Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele ST5 5BG, UK.
BMC Public Health. 2010 Mar 22;10:148. doi: 10.1186/1471-2458-10-148.
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.
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.
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.
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.
Dahlgren 和 Whitehead 的“彩虹”概述了健康的关键决定因素，并已广泛应用于公共卫生政策和研究中。然而，公众对健康决定因素的理解相对未知，特别是在常见的慢性关节问题如膝关节疼痛方面。我们旨在探讨个体对预防膝关节疼痛的态度，并通过使用彩虹模型来探讨社会健康决定因素，评估人们如何理解自己的生活。
对社区中居住的老年人进行了 28 次半结构化访谈。访谈的形式使个人能够首先讲述自己的故事，然后使用彩虹图进一步促进讨论。访谈进行了数字录音，并对转录进行了完整的转录。使用定性计算机软件包 NVivo 2 来管理数据。进行了主题分析。
个人对健康的责任是一个主导主题，尽管健康和法定服务的作用也得到了承认。预防活动的障碍包括文化观念、对工作的态度和预防活动的感知成本。参与者使用彩虹图将个人生活定位在更广泛的社会、经济和政策背景中。
人们认为个人责任是维护健康的关键，并在考虑健康的社会决定因素时，参考过去、现在和未来的期望。彩虹图在个人层面上确实具有相关性，并有助于制定更具动态性和针对性的方法，以预防社区居住成年人的健康状况。
