Understanding social class differences in health: A qualitative analysis of smokers' health beliefs

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Abstract
Socio-economic differentials in health are widely documented, but little research has examined the experience and understanding of health using a qualitative approach and contrasting social location. This study examined perceptions of health and smoking in fifteen higher SES and fifteen lower SES smokers. The study focused on smoking because it is widely recognised as a health-damaging behaviour. A semi-structured open-ended interview explored perceptions and understandings of health and smoking and the relation between them. Interviews were transcribed and analysed for regularities and themes, and several specific thematic differences emerged: the meaning of health; personal control over health; reasons for smoking; the health consequences of smoking; and personal susceptibility to these consequences. There were clear differences between the groups on most themes, which led to the identification of three general processes which appear to underlie why lower SES people are more likely to engage in negative health behaviours, and specifically in smoking. These were: more limited expectations of health; perceived lower effectiveness of health-promoting behaviours; and greater situational pressures to engage in negative health behaviours. Situational context and material circumstance appear to play an important role in the development of social class differences in health orientation. Implications of the findings are discussed and considered with respect to their application in health promotion.