Wilson, RJ; (2017) A life course assessment of health management in the MRC National Survey of Health and Development. Doctoral thesis , UCL (University College London).

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Abstract

As the UK population expands and adverse health increases with the ageing population, health care services are under pressure to meet demands. Thus, it is necessary to understand how individuals manage their health at different stages in adulthood and identify the health and social factors across life associated with different approaches to health management. Data from the MRC National Survey of Health and Development, a British birth cohort study following 5362 individuals from birth to 68 years, were used to measure health management across adult life. Measures of health professional consultation at age 43, women’s management of symptoms and general health in midlife and health check attendance at age 68 were developed from the rich data archive. Associations were tested between health and social factors from childhood and adulthood (socioeconomic position, health, health care utilisation, lifestyle, personality and family support) and health management outcomes using multivariable regression models and structural equation modelling. Associations between measures of health management from earlier, mid and later adulthood were tested to explore patterns of health management across adult life. Childhood serious illness was associated with higher consultation at age 43 and with lower self-management in midlife and lower health check attendance in later life in women, although these associations largely operated through adult factors. Worse health in adulthood and more health care utilisation were associated with a higher likelihood of proactive health management approaches. Higher social class across life was associated with lower consultation, higher self-management and attending more health checks. Positive health behaviours were associated with higher levels of self-management and higher health check attendance. The correlates of health management differed between health challenges and life course stage. Proactive management of one health challenge was sometimes associated with the proactive management of another at a later stage in the life course. This suggests that whilst some individuals may have a greater propensity to proactively manage their health throughout adulthood by various means, other individuals may take little or no action when responding to health challenges; this group should be encouraged to better engage with proactive health management.

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