2 Attitudes toward health, healthcare, and eHealth of people with a low socioeconomic position 39 2.4 Discussion 2.4.1 Principal findings This study aimed to develop design-relevant knowledge about the attitudes of people with a low SEP toward their health, healthcare, and eHealth. Through a CBPR approach consisting of three phases, we identified two general attitudes based on nine distinct profiles. This knowledge could be used to develop a better understanding of existing attitudinal knowledge and to propose design recommendations that facilitate the alignment of health services toward these attitudes. 2.4.2 Relevance and implications Since most of the attitudes toward health, healthcare, and eHealth were positive, we believe that there is a willingness from a large part of the target group to adopt eHealth interventions to improve their lifestyle. Nevertheless, we discovered a diverse range of different attitudes that have different implications for the design of eHealth interventions. The attitudes represented by the profiles can be used to develop design recommendations to improve the alignment of eHealth interventions toward attitudes of low-SEP groups. 2.4.2.1 Optimistically Engaged The profiles (Light-hearted, Loyal, and Eager) represented by this general attitude have similarities and contradictions with existing literature. The Light-hearted profile was represented by high consciousness about health. Contrastingly, other studies found that low-SEP populations have a less conscious attitude toward health and think less about the future (Cutler & Lleras-Muney, 2006; Wardle & Steptoe, 2003). Complex social situations, caring responsibilities (Coupe et al., 2018), and time and energy constraints (Bukman et al., 2014) result in little room to act toward and think about long-term investments such as a healthy lifestyle. These contrasting findings could be explained by the current living situation of our participants. Almost all participants were either retired, unemployed or disabled and therefore were not constrained by their jobs or worried about finances as they receive financial support from the government. In Wardle and Steptoe (2003), all participants were employed, and in (Coupe et al., 2018), only 13% of the population was employed. Yet, the finding came from interviews with healthcare providers and not from the low-SEP population themselves. In a previous study in a community center in Rotterdam, participants indicated that a lack of time was a major
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