Applying “Acting Within Contexts” to intervention evaluation and equitable intervention design

Abstract

Abstract With the rise of chronic illness in the last century, notably diabetes, cardiovascular disease, and obesity, public health has worked to identify the causes of these diseases in order to develop effective interventions and improve population health. Research has shown that these chronic diseases are strongly linked to lifestyle-related risk factors such as smoking, poor eating habits, and physical inactivity. Based on this knowledge, public health interventions have focused on health information and education programs that target these lifestyle-related risk factors. However, these programs have been found to be ineffective because these lifestyle-related strategies do not take into account the contexts that influence behaviour change. This has been found to be particularly true for vulnerable populations who tend to live in contexts of poverty. We therefore asked: how do contexts of vulnerability influence the way people act in their daily lives? To address this question, findings from a qualitative project led to the development of the “Acting Within Contexts” framework. It is a system of five interrelated components (i.e. agency, resources, capacities, threats, and opportunities), which offers an analytical lens to better understand the influence of vulnerable contexts on how people carry out their daily actions. This presentation will first propose an explanation of the limits of public health interventions that aim to change behaviours. Secondly, based on the two previous presentations, it will present how “Acting Within Contexts” can be used: 1) to develop a better understanding of contexts in which vulnerable populations live, based on how the five components interact in people's lives to either hinder or facilitate their access to health; and 2) to design interventions that will shift the focus away from lifestyle-related risk factors, and rather, towards targeting the five components that make up people's everyday contexts.