Socioeconomic status and health behaviour self-regulation: moderating effects in social-cognitive theories

Abstract

Background: Health inequalities are to a large degree due to socioeconomic differences in health-related behaviours. However, the mechanisms by which socioeconomic status (SES) affects health behaviour are a topic of ongoing debate. Previous research is inconsistent as to whether SES moderates effects of social cognitions on health behaviours and has been limited by inconsistent operationalizations of SES, single health behaviours, and demographically narrow samples. This paper presents two studies addressing these shortcomings in a multi-behaviour framework. Methods: In two paid online studies using Amazon mTurk (Study 1, US participants) and Prolific Academic (Study 2, mainly UK participants), 1,005 (Study 1) and 1,273 (Study 2) participants each provided multiple indicators of SES (education, income, occupation status, ZIP code) and cross-sectional (Study 1) or 4-week longitudinal (Study 2) data on TPB predictors and health behaviours. Hierarchical random-effects models with cross-level interactions were used to examine moderating effects of SES on TPB-behaviour relations. Findings: Education significantly moderated intention-behaviour and attitude-behaviour effects in both studies, with better educated individuals indicating stronger positive effects. In addition, an area-based measurement of SES (Study 1) moderated attitude-behaviour effects such that these relationships were closer in participants who lived in areas with higher SES. Discussion: Education appears to be an important resource for the translation of intentions into behaviour, while other SES indicators showed less consistent effects. This has implications in particular for interventions aiming at increasing intentions to change health behaviours, as these might in fact increase health inequalities.