Despite many efforts, nutritional health interventions have been largely unable to reduce health inequalities between less‐ and more‐educated individuals, since their effectiveness among the former is often limited. Conventionally, adverse financial circumstances and poorer health literacy are argued to explain this. Drawing on recent sociological insights, we propose a complementing and novel sociocultural explanation based on how contemporary power relations in society breed anti‐institutionalism among less‐educated individuals. Using a survey of a representative sample of the Dutch population (n = 2398), we focus on the strategic case of the lower uptake of nutrition information among less‐educated individuals. We find that two aspects of anti‐institutionalism, i.e. institutional distrust and antipaternalism, substantially account for the educational gap in the uptake of nutrition information. This indicates that current nutrition information inspires opposition among less‐educated individuals. More generally, it suggests that the development of nutritional health interventions should avoid invoking institutional connotations, to increase their acceptance by those who commonly need these most.
Unhealthy diets are a major threat to population health and are especially prevalent among those with a low socioeconomic status (SES). Health promotion initiatives often rely on nutrition information interventions (NIIs), but are usually less effective among adults with a low SES than in their high-SES counterparts. Explanations for this lower effectiveness are set out in extant studies. These have been conducted across a wide range of disciplines and subject fields and using a variety of methodological approaches. We have therefore conducted a scoping review to identify and synthesise the following: (1) explanations suggested in studies carried out in high-income countries for why NIIs are (in)effective among adults with a low SES and (2) whether these suggested explanations were studied empirically. Eight databases were searched for relevant studies published since 2009 across various disciplines. This identified 4951 papers, 27 of which were included in our review after screening. Only fifteen of these proposed an explanation for the (in)effectiveness of NIIs among adults with a low SES. The following four main themes were uncovered: health literacy, economic resources, social resources and convenience. Ten studies tested their explanations empirically, but the results were inconsistent. The reasons why NIIs are (in)effective among low-SES adults are therefore still largely unclear. Also, current literature predominantly relies on individualistic explanations, most notably focusing on psychological and economic attributes. Consequently, if the effectiveness of NIIs among low-SES populations is to be improved, future studies should examine a wider range of explanations and test them systematically and empirically.
Issues
This paper identifies and synthesises explanations proposed in the literature for the (in)effectiveness of institutional anti‐smoking health‐information interventions (HII) among low‐socioeconomic status (SES) adults in high‐income countries.
Approach
We searched eight databases for relevant papers from various disciplines: Studies published in English since 2009, on the effectiveness among low‐SES adults of anti‐smoking HIIs, aimed at changing knowledge/behaviour, and conducted by official institutions, were included. Through a scoping review, we synthesised: study design, SES indicator, intervention type, intervention source, study population, outcomes, low‐SES effects, equity effects, proposed explanations and whether these were studied empirically.
Key Findings
Thirty‐eight studies were included in this scoping review. Seventeen suggested explanations for the (in)effectiveness of the HIIs in low‐SES adults, but only nine assessed them empirically. Thematic analysis yielded six themes: message engagement, material conditions, cognition, risk perception, social environment and self‐efficacy.
Implications
Explanations for intervention results are not always present, and empirical evidence for explanations is often not provided. Including such explanations and testing their empirical merits in future research can provide the crucial information needed for developing more effective anti‐smoking HIIs for low‐SES adults.
Conclusions
To our knowledge, this is the first review to explore the explanations proposed for why anti‐smoking HIIs are (in)effective among low‐SES adults. It contains insights for future studies aiming to provide empirical evidence on the causes of this (in)effectiveness, and concludes that such research is yet largely missing, but crucial to the quest for more effective and equitable anti‐smoking interventions.
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