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Do conceptualisations of health differ across social strata? A concept mapping study among lay people
  1. Karien Stronks1,
  2. Nancy Hoeymans2,
  3. Beatrijs Haverkamp3,
  4. Frank R J den Hertog4,
  5. Marja J H van Bon-Martens5,
  6. Henrike Galenkamp1,
  7. Marcel Verweij3,
  8. Hans A M van Oers4,6
  1. 1 Department of Public Health, Amsterdam Public Health (APH) Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Department of Public Health, City of Utrecht, Utrecht, The Netherlands
  3. 3 Department of Social Sciences, section Communication, Philosophy and Technology, Wageningen University, Wageningen, The Netherlands
  4. 4 National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  5. 5 Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
  6. 6 Tilburg University, Tilburg School of Social and Behavioral Sciences, Amsterdam, The Netherlands
  1. Correspondence to Dr Karien Stronks; k.stronks{at}amc.uva.nl

Abstract

Objectives The legitimacy of policies that aim at tackling socioeconomic inequalities in health can be challenged if they do not reflect the conceptualisations of health that are valued in all strata. Therefore, this study analyses how different socioeconomic groups formulate their own answers regarding: what does health mean to you?

Design Concept mapping procedures were performed in three groups that differ in educational level. All procedures followed exactly the same design.

Setting Area of the city of Utrecht, the Netherlands.

Participants Lay persons with a lower, intermediate and higher educational level (±15/group).

Results The concept maps for the three groups consisted of nine, eight and seven clusters each, respectively. Four clusters occurred in all groups: absence of disease/disabilities, health-related behaviours, social life, attitude towards life. The content of some of these differed between groups, for example, behaviours were interpreted as having opportunities to behave healthily in the lower education group, and in terms of their impact on health in the higher education group. Other clusters appeared to be specific for particular groups, such as autonomy (intermediate/higher education group). Finally, ranking ranged from a higher ranking of the positively formulated aspects in the higher education group (eg, lust for life) to that of the negatively formulated aspects in the lower education group (eg, having no chronic disease).

Conclusion Our results provide indications to suggest that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to (1) the absence of health threats (vs positive aspects), (2) a person within his/her circumstances (vs quality of own body/mind), (3) the value of functional (vs hedonistic) notions and (4) an accepting (vs active) attitude towards life.

  • inequalities in health
  • concept mapping
  • conceptualisations of health

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors KS developed the idea, participated in the design of the study, the data collection and the interpretation of the concept maps and drafted the manuscript. NH participated in the design of the study, in the data collection and in the interpretation of the concept maps and drafted the manuscript. FRJdH led the design of the data collection and data analyses and interpretation of the concept maps, and contributed to the revision of the draft manuscript. MV developed the idea, participated in the design of the study and in the interpretation of the concept maps and contributed to the revision of the draft manuscript. BH, MJHvB-M and HAMvO participated in the design of the study, in the data collection and in the interpretation of the concept maps, and contributed to the revision of the draft manuscript. HG was involved in the interpretation of the concept maps and contributed to the revision of the draft manuscript. All authors have seen and approved the final manuscript.

  • Funding The authors were financially supported by the Netherlands Organization for Scientific Research (NWO), grant number: 319-20-002.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated and analysed are available from the corresponding author on request. Informed consent for data sharing was not obtained, but the presented data are anonymised and risk of identification is very low.

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