Reframing Physical Activity and Dietary Adherence While Managing Chronic Conditions Using Planetary Health Equity Approach in a Low-Income Neighborhood in Southern India

Adhering to physical activity and diet, risk factors for non-communicable diseases, is important in the management of treatment and medications for chronic conditions, such as diabetes and hypertension. With this aim, this study examines the perceived determinants influencing adherence to and maintenance of these two behavioral risk factors while individuals manage their chronic conditions. Within a planetary health equity framework, a phenomenological approach was taken in a qualitative study to explore the perceived determinants and their interlinkages that collectively shape behavioral adherence to walking and dietary practices among individuals diagnosed with diabetes and hypertension in a single neighborhood. A total of twenty in-depth interviews were conducted. This study found that individual, social, economic, and environmental determinants and their interlinkages made adherence to the physical activity and diet advised by treating physicians challenging and complex. This study also found that behavioral adherence goes beyond individual choice; material and spatial circumstances also play a key role in adherence and maintenance of changing behaviors. Therefore, behavior change without improving these underlying determinants is likely to have less impact on adaptation to walking and diet. A planetary health equity approach that addresses the nexus between human health, society, and the environment must be adopted to resolve the critical challenges in adhering to behavioral change and its maintenance. Intervention strategies must act beyond clinic-based medication and counseling to, through a whole-community and whole-systems approach, integrating primary healthcare, urban planning, environmental governance, and socioeconomic protection.