A mixed methods exploration of the lifestyle drift concept to support the development of measurement tools.

Introduction: Lifestyle drift is a concept that has been used to describe a process whereby policy initiatives designed to support upstream prevention through influencing social determinants drift downstream to a focus on individual behavioural change. This process significantly impacts progress on population-level health equity and there is a critical need to better understand the contributing factors and to learn new ways to mitigate lifestyle drift. This paper describes an initial exploration of the dimensions of lifestyle drift in order to lay a foundation for measurement development. Methods: We conducted a survey to examine the experiences of stakeholders supporting the implementation of prevention and their perceptions of lifestyle drift. The sample consisted of 20 respondents from across Canada working within a range of sectors related to health and youth development. Survey items focused on causes and mechanisms described in the literature. Open-ended questions examined respondent experiences of lifestyle drift issues and their strategies to manage them. Inter-item correlations were used to investigate the relatedness of these initial groupings of the quantitative items and thematic analysis was used to explore the qualitative data. Results: Initial conceptual categories were: funding, individualized behaviours, organizational behaviours, commercial and social determinant of health, medical model and "other." Two major themes emerged from the analysis that focused on factors that contribute to lifestyle drift as well as strategies to mitigate it. Conclusions: This research supports better understanding of contextual issues that influence upstream prevention initiatives. Findings will be useful for future efforts to advance the measurement of lifestyle drift.