Skip to main content
SpringerLink
Log in

Socioeconomic Status and Psychosocial Mechanisms of Lifestyle Change in a Type 2 Diabetes Prevention Trial

  • Rapid Communication
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Little is known about psychosocial mechanisms that may underlie differences in lifestyle change between socioeconomic groups.

Purpose

The purpose of this study is to examine how educational level influences middle-aged participants’ (N = 385) psychosocial responses to the GOAL Lifestyle Implementation Trial.

Methods

The measurements of self-efficacy and planning for healthy lifestyle were conducted pre-intervention (T1) and post-intervention (T2, 3 months), and measurements of exercise and healthy eating as outcomes at T1 and at 12 months (T3).

Results

Psychosocial determinants at T1 and their T1–T2 changes were mostly similar, irrespective of educational levels. Exercise barriers self-efficacy was enhanced slightly less (p = 0.08) among the low-SES. T2 levels as well as pre–post-intervention changes in exercise self-efficacy predicted 12-month changes in exercise, and T2 diet coping planning predicted changes in dietary fat intake. The associations were similar across all SES groups.

Conclusions

Enhancing self-efficacy and planning is similarly effective among intervention participants regardless of education level.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Adler NE, Boyce WT, Chesney MA, et al. Socioeconomic status and health: The challenge of the gradient. Am Psychol. 1994; 41: 15-24.

    Article  Google Scholar 

  2. Laaksonen M, Talala K, Martelin T, et al. Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: A follow-up of 60,000 men and women over 23 years. Eur J Public Health. 2007; 18: 38-43.

    Article  PubMed  Google Scholar 

  3. Huisman M, Kunst AE, Bopp M, et al. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet. 2005; 365: 493-500.

    PubMed  Google Scholar 

  4. Meara ER, Richards S, Cutler DM. The gap gets bigger: Changes in mortality and life expectancy, by education, 1981–2000. Health Aff (Millwood). 2008; 27: 350-360.

    Article  Google Scholar 

  5. Cavelaars AE, Kunst AE, Geurts JJ, et al. Differences in self reported morbidity by educational level: A comparison of 11 western European countries. J Epidemiol Community Health. 1998; 52: 219-227.

    Article  CAS  PubMed  Google Scholar 

  6. Acheson D. Independent inquiry into inequalities in health: Report. London: HMSO; 1998.

    Google Scholar 

  7. Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E. Explaining trends in inequities: Evidence from Brazilian child health studies. Lancet. 2000; 356: 1093-1098.

    Article  CAS  PubMed  Google Scholar 

  8. Bandura A. Self-efficacy: The exercise of control. New York: Freeman; 1997.

    Google Scholar 

  9. Sniehotta FF, Schwarzer R, Scholz U, Schüz B. Action planning and coping planning for long-term lifestyle change: Theory and assessment. Eur J Soc Psychol. 2005; 35: 565-576.

    Article  Google Scholar 

  10. Schwarzer R, Schüz B, Ziegelmann JP, Lippke S, Luszczynska A, Scholz U. Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity. Ann Behav Med. 2007; 33: 156-166.

    Article  PubMed  Google Scholar 

  11. Taylor SE, Seeman TE. Psychosocial resources and the SES-health relationship. In: Adler NE, Marmot M, McEwen BS, Stewart J, eds. Socioeconomic status and health in industrial nations: Social, psychological, and biological pathways. New York: New York Academy of Sciences; 1999: 210-225.

    Google Scholar 

  12. Gurin P, Gurin G, Morrison BM. Personal and ideological aspects of internal and external control. Soc Psychol. 1978; 41: 275-296.

    Article  Google Scholar 

  13. Ross CE, Wu C-l. The links between education and health. Am Sociol Rev. 1995; 60: 719-745.

    Article  Google Scholar 

  14. Clark DO, Patrick DL, Grembowski D, Durham ML. Socioeconomic status and exercise self-efficacy in late life. J Behav Med. 1995; 18: 355-376.

    Article  CAS  PubMed  Google Scholar 

  15. Goldman DP, Smith JP. Can patient self-management help explain the SES health gradient? Proc Natl Acad Sci USA. 2002; 99: 10929-10934.

    Article  CAS  PubMed  Google Scholar 

  16. Absetz P, Valve R, Oldenburg B, et al. Type 2 diabetes prevention in the "real world": One-year results of the GOAL Implementation Trial. Diabetes Care. 2007; 30: 2465-2470.

    Article  PubMed  Google Scholar 

  17. Uutela A, Valve R, Talja M, Absetz P, Nissinen A, Fogelholm M. Health psychological theory in promoting population health in Päijät-Häme, Finland: First steps toward a type 2 diabetes prevention study. J Health Psychol. 2004; 9: 73-84.

    Article  PubMed  Google Scholar 

  18. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344: 1343-1350.

    Article  CAS  PubMed  Google Scholar 

  19. Schwarzer R, Fuchs R. Self-efficacy and health behaviours. In: Conner M, Norman P, eds. Predicting health behaviour. Buckingham: Open University Press; 1996: 163-196.

    Google Scholar 

  20. Oettingen G, Honig G, Gollwitzer PM. Effective self-regulation of goal attainment. Int J of Educ Res. 2000; 33: 705-732.

    Article  Google Scholar 

  21. Lindström J, Peltonen M, Eriksson JG, Louheranta A, Fogelholm M, Uusitupa M. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: The Finnish Diabetes Prevention Study. Diabetologia. 2006; 49: 912-920.

    Article  PubMed  Google Scholar 

  22. McArdle JJ. Latent variable modeling of differences and changes with longitudinal data. Annu Rev Psychol. 2009; 60: 577-605.

    Article  PubMed  Google Scholar 

  23. McArdle JJ, Nesselroade JR. Using multivariate data to structure developmental change. In: Cohen SH, Reese HW, eds. Life-span developmental psychology: methodological contributions. Hillsdale, NJ: Erlbaum; 1994: 223-267.

    Google Scholar 

  24. Adams J, White M. Are the stages of change socioeconomically distributed? A scoping review. Am J Health Promot. 2007; 21: 237-247.

    PubMed  Google Scholar 

  25. MacIntyre S, Hunt K. Socio-economic position, gender and health: How do they interact? J Health Psychol. 1997; 2: 315-334.

    Article  Google Scholar 

  26. Fogelholm M, Valve R, Absetz P, et al. Rural–urban differences in health and health behaviour: A baseline description of a community health-promotion programme for the elderly. Scand J Public Health. 2006; 34: 632-640.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland

    Nelli Hankonen M. Soc. Sc., Pilvikki Absetz D.Psych. & Antti Uutela Ph.D.

  2. Department of Social Psychology, University of Helsinki, Helsinki, Finland

    Ari Haukkala Ph.D.

Authors
  1. Nelli Hankonen M. Soc. Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pilvikki Absetz D.Psych.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ari Haukkala Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antti Uutela Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nelli Hankonen M. Soc. Sc..

About this article

Cite this article

Hankonen, N., Absetz, P., Haukkala, A. et al. Socioeconomic Status and Psychosocial Mechanisms of Lifestyle Change in a Type 2 Diabetes Prevention Trial. ann. behav. med. 38, 160–165 (2009). https://doi.org/10.1007/s12160-009-9144-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-009-9144-1

Keywords

Search

Navigation