Chapter 1 10 1.1 Background Imagine a world in which you live nearly 30 years less in good health because of the socioeconomic circumstances in which you live. While this sounds like a dystopian scenario, it actually is a harsh reality. Currently, in the Netherlands, there is an average 7-year difference in lifespan between individuals with the highest and lowest levels of education (RIVM, 2017). This gap widens to 27 years when considering a person’s health span, which refers to the years of good health they can enjoy (RIVM, 2017). People with lower levels of education tend to develop non-communicable chronic diseases (NCDs, e.g., cardiovascular disease, diabetes, and obesity) at an earlier age compared to their more highly educated counterparts (Mackenbach et al., 2008; Mackenbach et al., 2019; Stringhini et al., 2017). Similar disparities are observed across varying income (Jarvandi et al., 2012; Kaplan et al., 1996) and occupation levels (Ravesteijn et al., 2013; Volkers et al., 2007). Together, individuals with lower education, income, and occupational levels are referred to as those with a low socioeconomic position (SEP) (Braveman et al., 2005; Havranek et al., 2015). The ‘health gap’ between socioeconomic classes displays one of the most concerning examples of inequality within our current society. Moreover, the higher prevalence of NCDs among people with a low SEP leads to prolonged healthcare needs, a challenge that extends to both the individual and society (Adler & Stewart, 2010; Drewnowski et al., 2014; Latulipe et al., 2015; Mackenbach et al., 2008; Shishehbor et al., 2006). A major reason for the higher prevalence of NCDs in groups with a low SEP is the greater prevalence of an unhealthy lifestyle compared to groups with a high SEP. Studies have shown that people with a low SEP are more likely to display lower levels of leisuretime physical activity (Beenackers et al., 2012; Gidlow et al., 2016), increased television viewing time (Clark et al., 2010; King et al., 2010), poorer diet (Darmon & Drewnowski, 2008), and more smoking behavior (Hiscock et al., 2012) compared to people with a high SEP. A multitude of interconnected factors, including stress, low literacy, poor living conditions, poor parenting, lack of social support, and low self-efficacy, contribute to this unfavorable health behavior (Marmot, 2005; Pampel et al., 2010). The complexity of these interconnected factors makes it challenging to address the underlying causes of an unhealthy lifestyle. Lifestyle interventions have shown promising outcomes in areas such as physical activity, diet, and quitting smoking in the general population. Interventions focusing on diet and exercise have led to significant changes in body weight and physical activity (Greaves et al., 2011). In addition, behavioral approaches have proven to generally reduce tobacco usage (Stead et al., 2016). The rise of eHealth technologies has further transformed the approach to lifestyle interventions in recent years. Through
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