Jinks et al. BMC Public Health 2010, 10:148 http://www.biomedcentral.com/1471-2458/10/148 R E S E A R C H A R T I C L E Open Access “Well, it’s nobody’s responsibility but my own.” A qualitative study to explore views about the determinants of health and prevention of knee pain in older adults Clare Jinks1*†, Bie Nio Ong1†, Tracey O’Neill2† Abstract Background: Dahlgren and Whitehead’s ‘rainbow’ outlines key determinants of health and has been widely adopted within public health policy and research. Public understanding regarding the determinants of health is, however, relatively unknown, particularly in relation to common chronic joint problems like knee pain. We aimed to explore individual attitudes to the prevention of knee pain, and assess how people make sense of their lives by using the rainbow model to explore social determinants of health. Methods: Twenty-eight semi-structured interviews were undertaken with older adults living in the community. The format of the interview enabled individuals to first tell their story, then the rainbow picture was used to further prompt discussion. Interviews were digitally recorded and transcripts were fully transcribed. Qualitative computer software package NVivo 2 was used to manage the data. Thematic analysis was undertaken. Results: Individual responsibility for health was a dominant theme although the role of health and statutory services was also recognised. Barriers to uptake of prevention activities included cultural perceptions, attitudes towards work and perceived costs of prevention activities. Participants used the rainbow for locating their personal life within a wider social, economic and policy context. Conclusions: People view individual responsibility as key to maintaining health and draw upon the past, present and future expectations when considering social determinants of their health. The rainbow picture does have relevance at the individual level and can help to formulate more dynamic and contextualised approaches to the prevention of health conditions in community living adults. Background The thrust of English health policy on prevention remains dominated by a focus on major diseases, as reflected in the formulation and implementation of National Service Frameworks, and on changing indivi- dual behaviour and lifestyle. The latter is exemplified by the promotion of self-management programmes, initia- tives such as Health Trainers and Health Literacy and the over-arching emphasis on choice (e.g. ‘Choosing Health’) [1]. The more recent government paper * Correspondence: c.jinks@cphc.keele.ac.uk † Contributed equally 1Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele ST5 5BG, UK “Healthy Weight, Healthy lives: A Cross-Government Strategy for England” [2] outlines a more comprehensive approach, bringing together socio-economic and psycho- logical factors with public services. Yet, the focal point remains the individual and his/her lifestyle which gives rise to some fundamental questions as to how people themselves perceive health and illness, and whether attempts to change lifestyles find resonance with how they actually live their lives. The perspective presented by public health research as to how individual health is shaped starts from a different premise. Over the last two decades a number of models have been formulated that aim to explain the complex and multidimensional pathways to health, and © 2010 Jinks et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.