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.
Highlights
Low socioeconomic status (SES) is associated with a higher prevalence of unhealthy lifestyles compared to a high SES [1]
To develop successful eHealth interventions that support people with a low SES in achieving a healthy lifestyle, it is crucial to consider their attitude toward this technology and their health and healthcare in general
This study explored attitudes of people living in a low SES neighborhood toward their health, healthcare, and eHealth using a community-based participatory research approach
Summary
Low socioeconomic status (SES) is associated with a higher prevalence of unhealthy lifestyles compared to a high SES [1]. EHealth interventions such as monitoring devices, online communication platforms, and serious games have been proven effective in changing behavior and promoting a healthy lifestyle in various domains. People with a low SES are at increased risk of chronic diseases (e.g., cardiovascular disease, diabetes, and obesity) [2,3,4]. These interventions are less successful in changing the behavior of people with a low SES due to low reach, less adherence during the intervention or less effectiveness of the interventions [5,6,7,8,9]. EHealth is designed to expect its intended users to have a positive and pro-active health attitude. Considering the growth of current health inequalities, such interventions would have a bigger impact when they can support groups not sharing these attitudes
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