Everyday struggles to stay healthy: experiences of people at high risk of stroke residing in low socioeconomic urban neighbourhoods in Stockholm.

BACKGROUND

Residents in low socioeconomic urban neighbourhoods are disproportionately exposed to modifiable risk factors, yet their engagement in health-promoting behaviours remains poorly understood from a lived experience perspective. This study aims to explore how residents at high risk of stroke experience and engage in everyday health-promoting activities within their neighbourhoods.

METHODS

A qualitative study was conducted using semi-structured interviews with eighteen adults residing in low socioeconomic urban neighbourhoods in Sweden who were identified as being at high risk of stroke. Data were analysed using reflexive thematic analysis, following Braun and Clarke's approach, to capture participants' experiences at multiple levels.

RESULTS

Three themes were developed: When caring for others becomes a barrier to one's own health, When economic conditions hinder engagement in health-promoting behaviours, and When health-promoting spaces become stressful and unsafe. Participants described how caregiving responsibilities, financial constraints, and stress limited their capacity to engage in health-promoting activities. Although participants often had knowledge of healthy behaviours and expressed motivation, their efforts were disrupted by competing demands and constrained life conditions. Spaces typically framed as supportive of health, such as gyms, were not always experienced as accessible and could instead evoke discomfort, stress, or insecurity. Social support was present but often insufficient to overcome these cumulative challenges.

CONCLUSIONS

Engagement in health-promoting activities among individuals in low socioeconomic urban contexts is shaped by the intersection of relational, structural, and contextual factors, rather than by individual motivation alone. Health promotion may be experienced as an additional burden within already constrained lives. Effective health promotion strategies should therefore move beyond individual behaviour change and adopt context-sensitive, multi-level approaches that are integrated into everyday life by fostering meaningful and varied forms of engagement. Such approaches are essential to reach and ensure the active participation of residents of low socioeconomic areas in health-promoting initiatives.

CLINICAL TRIAL REGISTRATION: Not applicable.