Long term conditions framework: consultation analysis

16. Question 14

What barriers do people face making healthy decisions in preventing or slowing the progress of long term condition(s)?

Introduction

The vast majority (87%) of respondents answered Question 14, and the analysis identified four themes:

• theme 1: socio-economic barriers
• theme 2: insufficient knowledge and health literacy
• theme 3: personal, psychological, and attitudinal barriers
• theme 4: structural and systemic barriers

Respondents said that barriers were multi-faceted, shaped by a wide range of personal, social, and environmental factors, and intersectional. Further, many barriers identified at Question 14 have been described earlier at Question 8 and have only been covered in summary form in this section.

Theme 1: Socio-economic barriers

The majority of individual and organisation respondents said that socio-economic factors made it difficult for people to make healthy decisions in preventing or slowing the progress of long term conditions. Here, respondents mentioned:

• financial challenges – many respondents noted that poverty limited people’s ability to make healthy decisions, which has been exacerbated by the cost-of-living crisis. Also, the nature of their long term conditions can result in additional financial costs and challenges (for example, travel and transport costs, rising household bills, and reduced household income if working reduced hours)
• geographical barriers – some respondents said that people living in deprived urban and rural areas may experience accessibility challenges – for example, poor public transport or have to travel long distances to access supermarkets or shops that sold fresh food and produce, distance to access greenspace, gyms and sports centres, and non-medical services
• protected characteristics and health inequalities – a small number of respondents noted the intersectionality of barriers were shaped by a range of social factors, including ethnicity, gender, disability
• digital barriers – a small number of respondents highlighted that digital poverty, exclusion, and accessibility challenges made it difficult for people to make healthy decisions

Theme 2: Insufficient knowledge and health literacy

The majority of respondents said that insufficient knowledge and health literacy were key barriers that made it difficult for people to make healthy decisions to prevent or slow the progress of long term conditions. For example, they said some people may lack knowledge, skills and understanding on nutrition, appropriate physical activity, or how to manage their own health and condition. Wider issues around capacity to access, understand, and apply relevant information were also mentioned.

Theme 3: Personal, psychological and attitudinal barriers

Many respondents said there were a range of personal, psychological and attitudinal barriers for people in making healthy decisions to help prevent or slow the progress of long term conditions. These responses mentioned:

• mental health and wellbeing – some respondents said that a person’s mental health and wellbeing could be a barrier to making healthy decisions with reference to feelings of stress, anxiety, and fear – and the impact of these issues on a person’s confidence and motivation to make healthy lifestyle choices or to engage with support services
• stigma and attitudes (including self-stigma) – some respondents cited experiences of being ignored or dismissed when accessing healthcare and support services, and that it may also affect people’s willingness and ability to make healthy decisions or engage in treatment and care

Theme 4: Structural and systemic barriers

Some respondents identified wider structural and systemic barriers were also important considerations. The main points raised in responses centred on:

• limited access to healthcare and support – there may be limited support available to individuals within their local community
• long waiting times – individuals may be placed on long waiting lists for appointments, referrals to specialists, and treatment – which could result in a worsening of their condition if support is not accessed in a timely manner
• short consultation times – appointment times could be not long enough for individuals to provide information on their condition and receive adequate information and support from healthcare professionals