Abstract
Background
Links between social, economic and environmental factors and health outcomes are well-established. In this study we use cross-sectional survey and longitudinal interview data to explore how WDH shape experiences of health and reciprocally how health affects these domains.
Methods
We conducted multivariate regression analyses of quantitative survey responses from a representative sample of London borough residents (n = 1,039) to examine the association between perceptions of health, levels of satisfaction with WDH domains, and demographic variables. We then conducted thematic analyses in Nvivo of biannual interviews with 28 purposively selected respondents reporting low, medium and high wellbeing, some with chronic and serious health conditions and others without.
Results
Satisfaction with health is positively associated with survey respondents’ home ownership, higher income, and being younger. Being limited by a disability or long-term health condition was the strongest predictor of low satisfaction with health. However, the perceived importance of health to overall life satisfaction was not significantly associated with self-reported health status, income, age or other demographic variables. Respondents discussed how WDH influenced their agency, where the absence of factors (work, income) and the presence of others (relationships, an accessible environment) affected their capacity to manage their health and wellbeing. They gave examples of interactive and knock-on effects: mobility affecting their sense of safety and active travel decisions, which then influenced health. The positive influence of WDH were more difficult for respondents to articulate - descriptions of causal pathways focused on negative health outcomes.
Conclusions
WDH domains affect experiences of health and capacity to manage health. Future research should consider how specific WDH interventions influence these multi-directional relationships, including sense of agency and behaviours.
Key messages
• Survey and longitudinal interview data suggests that wider determinants of health affect capacity to manage health; respondents primarily focus on negative experiences of wider determinants.
• Interactions between wider determinants of health impact respondents’ perceived agency to manage health, future research should consider how interventions can enhance agency and modify behaviours.