in public health as they provide a means of assessing the ways economic, political, social and cultural factors influence health and disease (241, 242). Through exploration of phenomena in real-life contexts, sociological and anthropological theories and approaches facilitate examination of the interplay between social, cultural and environmental factors and the individual. These approaches can complement more traditional epidemiological and psychological approaches, contextualising behaviours and exploring the way sociocultural context mediates the relationships between risk factors and disease outcomes (243, 244). Three theoretical approaches from the disciplines of sociology and anthropology are summarised below; Habitus, Situated Action and the Theory of Needs. These three theories have been used in the area of public health and/or physical activity.
Habitus
Prominent French sociologist, Pierre Bourdieu sought to reconcile the dichotomy between the role of social structures and individual agency in understanding individual behaviours. Bourdieu’s theories have been extensively applied in public health research, contributing to our understanding of the social and cultural patterning of health
behaviours such as participation in PA and sport (245-252), and supportive environments for health as well as health inequalities (253-256). Habitus is central to Bourdieu’s
sociological approach and philosophy of practice and is defined as ‘embodied history, internalised as second nature’ (257 p56), ‘a structured and structuring structure’ (246 p170). Habitus is structured in that it reflects past experience and social conditions such as education, family structure and socioeconomic conditions and structuring in that it informs current behaviour, beliefs and perceptions, often unconsciously (258). An individual’s current practices ‘are not simply the result of one’s habitus but rather of the relations between one’s habitus and one’s current circumstances’ (258 p52). The
relationship between habitus and social context is dynamic and constantly evolving (258). This is not a linear relationship, but one that is constantly evolving despite the propensity for individuals to gravitate towards social conditions that best match their dispositions (habitus) and their attempts to avoid those social contexts where there may be a clash. The dynamic relationship between habitus and social context applies to all health behaviours where ‘health behaviour is not only a product of context broadly defined but
also contributes to and alters that context’ (234 p62S). Individual health behaviours are considered to arise from the relationship between expectations, social structures and resources. The relationship is multidirectional/ bidirectional with behaviours influenced by and influencing expectations, social structures and resources. During transitional life stages individuals may experience significant changes in their social conditions and social context. How individuals respond to these new social conditions and social context will in part be influenced by their habitus (dispositions/past experiences) as well as current or perceived options and constraints.
Situated action
Bourdieu’s concept of habitus has been criticised for being an overly reductionist or deterministic view of social life and human behaviour (259, 260). It is argued that Bourdieu focuses on continuity and not change and fails to account for individuals who do not fit their proposed trajectories based on their background and training. Sociologist, Chris Schilling proposes an alternative framework for understanding the relationship between body, social context and social capital termed situated action. This approach considers humans to be always in a state of action, but in differing modes depending upon the current degree of conflict or equilibrium with their environment (261 p12). The three key modes of action are habit, crisis and creative revelation. Habitual action is ‘based on the establishment in the individuals past of a coincidence between norms and structures of a social field’ (259 p481). Habitual action occurs when there is relative equilibrium between the social and physical environment. Crisis occurs when there is a conflict between social and physical environments and an individual’s needs and habitual means of action are no longer possible or desirable. This crisis state leads to creative revelation where individuals alter aspects of themselves or their environment in order to facilitate action. Creativity requires ‘engaged deliberation with one’s surroundings’ (259 p19), individuals may identify that their capacity for action is greater than previously assumed and find new, possibly innovative ways to overcome obstacles. Shilling considers the three components of situated action integral to the development of sporting skills. As an individual acquires new skills through practise they become habitual, thus freeing the individual to participate more fully and creatively in their chosen sport. Crises arise when there is a change in proficiency or following injury (261). Not all crises will lead to positive
creativity and have the potential to result in negative consequences. These three modes of action are considered relational and none is permanent.
Theory of needs
Medical anthropologist, Christie Keifer, proposes a theory for health-related behaviours that aims to integrate the concepts of health and illness within daily life (188). In the Theory of Needs it is proposed:
that individual lifestyles and decision processes can be understood as strategies for meeting personal needs within the context of a culture and an environment (188 p175).
The needs/context model ‘views people as active agents meeting their needs, considers the environment to be in part the result of purposeful action’ (188 p162). This theory highlights the relationship between meaning, context and change. Health related behaviours cannot be understood in isolation from the meaning and purposes they embody for those who perform them. Individual behaviour is determined by a:
complex interaction between the material facts (physical and social environment, biology, etc.) and the actors distinct and equally complex, culturally- and
biographically- influenced understanding of these facts, and their import for the satisfaction of their own needs (188 p163).
Keifer identifies five basic needs; security, love, respect, meaning and stimulation, with good health critical for ensuring these five needs are met. Three key characteristics of this model of needs are outlined; synergy, conflict and substitution. Synergy refers to the fact that activities commonly address several needs simultaneously. Basic needs may also conflict with each other with actions addressing one need conflicting with another. Substitution occurs when the inability to satisfy some needs results in a greater emphasis on the satisfaction of other needs. Keifer argues that in order to understand or change health behaviours it is important to understand what need the behaviour serves. For example, active transport may be undertaken due to financial considerations while those who participate in sport may enjoy the sociability.