Exploring Public, Practitioner and Policymaker Perspectives of Unhealthy Lifestyle Factors in the Context of Socioeconomic Deprivation: A Qualitative Study.

Introduction: Unhealthy lifestyle factors, such as smoking, high alcohol intake, poor diet and physical inactivity, are key risk factors for premature mortality. How unhealthy lifestyle factors are viewed in the wider context of socioeconomic deprivation is rarely considered. Understanding key stakeholder views on lifestyle factors in the context of deprivation is critical to intervention development and reducing harm in more deprived populations. The aim of this study was to explore public, healthcare professional and policymaker views around unhealthy lifestyle factors in the context of deprivation. The aim was broad to facilitate iterative development of ideas, as the views of this wide range of stakeholders are rarely captured.

Methods: Twenty-five adult members of the public in Scotland took part in four focus groups between August 2022 and June 2023. Eighteen semi-structured interviews were conducted with professionals: 12 primary-care practitioners and 6 public-health practitioners and policymakers. Reflexive thematic analysis was undertaken.

Results: Four main themes were developed: (1) Evolving complexity of lifestyle factors - the number of lifestyle factors that adversely impact health has grown, with increasingly complex interactions, (2) Social determinants of lifestyle - numerous links were made between socioeconomic conditions and unhealthy lifestyle factors by all participants, (3) Poverty as a fundamental social determinant - poverty was identified as a core factor for unhealthy lifestyle factors, and (4) Agency versus structure in relation to lifestyle - individual agency to address lifestyle factors was limited by structural constraints. Among professionals, understanding the challenging social determinants of unhealthy lifestyle factors was countered by a desire to support healthy change in those affected by deprivation.

Conclusion: Public and professional views around lifestyle highlight an evolving understanding of the new and growing number of lifestyle factors as well as the increasingly complex interplay between lifestyle factors. Views of the social determinants of lifestyle and structural limits to agency strengthen arguments for reduced emphasis on individual-level responsibility for unhealthy lifestyle factors and for deeper integration of social determinants into lifestyle interventions. In addition to addressing poverty and socioeconomic inequalities directly, innovative policy, planning and legislation that incorporate wider approaches could tackle upstream determinants of numerous unhealthy lifestyle factors simultaneously.

Patient Or Public Contribution: Members of the public who participated in this study have made contributions by sharing their views and perspectives. The National Health Service Research Scotland Primary Care Patient and Public Involvement (NRS PPI) Group contributed to the development of this work. The NRS PPI Group was consulted as part of the preparatory work for H. M. E. F.'s doctoral thesis funding application. The findings of the qualitative work were presented to them, and they informed the interpretation of those findings and related work presented at conferences and public engagement events.