Causes, Solutions and Health Inequalities: Comparing Perspectives of Professional Stakeholders and Community Participants Experiencing Low Income and Poor Health in London

IF 3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES Health Expectations Pub Date : 2024-12-17 DOI:10.1111/hex.70128

Neil McHugh, Rachel Baker, Cam Donaldson, Ahalya Bala, Marta Mojarrieta, Gregory White, Olga Biosca

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Abstract

Background

Engaging with the public can influence policy decisions, particularly towards more radical policy change. While established research exists exploring public perceptions on causes of health inequalities, much less exists on how to tackle health inequalities in the UK. Despite an emphasis on ‘lived experience’, currently no study has focused on how individuals with very poor health conceive of both causes of, and solutions to, health inequalities.

Methods

Q methodology was used to identify and describe the shared perspectives that exist on causes of, and solutions to, health inequalities experienced in low-income communities. Community participants living with low-incomes and poor health (n = 20) and professional stakeholders (n = 20) from London rank ordered 34 ‘Causes’ and 39 ‘Solutions’ statements onto quasi-normal shaped grids according to their point of view. Factor analysis defined factors for both ‘Causes’ and ‘Solutions’.

Results

Analysis produced three-factor solutions for both the ‘Causes’ and ‘Solutions’. ‘Causes’ are (i) ‘Systemic inequality and poverty’, (ii) ‘Ignored and marginalised communities’, (iii) ‘Precariousness, chronic stress and hopelessness’. ‘Solutions’ are (i) ‘Meeting basic needs and providing opportunities to thrive’, (ii) ‘Empowering individuals to take control’, (iii) ‘Supporting healthy choices’. No professional stakeholders aligned with ‘Ignored and marginalised communities’ while at least one community participant or professional stakeholder aligned with all other factors.

Conclusion

Results support the view that the public has a relatively sophisticated understanding of causes of health inequalities and help challenge assumptions held by policy actors that lay members of the public do not recognise and understand more upstream ways to respond to health inequalities.

Patient or Public Contribution

The public contributed to the design of the Q study. Surveys and interviews with community participants informed the development of the statement set and the statement set was also piloted with community participants and finalised based on feedback.

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原因、解决方案和健康不平等：比较专业利益相关者与伦敦低收入和健康状况不佳社区参与者的观点。

背景：与公众接触可以影响政策决定，尤其是对更激进的政策变革产生影响。虽然已有研究探讨了公众对健康不平等原因的看法，但关于如何解决英国健康不平等问题的研究却少得多。尽管研究强调 "生活经验"，但目前还没有研究关注健康状况极差的个人如何看待健康不平等的原因和解决方案：方法：采用 Q 方法来识别和描述低收入社区中存在的关于健康不平等的原因和解决方案的共同观点。来自伦敦的低收入和健康状况不佳的社区参与者（20 人）和专业利益相关者（20 人）根据自己的观点，将 34 个 "原因 "和 39 个 "解决方案 "陈述按准正态网格排序。因子分析确定了 "原因 "和 "解决方案 "的因子：结果：分析得出了 "原因 "和 "解决方案 "的三因素解决方案。原因 "包括 (i) "系统性不平等和贫困"，(ii) "被忽视和边缘化社区"，(iii) "不稳定、长期压力和绝望"。解决方案 "是：(i) "满足基本需求，提供发展机会"，(ii) "增强个人控制能力"，(iii) "支持健康选择"。没有专业利益相关者赞同 "被忽视和边缘化社区"，而至少有一名社区参与者或专业利益相关者赞同所有其他因素：结果支持公众对健康不平等的原因有相对深入的了解这一观点，并有助于挑战政策参与者的假设，即非专业公众不认识和不了解应对健康不平等的更上游的方法：患者或公众的贡献：公众为 Q 研究的设计做出了贡献。对社区参与者进行的调查和访谈为声明集的制定提供了信息，声明集还在社区参与者中进行了试点，并根据反馈意见最终定稿。

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来源期刊

Health Expectations 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

9.40%

发文量

251

审稿时长

>12 weeks

期刊介绍： Health Expectations promotes critical thinking and informed debate about all aspects of patient and public involvement and engagement (PPIE) in health and social care, health policy and health services research including: • Person-centred care and quality improvement • Patients'' participation in decisions about disease prevention and management • Public perceptions of health services • Citizen involvement in health care policy making and priority-setting • Methods for monitoring and evaluating participation • Empowerment and consumerism • Patients'' role in safety and quality • Patient and public role in health services research • Co-production (researchers working with patients and the public) of research, health care and policy Health Expectations is a quarterly, peer-reviewed journal publishing original research, review articles and critical commentaries. It includes papers which clarify concepts, develop theories, and critically analyse and evaluate specific policies and practices. The Journal provides an inter-disciplinary and international forum in which researchers (including PPIE researchers) from a range of backgrounds and expertise can present their work to other researchers, policy-makers, health care professionals, managers, patients and consumer advocates.