Vasiljevic Milica, Ng Yin-Lam, Griffin Simon J, Sutton Stephen, Marteau Theresa M
Behaviour and Health Research Unit, University of Cambridge, UK.
Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK.
Br J Health Psychol. 2016 Feb;21(1):11-30. doi: 10.1111/bjhp.12152. Epub 2015 Aug 12.
Unhealthy behaviour is more common amongst the deprived, thereby contributing to health inequalities. The evidence that the gap between intention and behaviour is greater amongst the more deprived is limited and inconsistent. We tested this hypothesis using objective and self-report measures of three behaviours, both individual- and area-level indices of socio-economic status, and pooling data from five studies.
Secondary data analysis.
Multiple linear regressions and meta-analyses of data on physical activity, diet, and medication adherence in smoking cessation from 2,511 participants.
Across five studies, we found no evidence for an interaction between deprivation and intention in predicting objective or self-report measures of behaviour. Using objectively measured behaviour and area-level deprivation, meta-analyses suggested that the gap between self-efficacy and behaviour was greater amongst the more deprived (B = .17 [95% CI = 0.02, 0.31]).
We find no compelling evidence to support the hypothesis that the intention-behaviour gap is greater amongst the more deprived.
What is already known on this subject? Unhealthy behaviour is more common in those who are more deprived. This may reflect a larger gap between intentions and behaviour amongst the more deprived. The limited evidence to date testing this hypothesis is mixed. What does this study add? In the most robust study to date, combining results from five trials, we found no evidence for this explanation. The gap between intentions and behaviour did not vary with deprivation for the following: diet, physical activity, or medication adherence in smoking cessation. We did, however, find a larger gap between perceived control over behaviour (self-efficacy) and behaviour in those more deprived. These findings add to existing evidence to suggest that higher rates of unhealthier behaviour in more deprived groups may be reduced by the following: ◦ Strengthening behavioural control mechanisms (such as executive function and non-conscious processes) or ◦ Behaviour change interventions that bypass behavioural control mechanisms.
不健康行为在贫困人群中更为普遍，从而导致了健康不平等。关于在贫困程度较高的人群中，意图与行为之间的差距更大这一证据有限且不一致。我们使用三种行为的客观和自我报告测量方法、社会经济地位的个体和区域层面指标，并汇总五项研究的数据来检验这一假设。
二次数据分析。
对2511名参与者的身体活动、饮食和戒烟药物依从性数据进行多元线性回归和荟萃分析。
在五项研究中，我们没有发现贫困与意图之间在预测行为的客观或自我报告测量方面存在相互作用的证据。使用客观测量的行为和区域层面的贫困程度，荟萃分析表明，在贫困程度较高的人群中，自我效能感与行为之间的差距更大（B = 0.17 [95% CI = 0.02, 0.31]）。
我们没有找到令人信服的证据来支持贫困程度较高的人群中意图 - 行为差距更大这一假设。
关于这个主题已知的内容是什么？不健康行为在贫困程度较高的人群中更为常见。这可能反映出贫困程度较高的人群中意图与行为之间的差距更大。迄今为止检验这一假设的有限证据好坏参半。这项研究增加了什么？在迄今为止最有力的研究中，结合五项试验的结果，我们没有发现支持这一解释的证据。在以下方面，意图与行为之间的差距并不随贫困程度而变化：饮食、身体活动或戒烟药物依从性。然而，我们确实发现，在贫困程度较高的人群中，对行为的感知控制（自我效能感）与行为之间的差距更大。这些发现补充了现有证据，表明可以通过以下方式降低贫困程度较高群体中更不健康行为的发生率：加强行为控制机制（如执行功能和非意识过程）或绕过行为控制机制的行为改变干预措施。
