Is the intention–behaviour gap greater amongst the more deprived? A meta‐analysis of five studies on physical activity, diet, and medication adherence in smoking cessation

Abstract

ObjectivesUnhealthy behaviour is more common amongst the deprived, thereby contributing to health inequalities. The evidence that the gap between intention and behaviour is greater amongst the more deprived is limited and inconsistent. We tested this hypothesis using objective and self‐report measures of three behaviours, both individual‐ and area‐level indices of socio‐economic status, and pooling data from five studies.DesignSecondary data analysis.MethodsMultiple linear regressions and meta‐analyses of data on physical activity, diet, and medication adherence in smoking cessation from 2,511 participants.ResultsAcross five studies, we found no evidence for an interaction between deprivation and intention in predicting objective or self‐report measures of behaviour. Using objectively measured behaviour and area‐level deprivation, meta‐analyses suggested that the gap between self‐efficacy and behaviour was greater amongst the more deprived (B = .17 [95% CI = 0.02, 0.31]).ConclusionsWe find no compelling evidence to support the hypothesis that the intention–behaviour gap is greater amongst the more deprived. Statement of contribution What is already known on this subject? Unhealthy behaviour is more common in those who are more deprived.This may reflect a larger gap between intentions and behaviour amongst the more deprived.The limited evidence to date testing this hypothesis is mixed. What does this study add? In the most robust study to date, combining results from five trials, we found no evidence for this explanation.The gap between intentions and behaviour did not vary with deprivation for the following: diet, physical activity, or medication adherence in smoking cessation.We did, however, find a larger gap between perceived control over behaviour (self‐efficacy) and behaviour in those more deprived.These findings add to existing evidence to suggest that higher rates of unhealthier behaviour in more deprived groups may be reduced by the following: Strengthening behavioural control mechanisms (such as executive function and non‐conscious processes) or Behaviour change interventions that bypass behavioural control mechanisms.

Socio‐economic status and theories of health behaviour: Time to upgrade a control variable

“…() reporting closer relationships between intention and behaviour in people living in more affluent areas, whereas Vasiljevic et al . () found no such moderation effects. However, it can be argued that neither study has adopted a real multilevel perspective, as both have matched environment‐level data to individual data – with the potential of committing an ecological fallacy (Robinson, ).…”

“…() found education to moderate the effects of intention on physical activity and showed that this effect is in turn mediated by intention stability, suggesting that individuals with better education are better at forming stable and more robust intentions. On the other hand, a large study examining and meta‐analysing multiple health behaviours (Vasiljevic, Ng, Griffin, Sutton, & Marteau, ) found no moderating effects of education on the intention–behaviour relation or the relation between self‐efficacy and behaviour.…”

Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A Systematic Review and Meta‐Analysis Based on the Theory of Planned Behaviour

“…For example, Vasiljevic et al. () only found a significant moderation of the association between health cognitions and behaviour when area‐level SES measures were used but not individual‐level measures. This suggests that SES may have different effects depending on how it is defined and measured (Schüz, ).…”

“…() demonstrate a moderating effect of SES on the relationship between health cognitions and various health behaviours. Conversely, Vasiljevic, Ng, Griffin, Sutton, and Marteau () found no moderating effects of SES indicators on the relationship between intentions and behaviour. This study is notable, however, in that, contrary to a large body of literature, no significant main effects of intentions on behaviour are found.…”

Classism and dehumanization in chronic pain: A qualitative study of nurses’ inferences about women of different socio‐economic status

“…Therefore, health psychology still needs a 'stronger consideration of SES' (Schuz, 2017,p.5). SES has already been shown to be associated with health behavioursfor example, physical activity (Vasiljevic, Ng, Griffin, Sutton, & Marteau, 2016) or early help-seeking for breast cancer (Marcu, Black, Vedsted, Lyratzopoulos, & Whitaker, 2016)but its role in the dehumanization of low-SES pain patients by health professionals is still poorly understood (Diniz, Bernardes, & Castro, 2019;Haslam & Stratemeyer, 2016).…”