The context for constrained choice: a case of cardiovascular diseases in Johannesburg, South Africa

Cardiovascular diseases (CVD) among the working age population in South Africa is increasing despite evidence that positive health behaviours prevent mortality and morbidity. Examining constrained choice in the context of South Africa���s quadruple burden of disease is therefore timely. Using a psychosocial framework, this paper explores the nexus between the socio-environment and health behaviours among lay retail pharmacy workers in Johannesburg. It further questions individual decision-making regarding health and help-seeking behaviours in the era of neoliberal consumerism. A mixed methods study (survey: N=400; interviews: N=60) yielded multifaceted understandings of constrained choice. Narratives on the lived experiences of lay individuals with different sociodemographic profiles revealed nuanced perceptions and discourses about CVD, risk, health and illness. Constraints for health improvement included personal and workplace challenges, financial difficulty, cultural ideologies, family responsibilities and time limitations. These influenced how workers gave meaning to their overall health and choice of care. There are several underlying factors embedded in constrained choice in an everchanging South African risk society. The findings of this research has potential to develop contextual health promotion interventions and disease prevention programs.