Are the Stages of Change Socioeconomically Distributed? a Scoping Review

Abstract

Objective. To conduct a rapid scoping review to explore the hypothesis that socioeconomic affluence is associated with a more advanced stage of change for health behaviors. Data Source. Key-word searches of MEDline, Embase, PyschINFO, and www.google.com were conducted. Study Inclusion and Exclusion Criteria. Studies identified by the searches were included if they were published between 1982 and September 2003, written in English, and reported information on the distribution of the stages of change for any health behavior according to a marker of socioeconomic position (SEP). Data Extraction. Data on the behavior studied, the sample studied, the measure of SEP used, the definitions of the stages of change used, and the distribution of the stages of change according SEP were extracted by a single reviewer. Data Synthesis. As far as possible, data were reanalyzed by the chi-square test to determine if there was evidence that the distribution of the stages of change varied according to SEP. A formal meta-analysis was not appropriate. Results. Twenty-one studies reporting data on 30 samples and 188,850 individuals were included. Significant variations in the distribution of the stages of change were found according to SEP, in the expected direction, in 16 (53%) samples representing 171,183 (91%) individuals. Conclusions. There is substantial published evidence that more-affluent people tend to be in more-advanced stages of change than are more-deprived people.