McHugh Neil, Baker Rachel, Donaldson Cam, Bala Ahalya, Mojarrieta Marta, White Gregory, Biosca Olga
Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, Scotland, UK.
National Centre for Epidemiology & Population Health (NCEPH), Australian National University, Canberra, Australia.
Health Expect. 2024 Dec;27(6):e70128. doi: 10.1111/hex.70128.
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.
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'.
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.
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.
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.
与公众互动能够影响政策决策，尤其是推动更为激进的政策变革。虽然已有研究探讨公众对健康不平等成因的看法，但关于如何解决英国的健康不平等问题的研究却少得多。尽管强调“生活经验”，但目前尚无研究聚焦于健康状况极差的个体如何看待健康不平等的成因及解决方案。
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成因及解决方案的共同观点。来自伦敦的低收入且健康状况不佳的社区参与者（n = 20）和专业利益相关者（n = 20）根据自己的观点，将34条“成因”陈述和39条“解决方案”陈述排列在近似正态分布的网格上。因子分析确定了“成因”和“解决方案”的因子。
分析得出了“成因”和“解决方案”的三因子解决方案。“成因”包括：（i）“系统性不平等与贫困”，（ii）“被忽视和边缘化的社区”，（iii）“不稳定、长期压力和绝望”。“解决方案”包括：（i）“满足基本需求并提供茁壮成长的机会”，（ii）“赋予个人控制权”，（iii）“支持健康选择”。没有专业利益相关者认同“被忽视和边缘化的社区”这一因子，而至少有一名社区参与者或专业利益相关者认同所有其他因子。
研究结果支持这样一种观点，即公众对健康不平等的成因有较为复杂的理解，并有助于挑战政策制定者所持的假设，即普通公众没有认识到并理解应对健康不平等的更宏观的方式。
公众参与了Q研究的设计。对社区参与者的调查和访谈为陈述集的制定提供了信息，陈述集也在社区参与者中进行了试点，并根据反馈进行了最终确定。
