Abstract P530: Health Beliefs Shaped by Experiences of Socioeconomic Deprivation and Psychosocial Distress is Critical to Maintaining Lifestyle Choices for Reducing Stroke Risk: A Mixed Methods Analysis
Authors: Shwetha A George, Rita V Krishnamurthi, Suzanne Barker-Collo, Valery L Feigin
Journal: Circulation (2020)

Introduction: 9 out of 10 stroke events are attributable to modifiable (including lifestyle) risk factors. Therefore, long-term preventative health behaviour changes (PHBCs) is critical for reducing stroke incidence. However, current, New Zealand (NZ) education-based behavioral interventions report a high participant non-response rate or relapse into risk-behaviours within 6 months. In this regard, this study is the first to explore influences of psychosocial distress, socioeconomic deprivation and health beliefs influences on motivation for initiating/maintaining PHBC in the NZ population. Methods: (1) Qualitative interviews were conducted with 40 NZ participants recruited from the Reducing the International Burden of Stroke Using Mobile Technology E-health research program. Participants' perceived stroke susceptibility, barriers to/benefits of PHBCs and managing psychosocial distress were explored. Recorded and transcribed interviews were then thematically analysed. (2) Quantitative: 200 participants completed questionnaires on dietary habits and food choice motivations. Hierarchical regression modelling was performed to evaluate influences of socioeconomic deprivation on food choices. Results: (1) Participants acknowledged the beneficial effects of PHBCs in reducing stroke risk. Notwithstanding, performing PHBC during chronic stress/anxiety was challenging due to the instant, short-term relief gained through risk behaviours. Interactions with peers who actively engaged in risk behaviours and inadequate support systems limited self-efficacy in sustaining PHBCs. Mitigating future health risks and being a positive role model were some of the perceived benefits of maintaining PHBCs. (2) The degree of individual deprivation significantly predicted consumption of risk reducing foods (e.g., fruits) (F(4,168)=11.24, R 2 =0.20, p&lt;0.000). After adjusting for demographic variables, individual and community deprivation was found to significantly predict food choice motivations based on familiarity (F(4,168)=2.97, R 2 =0.07, p&lt;0.05; F(5,164)=2.27, R 2 =0.07, p&lt;0.05), price (F(4,168)=13.36, R 2 =0.24, p&lt;0.001; F(5,164)=10.29, R 2 =0.24, p&lt;0.001), natural content (F(4,168)=4.28, R 2 =0.10, p&lt;0.01; F(5,164)=3.97, R 2 =0.11, p&lt;0.01), ethical acceptability (F(4,168)=2.80, R 2 =0.06, p&lt;0.05; F(5,164)=2.66, R 2 =0.08, p&lt;0.05) and convenience (F(4,168)=3.92, R 2 =0.09, p&lt;0.01; F(5,164)=3.09, R 2 =0.09, p&lt;0.05). Nutritional knowledge was also significantly predicted by individual (F(4,168)=4.08, R 2 =0.09, p&lt;0.01) and community (F(5,164)=3.25, R 2 =0.09, p&lt;0.01) deprivation. Conclusions: Motivation for sustaining PHBCs can be impeded by socioeconomic deprivation and psychosocial distress. Long-term PHBC maintenance may then be optimised by client-centred strategies as opposed to conventional, education-based prevention paradigms.