: Educational inequalities in leisure-time physical activity in 15 European countries. Eur J Public Health 2014, 24:199-204.
• [8]Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J: Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish diabetes prevention study. Lancet 2006, 368:1673-1679.
• [9]Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393-403.
• [10]Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, Fowler S: The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med 2005, 142:611-619.
• [11]Roumen C, Feskens EJM, Corpeleijn E, Mensink M, Saris WHM, Blaak EE: Predictors of lifestyle intervention outcome and dropout: the SLIM study. Eur J Clin Nutr 2011, 65:1141-1147.
• [12]Salmela SM, Vähäsarja KA, Villberg JJ, Vanhala MJ, Saaristo TE, Lindström J, Oksa HH, Korpi-Hyövälti EA, Moilanen L, Keinänen-Kiukaanniemi S, Poskiparta ME: Perceiving need for lifestyle counselling: findings from Finnish individuals at high risk of type 2 diabetes. Diabetes Care 2012, 35:239-241.
• [13]Lakerveld J, IJzelenberg W, van Tulder MW, Hellemans IM, Rauwerda JA, van Rossum AC, Seidell JC: Motives for (not) participating in a lifestyle intervention trial. BMC Med Res Methodol 2008, 8:17. BioMed Central Full Text
• [14]Chinn DJ, White M, Howel D, Harland JOE, Drinkwater CK: Factors associated with non-participation in a physical activity promotion trial. Public Health 2006, 120:309-319.
• [15]Moroshko I, Brennan L, O’Brien P: Predictors of dropout in weight loss interventions: a systematic review of the literature. Obes Rev 2011, 12:912-934.
• [16]Noar SM, Benac CN, Harris MS: Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull 2007, 133:673-693.
• [17]Hawkins RP, Kreuter M, Resnicow K, Fishbein M, Dijkstra A: Understanding tailoring in communicating about health. Health Educ Res 2008, 23:454-466.
• [18]Rimer BK, Kreuter MW: Advancing tailored health communication: a persuasion and message effects perspective. J Commun 2006, 56:S184-S201.
• [19]Kreuter MW, Wray RJ: Tailored and targeted health communication: strategies for enhancing information relevance. Am J Health Behav 2003, 27:S227-S232.
• [20]Cleland V, Granados A, Crawford D, Winzenberg T, Ball K: Effectiveness of interventions to promote physical activity among socioeconomically disadvantaged women: a systematic review and meta-analysis. Obes Rev 2012, 14:197-212.
• [21]Coveney J: A qualitative study exploring socio-economic differences in parental lay knowledge of food and health: implications for public health nutrition. Public Health Nutr 2005, 8:290-297.
• [22]Heikkinen H, Patja K, Jallinoja P: Smokers’ accounts on the health risks of smoking: why is smoking not dangerous for me? Soc Sci Med 2010, 71:877-883.
• [23]Bisogni CA, Jastran M, Seligson M, Thompson A: How people interpret healthy eating: contributions of qualitative research. J Nutr Educ Behav 2012, 44:282-301.
• [24]Bouwman LI, te Molder H, Koelen MM, van Woerkum CMJ: I eat healthfully but I am not a freak. Consumers’ everyday life perspective on healthful eating. Appetite 2009, 53:390-398.
• [25]Nöhammer E, Stummer H, Schusterschitz C: Employee perceived barriers to participation in worksite health promotion. J Public Health 2014, 22:23-31.
• [26]Ballering C, Schreurs H, Renders C, Kooiker S, van Ameijden E: Een inkijk in verhalen achter leefstijlgewoontes [A glimpse of stories behind lifestyle habits. In Dutch]. Tijdschrift voor Gezondheidswetenschappen 2013, 91:263-269.
• [27]van Dillen SME, Hiddink GJ, Koelen MA, de Graaf C, van Woerkum CMJ: Perceived relevance and information needs regarding food topics and preferred information sources among Dutch adults: results of a quantitative consumer study. Eur J Clin Nutr 2004, 58:1306-1313.
• [28]Ball K, Salmon J, Giles-Corti B, Crawford D: How can socio-economic differences in physical activity among women be explained? A qualitative study. Women Health 2006, 43:93-113.
• [29]Morgan DL: Focus groups. Annu Rev Sociol 1996, 22:129-152.
• [30]Dickson D: The focus group approach. In Handbook of Communication Audits for Organizations. Edited by Hargie O, Tourish D. London: Routledge; 2000:85-103.
• [31]Fishbein M, Triandis HC, Kanfer FH, Becker M, Middlestadt SE, Eichler A: Factors influencing behavior and behavior change. In Handbook of Health Psychology. Edited by Baum A, Revenson TA, Singer JE. Mahwah, NJ: Lawrence Erlbaum Associates; 2001:3-17.
• [32]Waterlander WE, de Mul A, Schuit AJ, Seidell JC, Steenhuis IHM: Perceptions on the use of pricing strategies to stimulate healthy eating among residents of deprived neighbourhoods: a focus group study. Int J Behav Nutr Phys Act 2010, 7:44. BioMed Central Full Text
• [33]Konttinen H, Sarlio-Lähteenkorva S, Silventoinen K, Männistö S, Haukkala A: Socio-economic disparities in the consumption of vegetables, fruit and energy-dense foods: the role of motive priorities. Public Health Nutr 2013, 16:873-882.
• [34]Kamphuis CBM, van Lenthe FJ, Giskes K, Brug J, Mackenbach JP: Perceived environmental determinants of physical activity and fruit and vegetable consumption among high and low socioeconomic groups in the Netherlands. Health Place 2007, 13:493-503.
• [35]Inglis V, Ball K, Crawford D: Why do women of low socioeconomic status have poorer dietary behaviours than women of higher socioeconomic status? A qualitative exploration. Appetite 2005, 45:334-343.
• [36]Schmidt M, Absalah S, Nierkens V, Stronks K: Which factors engage women in deprived neighbourhoods to participate in exercise referral schemes? BMC Public Health 2008, 8:371. BioMed Central Full Text
• [37]Withall J, Jago R, Fox KR: Why some do but most don’t. Barriers and enablers to engaging low-income groups in physical activity programmes: a mixed methods study. BMC Public Health 2011, 11:507. BioMed Central Full Text
• [38]Siu J, Giskes K, Turrell G: Socio-economic differences in weight-control behaviours and barriers to weight control. Public Health Nutr 2011, 14:1768-1778.
• [39]Wardle J, Steptoe A: Socioeconomic differences in attitudes and beliefs about healthy lifestyles. J Epidemiol Community Health 2003, 57:440-443.
• [40]Damiani G, Federico B, Bianchi CBNA, Ronconi A, Basso D, Fiorenza S, Sassi F: Socio-economic status and prevention of cardiovascular disease in Italy: evidence from a national health survey. Eur J Public Health 2011, 21:591-596.
• [41]Sambamoorthi U, McAlpine DD: Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Prev Med 2003, 37:475-484.
• [42]McCaffery K, Wardle J, Nadel M, Atkin W: Socioeconomic variation in participation in colorectal cancer screening. J Med Screen 2002, 9:104-108.
• [43]Orton E, Forbes-Haley A, Tunbridge L, Cohen S: Equity of uptake of a diabetic retinopathy screening programme in a geographically and socio-economically diverse population. Public Health 2013, 127:814-821.
• [44]van der Waerden JEB, Hoefnagels C, Jansen MWJ, Hosman CMH: Exploring recruitment, willingness to participate, and retention of low-SES women in stress and depression prevention. BMC Public Health 2010, 10:588. BioMed Central Full Text
• [45]Ball K, Crawford D, Mishra G: Socio-economic inequalities in women’s fruit and vegetable intakes: a multilevel study of individual, social and environmental mediators. Public Health Nutr 2006, 9:623-630.
• [46]Wiig Dammann K, Smith C: Factors affecting low-income women’s food choices and the perceived impact of dietary intake and socioeconomic status on their health and weight. J Nutr Educ Behav 2009, 41:242-253.
• [47]Cleland V, Ball K: What might work? Exploring the perceived feasibility of strategies to promote physical activity among women living in socioeconomically disadvantaged neighbourhoods. Health Educ Res 2013, 28:205-219.