Engagement in health-promoting activities among people at high risk of stroke in low socioeconomic urban neighbourhoods is shaped by the intersection of relational, structural, and contextual factors rather than by individual motivation alone, so health promotion should move beyond individual behaviour change to context-sensitive, multi-level approaches.
Key Findings
Results
Caregiving responsibilities for family and others acted as a barrier to participants' own health-promoting activities.
This was the first of three themes developed: 'When caring for others becomes a barrier to one's own health'.
Participants described caregiving responsibilities as limiting their capacity to engage in health-promoting activities.
Data came from semi-structured interviews with eighteen adults at high risk of stroke, analysed with reflexive thematic analysis (Braun and Clarke).
Results
Economic conditions and financial constraints hindered participants' engagement in health-promoting behaviours.
This was the second theme: 'When economic conditions hinder engagement in health-promoting behaviours'.
Financial constraints were described as limiting participants' capacity to engage in health-promoting activities.
Participants lived in low socioeconomic urban neighbourhoods in Stockholm, Sweden.
Results
Spaces typically framed as health-supportive, such as gyms, were not always experienced as accessible and could evoke discomfort, stress, or insecurity.
This was the third theme: 'When health-promoting spaces become stressful and unsafe'.
Stress was described as limiting participants' capacity to engage in health-promoting activities.
Spaces intended to support health could therefore become sources of stress rather than support.
Results
Participants often had knowledge of healthy behaviours and expressed motivation, but their efforts were disrupted by competing demands and constrained life conditions.
Lack of knowledge or motivation was not the main barrier described.
Competing demands such as caregiving and financial strain interrupted participants' efforts.
The authors conclude that engagement is not shaped by individual motivation alone.
Results
Social support was present but often insufficient to overcome the cumulative challenges participants faced.
Participants reported having social support.
This support was frequently not enough to offset the combined effects of caregiving, financial constraints, and stress.
Conclusions
Engagement in health-promoting activities in low socioeconomic urban contexts is shaped by the intersection of relational, structural, and contextual factors, and health promotion may be experienced as an additional burden.
The authors interpret health promotion as potentially an extra burden within already constrained lives.
This conclusion rests on a qualitative analysis capturing participants' experiences at multiple levels.
Conclusions
The authors conclude that effective health promotion should adopt context-sensitive, multi-level approaches integrated into everyday life, fostering meaningful and varied forms of engagement.
Strategies should move beyond individual behaviour change.
Such approaches are described as essential to reach and ensure active participation of residents of low socioeconomic areas in health-promoting initiatives.
What This Means
This study interviewed eighteen adults living in lower-income neighbourhoods in Stockholm who were at high risk of stroke. The researchers wanted to understand, from the participants' own experiences, how they try to stay healthy in everyday life. They found three main obstacles: caring for other people left little time or energy for their own health, money problems made healthy choices harder, and places meant to support health, like gyms, could feel stressful, unwelcoming, or unsafe.
Participants generally knew what healthy behaviours were and wanted to adopt them. However, competing demands and difficult life circumstances kept getting in the way. They had some social support, but it often wasn't enough to counter the combined pressures. For some, being asked to do more for their health could feel like one more burden on top of an already demanding life.
This research suggests that health programmes focusing only on motivating individuals or giving health information may miss the real barriers people face. The authors argue that approaches should take into account family responsibilities, finances, and the nature of local spaces, and should be built into daily life in varied and meaningful ways. As a qualitative study with eighteen people, it describes experiences in depth rather than measuring how common they are.
Farias L, Holmlund L, Hawajri O, Guidetti S, Patomella A. (2026). Everyday struggles to stay healthy: experiences of people at high risk of stroke residing in low socioeconomic urban neighbourhoods in Stockholm.. BMC public health. https://doi.org/10.1186/s12889-026-29974-7