Attitudes Toward Health, Healthcare, and eHealth of People With a Low Socioeconomic Status: A Community-Based Participatory Approach

Abstract

Low socioeconomic status (SES) is associated with a higher prevalence of unhealthy lifestyles compared to a high SES. Health interventions that promote a healthy lifestyle, like eHealth solutions, face limited adoption in low SES groups. To improve the adoption of eHealth interventions, their alignment with the target group's attitudes is crucial. This study investigated the attitudes of people with a low SES toward health, healthcare, and eHealth. We adopted a mixed-method community-based participatory research approach with 23 members of a community center in a low SES neighborhood in the city of Rotterdam, the Netherlands. We conducted a first set of interviews and analyzed these using a grounded theory approach resulting in a group of themes. These basic themes' representative value was validated and refined by an online questionnaire involving a different sample of 43 participants from multiple community centers in the same neighborhood. We executed three focus groups to validate and contextualize the results. We identified two general attitudes based on nine profiles toward health, healthcare, and eHealth. The first general attitude, optimistically engaged, embodied approximately half our sample and involved light-heartedness toward health, loyalty toward healthcare, and eagerness to adopt eHealth. The second general attitude, doubtfully disadvantaged, represented roughly a quarter of our sample and was related to feeling encumbered toward health, feeling disadvantaged within healthcare, and hesitance toward eHealth adoption. The resulting attitudes strengthen the knowledge of the motivation and behavior of people with low SES regarding their health. Our results indicate that negative health attitudes are not as evident as often claimed. Nevertheless, intervention developers should still be mindful of differentiating life situations, motivations, healthcare needs, and eHealth expectations. Based on our findings, we recommend eHealth should fit into the person's daily life, ensure personal communication, be perceived usable and useful, adapt its communication to literacy level and life situation, allow for meaningful self-monitoring and embody self-efficacy enhancing strategies.

The Barriers and Facilitators of eHealth-Based Lifestyle Intervention Programs for People With a Low Socioeconomic Status: Scoping Review

“…Another promising strategy is collaboration with the social network of people with a low SES (eg, caregivers, relatives, and experts) [ 44 ]. Recent studies identified the importance of using a personal approach and connecting via existing networks (ie, community centers or ambassadors) to successfully recruit low SES populations for lifestyle interventions [ 20 , 93 ]. Furthermore, we found that social media may achieve this goal since it has a broad reach, but the lack of robust evidence makes it difficult to draw firm conclusions.…”

“…However, current eHealth interventions require users to have good digital skills and a high literacy level, which are often lacking in low SES groups. Moreover, such interventions must consider their different life situations, health care needs, and eHealth expectations [ 20 ]. When eHealth interventions do not consider the needs of this target group, intervention uptake can hinder and reinforce the inequitable use of eHealth, exacerbating health inequalities [ 21 , 22 ].…”

Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study

“…An overall high level of digital proficiency removes the potential barriers that could prevent lower socioeconomic segments from engaging with health programs delivered through mobile apps. In addition, among communities with the lowest socioeconomic conditions in the Netherlands, there is a positive attitude toward web-based lifestyle programs [ 47 ]; this, combined with the high digital skills, potentially facilitates the adoption of the mobile app of the health program.…”

A Digital Cancer Ecosystem to Deliver Health and Psychosocial Education as Preventive Intervention

“…It is recommended to offer instruction and support services, especially for middle-aged and older patients to boost patient engagement [ 28 ]. But the eHealth behavior is not only influenced by SES variables, as points out the study of Faber et al [ 29 ], which details the importance of eHealth interventions being aligned with the person’s attitude. Such research, which investigates the eHealth attitudes of people living in a neighborhood with low SES, identify two general attitudes.…”