Defining Health Movements and Health Needs Across the Life Course: A Qualitative Study.

backgroundIn an effort to improve population health, communities are being enabled to take charge of their health through the Movements for Health (M4H) programme in Singapore. The present study seeks to understand what characterises a health movement and explores health narratives which resonate over the different life stages.

methodsA multi-component qualitative formative study was undertaken. Focus group discussions (FGDs, n = 12) and one semi-structured interview (altogether involving n = 52 individuals) were carried out with government and community implementation stakeholders, alongside go-along interviews (n = 24, involving 11 volunteers, 13 programme participants) and e-diaries (n = 37, with 22 programme participants and 15 volunteers).

resultsThemes are reported in bold, with subthemes in italics. Health movement building was defined as an evolving process marked by co-creation, emotional investment and framed by a shared understanding founded on explicit theory. Furthermore, health movements were characterised as taking root in the community, needing a shared 'cause' to be self-sustaining. They should be able to garner momentum and be replicable, and thus ultimately far-reaching and inclusive of all walks of life. Themes cross-cutting life stages include concerns about chronic illness, which are not limited to seniors. Positive role modelling is crucial in encouraging hesitant participants towards healthier behaviours. Additionally, the importance of building supportive, emotional connections with implementers was emphasised. Priority areas for changing health behaviours and informing health literacy planning across various life stages have also been identified. For youths, mental health struggles, such as mood regulation issues, are prevalent and often exacerbated by parental invalidation. Adults tend to deprioritize social health due to responsibilities like breadwinning and childminding, coping through social connections forged among programme participants. Seniors expressed trepidation regarding their physical health, fearing a loss of independence and verbalising how limited mobility affects their ability to exercise and socialise.

conclusionThe present study has provided insights into the early phases of the novel M4H community-led programmatic approach. Our findings defined health movements and health needs across the life course, whilst expanding on related theoretical and applied community development traditions. PATIENT OR PUBLIC CONTRIBUTION: This study mixes participatory data (i.e. go-along interviews) with other qualitative data to provide insights into the co-creation process of health movement building. The study also adopted a user-centred approach, and the content appropriateness of the programmes was fed back to the community-level implementers (i.e. Community Movement Champions [CMCs]) and the M4H administrating committee to inform future programming. Future CMCs have taken up the recommendations extracted from stakeholder engagement, where components on sleep, mental health, etc., have been added. Community coaches and commissioning stakeholders are involved in authorship.