Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2025-01-05T16:31:34.411Z Has data issue: false hasContentIssue false

27 - Addressing Underserved Populations and Disparities in Behavior Change

from Part II - Methods and Processes of Behavior Change: Intervention Development, Application, and Translation

Published online by Cambridge University Press:  04 July 2020

By
Benjamin Schüz  and
Monica Webb Hooper
Edited by
Martin S. Hagger ,
Linda D. Cameron ,
Kyra Hamilton ,
Nelli Hankonen  and
Taru Lintunen
Martin S. Hagger
Affiliation:
University of California, Merced
Linda D. Cameron
Affiliation:
University of California, Merced
Kyra Hamilton
Affiliation:
Griffith University
Nelli Hankonen
Affiliation:
University of Helsinki
Taru Lintunen
Affiliation:
University of Jyväskylä
Get access

Summary

Participation in many behaviors is associated with individuals’ social status and differences in access to resources, which affect their opportunities to engage in these behaviors. For example, behaviors in the health and environmental domain differ between individuals and groups of differing socioeconomic status (SES). While associations between social position and behavior are increasingly recognized and explored, relatively little is known of the mechanisms and processes by which these disparities relate to behavior change. This chapter discusses concepts of inequity relevant to behavior change, highlighting the need for consistent and meaningful operationalizations. The chapter outlines the theoretical frameworks of disparities, emphasizes the important role that multilevel perspectives of socio-structural determinants of disparities play in behavior change, and highlights how behavioral theory can help in understanding disparities in behavior change. Using health behavior examples, mechanisms underlying intervention-generated inequities are identified. If the effects of theory-based determinants on behavior differ by SES, interventions based on these determinants are likely to be differentially effective in groups differing by SES, further contributing to health disparities. Future research on behavior change should include a stronger focus on equity across domains, better document the differential effects on behavior change, and clearly specify the role of inequity in theories of behavior change.

Keywords

social disparitiessocial inequityequitypersonal resourcessocioeconomic statussocio-structural determinants of disparitieshealth inequalities
Type
Chapter
Information
The Handbook of Behavior Change , pp. 385 - 400
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211. https://doi.org/10.1016/0749-5978(91)90020-TGoogle Scholar
Allen, L., Williams, J., Townsend, N. et al. (2017). Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: A systematic review. The Lancet Global Health, 5, e277–e289. https://doi.org/10.1016/S2214-109X(17)30058-XCrossRefGoogle ScholarPubMed
Attwood, S., van Sluijs, E., & Sutton, S. (2016). Exploring equity in primary-care-based physical activity interventions using PROGRESS-Plus: A systematic review and evidence synthesis. International Journal of Behavioral Nutrition and Physical Activity, 13, 60. https://doi.org/10.1186/s12966-016-0384-8Google Scholar
Bauer, G. R. (2014). Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science and Medicine, 110, S10–S17. https://doi.org/10.1016/j.socscimed.2014.03.022Google Scholar
Bimbi, D. S., Nanin, J. E., Parsons, J. T., Vicioso, K. J., Missildine, W., & Frost, D. (2006). Assessing gay and bisexual men’s outcome expectancies for sexual risk under the influence of alcohol and drugs. Substance Use and Misuse, 41, 643–665. https://doi.org/10.1080/10826080500411080Google Scholar
Burdette, A. M., Webb, N. S., Hill, T. D., & Jokinen-Gordon, H. (2017). Race-specific trends in HPV vaccinations and provider recommendations: Persistent disparities or social progress? Public Health, 142, 167–176. https://doi.org/10.1016/j.puhe.2016.07.009Google Scholar
Doran, J. M., Pietrzak, R. H., Hoff, R., & Harpaz-Rotem, I. (2017). Psychotherapy utilization and retention in a national sample of veterans With PTSD. Journal of Clinical Psychology, 73, 1259–1279. https://doi.org/10.1002/jclp.22445Google Scholar
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460Google Scholar
Erves, J. C., Mayo-Gamble, T. L., Malin-Fair, A. et al. (2017). Needs, priorities, and recommendations for engaging underrepresented populations in clinical research: A community perspective. Journal of Community Health, 42, 472–480. https://doi.org/10.1007/s10900-016-0279-2CrossRefGoogle ScholarPubMed
Fishbein, M., Triandis, H. C., Kanfer, F. H., Becker, M. H., Middlestadt, S. E., & Eichler, A. (2001). Factors influencing behavior and behavior change. In Baum, A., Revenson, T. A., & Singer, J. E. (Eds.), Handbook of Health Psychology (pp. 3–17). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Ford, J. G., Howerton, M. W., Lai, G. Y. et al. (2008). Barriers to recruiting underrepresented populations to cancer clinical trials: A systematic review. Cancer, 112, 228–242. https://doi.org/10.1002/cncr.23157Google Scholar
Freedman, L. S., Simon, R., Foulkes, M. A. et al. 1995). Inclusion of women and minorities in clinical trials and the NIH Revitalization Act of 1993: The perspective of NIH clinical trialists. Controlled Clinical Trials, 16, 277–285; discussion 286–279, 293–309. https://doi.org/10.1016/0197-2456(95)00048-8CrossRefGoogle ScholarPubMed
Geller, S. E., Koch, A., Pellettieri, B., & Carnes, M. (2011). Inclusion, analysis, and reporting of sex and race/ethnicity in clinical trials: Have we made progress? Journal of Women’s Health, 20, 315–320. https://doi.org/10.1089/jwh.2010.2469Google Scholar
Hankonen, N., Heino, M. T. J., Kujala, E. et al. (2017). What explains the socioeconomic status gap in activity? Educational differences in determinants of physical activity and screentime. BMC Public Health, 17, 1–15. https://doi.org/10.1186/s12889-016-3880-5Google Scholar
Hardeman, W., Sutton, S., Griffin, S. et al. (2005). A causal modelling approach to the development of theory-based behaviour change programmes for trial evaluation. Health Education Research, 20, 676–687. https://doi.org/10.1093/her/cyh022CrossRefGoogle Scholar
Haughton, C. F., Silfee, V. J., Wang, M. L. et al. (2018). Racial/ethnic representation in lifestyle weight loss intervention studies in the United States: A systematic review. Preventive Medicine Reports, 9, 131–137. https://doi.org/10.1016/j.pmedr.2018.01.012Google Scholar
Hooper, M. W., Baker, E. A., & Robinson, R. G. (2014). Efficacy of a DVD-based smoking cessation intervention for African Americans. Nicotine and Tobacco Research, 16, 1327–1335. https://doi.org/10.1093/ntr/ntu079Google Scholar
Hooper, M. W., Larry, R., Okuyemi, K. et al. (2013). Culturally specific versus standard group cognitive behavioral therapy for smoking cessation among African Americans: An RCT protocol. BMC Psychol, 1, 15. https://doi.org/10.1186/2050-7283-1-15CrossRefGoogle ScholarPubMed
Jahnel, T., Ferguson, S. G., Shiffman, S., & Schüz, B. (2019). Daily stress as link between disadvantage and smoking: An ecological momentary assessment study. BMC Public Health, 19, 1284. https://doi.org/10.1186/s12889-019-7631-2CrossRefGoogle ScholarPubMed
Kagawa Singer, M. (2012). Applying the concept of culture to reduce health disparities through health behavior research. Preventive Medicine, 55, 356–361. https://doi.org/10.1016/j.ypmed.2012.02.011CrossRefGoogle ScholarPubMed
Kashubeck-West, S., & Szymanski, D. M. (2008). Risky sexual behavior in gay and bisexual men: Internalized heterosexism, sensation seeking, and substance use. Counseling Psychologist, 36, 595–614. https://doi.org/10.1177/0011000007309633Google Scholar
Kreuter, M. W., Lukwago, S. N., Bucholtz, D. C., Clark, E. M., & Sanders-Thompson, V. (2003). Achieving cultural appropriateness in health promotion programs: Targeted and tailored approaches. Health Education and Behavior, 30, 133–146. https://doi.org/10.1177/1090198102251021CrossRefGoogle ScholarPubMed
Kwiatkowski, K., Coe, K., Bailar, J. C., & Swanson, G. M. (2013). Inclusion of minorities and women in cancer clinical trials, a decade later: Have we improved? Cancer, 119, 2956–2963. https://doi.org/10.1002/cncr.28168Google Scholar
Laidley, T. M. (2011). The influence of social class and cultural variables on environmental behaviors: Municipal-level evidence from Massachusetts. Environment and Behavior, 45, 170–197. https://doi.org/10.1177/0013916511416647Google Scholar
Lehne, G., & Bolte, G. (2017). Impact of universal interventions on social inequalities in physical activity among older adults: An equity-focused systematic review. International Journal of Behavioral Nutrition and Physical Activity, 14, 20. https://doi.org/10.1186/s12966-017-0472-4Google Scholar
Leventhal, H., Diefenbach, M., & Leventhal, E. A. (1992). Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cognitive Therapy and Research, 16, 143–163. https://doi.org/10.1007/bf01173486Google Scholar
Lindbladh, E., Lyttkens, C. H., Hanson, B. S., Östergren, P., Isacsson, S. O., & Lindgren, B. (1996). An economic and sociological interpretation of social differences in health-related behaviour: An encounter as a guide to social epidemiology. Social Science and Medicine, 43, 1817–1827. https://doi.org/10.1016/S0277-9536(96)00087-1Google Scholar
Lorenc, T., Petticrew, M., Welch, V., & Tugwell, P. (2013). What types of interventions generate inequalities? Evidence from systematic reviews. Journal of Epidemiology and Community Health, 67, 190. https://doi.org/10.1136/jech-2012-201257Google Scholar
Manstead, A. S. R. (2018). The psychology of social class: How socioeconomic status impacts thought, feelings, and behaviour. British Journal of Social Psychology, 57, 267–291. https://doi.org/10.1111/bjso.12251Google Scholar
Marmot, M. (2015). The Health Gap: The Challenge of an Unequal World. London: Bloomsbury.Google Scholar
Marshal, M. P., Friedman, M. S., Stall, R. et al. (2008). Sexual orientation and adolescent substance use: A meta-analysis and methodological review. Addiction, 103, 546–556. https://doi.org/10.1111/j.1360-0443.2008.02149.xGoogle Scholar
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education and Behavior, 15, 351–377. https://doi.org/10.1177/109019818801500401Google Scholar
Meader, N., King, K., Moe-Byrne, T. et al. (2016). A systematic review on the clustering and co-occurrence of multiple risk behaviours. BMC Public Health, 16. https://doi.org/10.1186/s12889-016-3373-6Google Scholar
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. https://doi.org/10.1037/0033-2909.129.5.674Google Scholar
Michie, S., Richardson, M., Johnston, M. et al. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46, 81–95. https://doi.org/10.1007/s12160-013-9486-6CrossRefGoogle ScholarPubMed
Mickelson, R. A. (2003). When are racial disparities in education the result of racial discrimination? A social science perspective. Teachers College Record, 105, 1052–1086. https://doi.org/10.1111/1467-9620.00277Google Scholar
Myers, H. F. (2009). Ethnicity- and socio-economic status-related stresses in context: An integrative review and conceptual model. Journal of Behavioral Medicine, 32, 9–19. https://doi.org/10.1007/s10865-008-9181-4CrossRefGoogle ScholarPubMed
O’Neill, J., Tabish, H., Welch, V. et al. (2014). Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology, 67, 56–64. https://doi.org/10.1016/j.jclinepi.2013.08.005CrossRefGoogle ScholarPubMed
Odgers, C. L., Moffitt, T. E., Broadbent, J. M. et al. (2008). Female and male antisocial trajectories: From childhood origins to adult outcomes. Development and Psychopathology, 20, 673–716. https://doi.org/10.1017/S0954579408000333Google Scholar
Otado, J., Kwagyan, J., Edwards, D., Ukaegbu, A., Rockcliffe, F., & Osafo, N. (2015). Culturally competent strategies for recruitment and retention of African American populations into clinical trials. Clinical and Translational Science, 8, 460–466. https://doi.org/10.1111/cts.12285Google Scholar
Ouellette, S. C., & DiPlacido, J. (2001). Personality’s role in the protection and enhancement of health: Where the research has been, where it is stuck, how it might move. In Baum, A., Revenson, T. A., & Singer, J. E. (Eds.), Handbook of Health Psychology (pp. 175–193). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Petrovic, D., de Mestral, C., Bochud, M. et al. (2018). The contribution of health behaviors to socioeconomic inequalities in health: A systematic review. Preventive Medicine, 113, 15–31. https://doi.org/10.1016/j.ypmed.2018.05.003Google Scholar
Piff, P. K., Kraus, M. W., Côté, S., Cheng, B. H., & Keltner, D. (2010). Having less, giving more: The influence of social class on prosocial behavior. Journal of Personality and Social Psychology, 99, 771–784. https://doi.org/10.1037/a0020092CrossRefGoogle ScholarPubMed
Ready, D. D. (2010). Socioeconomic disadvantage, school attendance, and early cognitive development: The differential effects of school exposure. Sociology of Education, 83, 271–286. https://doi.org/10.1177/0038040710383520Google Scholar
Resnicow, K., Baranowski, T., Ahluwalia, J. S., & Braithwaite, R. L. (1999). Cultural sensitivity in public health: Defined and demystified. Ethnicity and Disease, 9, 10–21.Google ScholarPubMed
Rounsaville, B. J., Carroll, K. M., & Onken, L. S. (2001). A stage model of behavioral therapies research: Getting started and moving on from Stage I. Clinical Psychology: Science and Practice, 8, 133–142. https://doi.org/10.1093/clipsy.8.2.133Google Scholar
Schüz, B. (2017). Socio-economic status and theories of health behaviour: Time to upgrade a control variable. British Journal of Health Psychology, 22, 1–7. https://doi.org/10.1111/bjhp.12205Google Scholar
Schüz, B., Brick, C., Wilding, S., & Conner, M. (2019). Socioeconomic status moderates the effects of health cognitions on health behaviors within participants: Two multibehavior studies. Annals of Behavioral Medicine. https://doi.org/10.1093/abm/kaz023Google Scholar
Schüz, B., Li, A. S. W., Hardinge, A., McEachan, R. R. C., & Conner, M. (2017). Socioeconomic status as a moderator between social cognitions and physical activity: Systematic review and meta-analysis based on the Theory of Planned Behavior. Psychology of Sport and Exercise, 30, 186–195. https://doi.org/10.1016/j.psychsport.2017.03.004CrossRefGoogle Scholar
Schüz, B., Wurm, S., Ziegelmann, J. P. et al. (2012). Contextual and individual predictors of physical activity: Interactions between environmental factors and health cognitions. Health Psychology, 31, 714–723. https://doi.org/10.1037/a0027596CrossRefGoogle ScholarPubMed
Shaw, M., Galobardes, B., Lawlor, D. A., Lynch, J., Wheeler, B., & Smith, G. D. (2007). The Handbook of Inequality and Socioeconomic Position. Bristol: Policy Press.Google Scholar
Smith, T. B., Rodríguez, M. D., & Bernal, G. (2011). Culture. Journal of Clinical Psychology, 67, 166–175. https://doi.org/10.1002/jclp.20757Google Scholar
Spoont, M. R., Nelson, D. B., Murdoch, M. et al. (2015). Are there racial/ethnic disparities in VA PTSD treatment retention? Depression and Anxiety, 32, 415–425. https://doi.org/10.1002/da.22295Google Scholar
Trinidad, D. R., Perez-Stable, E. J., White, M. M., Emery, S. L., & Messer, K. (2011). A nationwide analysis of US racial/ethnic disparities in smoking behaviors, smoking cessation, and cessation-related factors. American Journal of Public Health, 101, 699–706. https://doi.org/ 10.2105/Ajph.2010.191668CrossRefGoogle ScholarPubMed
U.S. Department of Health and Human Services. (2008). The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I Report: Recommendations for the Framework and Format of Healthy People 2020. Retrieved from Section IV: Advisory Committee Findings and Recommendations. www.healthypeople.gov/sites/default/files/PhaseI_0.pdfGoogle Scholar
U.S. Department of Health and Human Services. (2010). National Partnership for Action to End Health Disparities: The National Plan for Action. Atlanta, GA: U.S. Department of Health and Human Services. https://minorityhealth.hhs.gov/npa/files/plans/toolkit/npa_toolkit.pdfGoogle Scholar
Webb Hooper, M., Antoni, M. H., Okuyemi, K., Dietz, N. A., & Resnicow, K. (2017). Randomized controlled trial of group-based culturally specific cognitive behavioral therapy among African American smokers. Nicotine and Tobacco Research, 19, 333–341. https://doi.org/10.1093/ntr/ntw181Google Scholar
Webb Hooper, M., Asfar, T., Unrod, M. et al. (2019). Reasons for exclusion from a smoking cessation trial: An analysis by race/ethnicity. Ethnicity and Disease, 29, 23–30. https://doi.org/10.18865/ed.29.1.23CrossRefGoogle ScholarPubMed
Webb Hooper, M., Mitchell, C., Marshall, V. et al. (2019). Understanding multilevel factors related to urban community trust in healthcare and research. Unpublished manuscript, Case Comprehensive Cancer Center, Cleveland, OH.Google Scholar
Webb Hooper, M., Payne, M., & Parkinson, K. A. (2017). Tobacco cessation pharmacotherapy use among racial/ethnic minorities in the United States: Considerations for primary care. Family Medicine and Community Health, 5, 193–203. https://doi.org/10.15212/FMCH.2017.0138Google Scholar
Webb, M. S., Baker, E. A., & de Ybarra, D. R. (2010). Effects of culturally specific cessation messages on theoretical antecedents of behavior among low-income African American smokers. Psychology of Addictive Behaviors, 24, 333–341. https://doi.org/10.1037/A0018700Google Scholar
Webb, M. S., Francis, J., Hines, B. C., & Guarles, F. B. (2007). Health disparities and culturally specific treatment: Perspectives and expectancies of African American smokers. Journal of Clinical Psychology, 63, 1247–1263. https://doi.org/10.1002/Jclp.20437Google Scholar
Wheldon, C. W., Kaufman, A. R., Kasza, K. A., & Moser, R. P. (2018). Tobacco use among adults by sexual orientation: Findings from the Population Assessment of Tobacco and Health Study. LGBT Health, 5, 33–44. https://doi.org/10.1089/lgbt.2017.0175Google Scholar
Williams, D. R., Neighbors, H. W., & Jackson, J. S. (2003). Racial/ethnic discrimination and health: Findings from community studies. American Journal of Public Health, 93, 200–208. https://doi.org/10.2105/ajph.93.2.200Google Scholar
Williams, W. W., Lu, P., O’Halloran, A. et al. (2017). Surveillance of vaccination coverage among adult populations – United States, 2015. Morbidity and Mortality Weekly Report, 66, 1–28. https://doi.org/10.15585/mmwr.ss6611a1Google Scholar
Wilson, S. M., Gilmore, A. K., Rhew, I. C., Hodge, K. A., & Kaysen, D. L. (2016). Minority stress is longitudinally associated with alcohol-related problems among sexual minority women. Addictive Behaviors, 61, 80–83.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×