Exploration of perceptions of health of low SES citizens in the Netherlands

Abstract

Abstract Background Health promotion programs (HPPs) have not yet succeeded in substantially reducing the health gap between higher and lower socioeconomic groups. It is thus a challenge to develop more effective strategies, based on an ecological perspective. To develop such strategies and activate citizens, this study explores citizens’ perceptions of health and what they need to improve it. Methods Setting Community HPP Voorstad on the Move (VoM) (July 2016-Jan 2020) in a district (+-11,000 inhabitants) in Deventer. Inhabitants’ socioeconomic status (SES), perceived health status and lifestyle are low relative to other city districts. Study design: A qualitative study of 11 community groups (n = 89) participating in two focus groups. Concept mapping was used to cluster and prioritize health perceptions. Social Practice Theory (SPT) guided the analysis of needs to change health-related behavior. Results “We don’t assume that everyone has the same idea about health, do we?” (citizen) Participants differed in age (16-82), cultural background (17% non-Dutch origin) and type of group activity. High-ranking dimensions of health are social relations, physical activity, a positive life attitude, healthy eating and empowerment. To improve health, social support from family and friends and self-confidence were the main needs. Physical impediments, (chronic) illness and financial aspects were also mentioned as barriers. The focus groups contributed to new activities as part of the VoM program facilitated by a health broker: e.g. a swimming group, biking buddies, social meetings. Conclusions Citizens perceive health as multidimensional, encompassing the physical and social environment, lifestyle behaviors, positive attitudes and being in control. Using SPT to unravel these needs in terms of meanings and competences helped to facilitate citizens’ active involvement in health-promoting activities. Key messages Low SES citizens perceive social relations, physical activity and a positive life attitude as important dimensions of health. Insight into citizens’ meanings and competences about health behaviors facilitates the development of health-promoting activities.