Social inequality, health behaviour determinants and health behaviour: A Systematic Review

Abstract

Objective: Health inequalities are partly due to inequalities in health behaviours. However, little is known about psychosocial mechanisms underlying health behaviour inequalities. Health behaviour determinants, e.g., those outlined in the Theoretical Domains Framework (TDF) may help understanding health behaviour inequalities. Previously two effect pathways have been theorized: behavioural determinants as mediators of the relationship between inequalities and health behaviour and inequalities as moderators of the relationship between behavioural determinants and health behaviour. This systematic review will summarise the existing literature on both pathways.Design: Relevant databases will be searched systematically for observational quantitative studies examining the indirect or moderating effects of inequality in the relationship between health behaviour determinants and health behaviour. Health behaviour determinants will be categorized according to the TDF, inequality indicators will be operationalized according to the PROGRESS-Plus framework. We will extract estimates of indirect effects and estimates of interaction effects. Quantitative meta-analysis will be conducted if study numbers allow.Discussion: This systematic review will summarise the current of evidence on indirect or moderating effects of social inequality in the relationship between determinants of health behaviour and health behaviour. The results of this review have substantial relevance for theory development, theory refinement and development of equity-focused interventions.Keywords: Social Inequality, Health Behaviour, Determinants of Health Behaviour, Theoretical Domains Framework, Mediation, Moderation

Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy

“…Such resources are unequally distributed between different population groups, favoring predominantly those at the upper end of the socio-economic spectrum [17][18][19]. In this regard, it has also been found that the links between psychosocial determinants of health behavior, such as attitudes and intentions, and health behavior are more pronounced and have stronger effects on behavior among high-than among low-SEP individuals [20,21]. Thus, interventions based on these psychosocial determinants may unintentionally increase inequalities by benefiting high-SEP individuals disproportionally more.…”

Equity-Specific Effects of Interventions to Promote Physical Activity among Middle-Aged and Older Adults: Development of a Collaborative Equity-Specific Re-Analysis Strategy

“…As these resources tend to be socioeconomically patterned, whereby high-SEP individuals have relatively greater resources than those with a low SEP, interventions are likely to be more beneficial for high-SEP individuals [15,17,18]. Another explanation being discussed is that some of the psychosocial determinants of behavior operate differentially according to SEP [19,20]. Moreover, discrepancies between the perceptions of low-SEP individuals and health promoters regarding health behavior, behavior change, and support for behavior change may also result in interventions being less effective among low-SEP population groups [21].…”