Understanding which factors are drivers of Lifestyle Behaviours in Disadvantaged Groups and Communities

Background:

England’s public health policy focuses on reducing inequalities and improving health, by tackling the structural inequalities that contribute to poor health for disadvantaged groups. The most deprived areas of England have the lowest healthy life expectancy and there is a twenty-year difference between people living in the most and least deprived parts of the country. A quarter of all people aged 16 to 64 have a long-term health condition, with cardiovascular disease (CVD) disproportionally impacting the most deprived communities and acting as a leading driver of health inequalities.

Smoking, physical inactivity, poor diet and excessive alcohol consumption are linked to CVD and other chronic conditions. These risk behaviours are socioeconomically patterned, have multiple interrelated causes and contribute to widening health inequalities.

Aims: 

The overall aim is to produce a timely, policy relevant synthesis of the evidence on the protective and risk factors that influence health behaviours across different disadvantaged groups (e.g. low-income groups, unemployed, care experienced, homeless people). We are particularly interested in the factors that promote the uptake of healthy behaviours as these offer potential intervention points.

Pulling together and synthesising this evidence would allow identification of common factors. It may also be possible to disentangle the drivers for some sub-groups, such as homeless people that present very different realities and unique challenges. This information is critical to understanding which policy options are likely to have the greatest impact in shaping health choices and to identifying factors which might offer promising areas for future intervention. It would also highlight where there are key evidence gaps

Methodology: 

we will build on a recent scoping review carried out for DHSC that identified and mapped evidence from systematic reviews on risk behaviours in disadvantaged groups. The map contains at least sixteen reviews (of mostly qualitative studies) exploring factors that shape the uptake of healthy behaviours. Together with policy stakeholders we will identify the groups of most interest and extract relevant data from the corresponding reviews.

We will undertake a qualitative evidence synthesis (QES) using a framework thematic synthesis approach. Thematic synthesis is well-suited to analysing data from qualitative evidence syntheses that explore people’s perspectives and experiences, acceptability, appropriateness, and factors influencing implementation.

An a priori draft conceptual model reflecting pre-existing assumptions about the broad groupings of factors that may influence lifestyle behaviours in disadvantaged groups will be developed. This model will be introduced at the initial stakeholder meeting to ensure that it is meaningful from both policymaker and service user perspectives, allowing for refinement based on their insights. We will also work with stakeholders to identify a possible policy framework that can be used to link modifiable and actionable factors to policy interventions.

The model and framework will then be further developed and integrated through the qualitative evidence synthesis QES, before reconvening stakeholders to consider which existing policy options are feasible and address the factors identified from the evidence.

We will update the searches to capture more recently published reviews. Sources of grey literature will be searched to capture research reviews from relevant organisations. We will engage with policy stakeholders and those with lived experience to determine the exact scope of the overview and the specific questions of interest. A protocol will be developed and registered on PROSPERO. We will i) determine inclusion/exclusion criteria and use these to select reviews for inclusion; ii) carry out data extraction using pre-specified templates; iii) assess the quality of reviews using the most appropriate quality assessment tools, for example the Assessment of Multiple Systematic Reviews tool (AMSTAR 2; iv) use framework synthesis to pull together the data and summarise narratively as well as graphically using tables and charts; v) structure and write up the reviews in accordance with the relevant PRISMA guidance.