Lifestyle Routine in the Structure/Agency Dynamics: Health Behaviors Enabled or Constrained, Cancer Screening As an Example

Participation in colorectal-cancer (CRC) screening, a life-saving, recommended, medical procedure, varies by socioeconomic status; individuals in high SES undergo screening more than others in low SES. These differences defy the tests being generally free of charge. The sociological perspective offered to clarify this paradox suggests taking into account the context of adopting health behaviors (screening being one example thereof) as part of a routine lifestyle. The dynamic structure/agency interface enables a range of enacting (or not) of health behaviors as part of a person's daily routine.

This analysis illustrates the role of routinely engaging in health behaviors as mediated by social-structural constraints and by agency-initiated choices. Study participants' daily-realities were elicited, as-well-as their perceptions and consequent health-related behaviors. Focus group discussions with individuals invited to screen were carried out in urban primary-care clinics in Israel. They were facilitated by the researchers, audio-taped and transcribed verbatim. Analysis was conducted based on grounded theory principles. Data analysis revealed that, vis-à-vis the screening invitation, participants related to the health-care system structure on one hand, and to their agency on the other. Deciding to adhere to CRC early detection was related to the screening perceived benefits, and embedded in an enabling social context. Screening avoidance stemmed from issues related to the interplay between specialist health-care services organization and participants' agency, crystallized in lifestyle routines, and to their personal higher priorities. Laypersons' explanations for adherence to CRC screening are not the opposite mirror image of their explanations for non-adherence; these explanations represent contextual elements (routine health lifestyle, health-care services accessibility) and are tied to different content domains (medical rationale for screening, insured members' unmet needs). We conclude by applying two sociological perspectives to interpret study findings: a. structure-agency, mediated by routine, and b. a relational perspective, emphasizing the adaptive interplay between doxa-field-habitus.