The Mechanisms Of "Shift-and-persist" On The Health Of The Lower Class And Their Promotion Strategy

Lower-class are one of the most well-established social predictors of poor health.The study found that patients in the lower-class group were 2.5 times more likely to be hospitalized or go to the emergency department,and 3.5 times more likely to have limited activity due to illness than those in the higher-class group.However,little is known about why some individuals from lower-class can maintain good physical health despite adversity.Based on a large number of empirical studies,researchers have found that the psychological factor,such as “shift-and-persist” strategy can effectively protect the health of lower-class individuals in adversity and prevent them from being invaded by diseases.This model proposes that,in the midst of adversity,some children find role models who teach them to trust others,better regulate their emotions,and focus on their futures.Over a lifetime,these lower-class children develop an approach to life that prioritizes shifting oneself(accepting stress for what it is and adapting the self through reappraisals)in combination with persisting(enduring life with strength by holding on to meaning and optimism).The“shift-and-persist” strategy model proposes that when individuals face long-term or repeated stress,“shiftand-persist” strategy can reduce the acute physiological activation of the hypothalamic-pituitaryadrenocortical axis(HPA axis),effectively inhibit the stress response of lower-class people when facing adverse situations,and thus reduce allostatic load.As time goes by,it prevents the development of the pathogenic process and ultimately slows down pathogenic disease processes over the long term for lowerclass individuals.Although the protective effect of the “shift-and-persist” strategy on the health of the lower-class has been established and some studies have explored the mechanisms of its protection,no research has been conducted to fully examine the process of protecting the health of the lower-class and to develop intervention programs to increase the level of “shift-and-persist”.Based on this,this study revised the “shift-and-persist” strategy questionnaire,verified the protective effect of “shift-and-persist” on the health of the lower-class,examined the mediating role of allostatic load,and constructed a mediated moderation model.On this basis,an integrated intervention plan was developed to improve the level of“shift-and-persist” strategy.In Study 1,the data of 367 adult subjects aged 18-25 in Sample 1 were used to analyze the items of the“shift-and-persist” strategy questionnaire after localization and processing,and then the official questionnaire was formed by deleting inappropriate questions.A convenience sampling method was used to obtain Sample 2 through an online questionnaire,and the data of 491 subjects aged 17-25 in Sample 2 were used to conduct validation factor analysis and reliability testing on the“shift-and-persist”strategy questionnaire.The revised “shift-and-persist” strategy questionnaire had the same dimensional structure as the original questionnaire,including two dimensions of “shift-and-persist”,with a total of 16 questions;The two-factor structure model of the questionnaire has a good fit index,χ~2/df=3.06,CFI=0.94,TLI=0.93,RMSEA=0.00,SRMR=0.04;The internal consistency reliability of the total questionnaire and each dimension ranges from 0.89 to 0.94.The results indicated that the revised“shift-and-persist”questionnaire has good reliability and validity and can be used in the follow-up study.In study 2,a cluster sampling method was adopted to conduct a questionnaire survey on college students through an online platform.Based on the data of 1206 college students,the protective effect of“shift-and-persist” on the health of lower-class and its internal mechanism were investigated.The results showed that the lower-class with high “shift-and-persist” scores had better self-rated health and mental health outcomes,and allostatic load played a mediating role in this process.Specifically,the lower-class with high “shift-and-persist” scores had lower allostatic load scores and better self-rated health and mental health outcomes,confirming the mediated moderating model.In Study 3,540 college students from Chongqing,Sichuan,Guangdong,and Henan were recruited to fill out the application and initial questionnaire through online social media posters,offline distribution of leaflets,and posting of flyers.54 subjects with low scores of “shift-and-persist”,low scores of self-rated health,and high scores of depression and anxiety were selected.The subjects were randomly assigned to the intervention and control groups.A 2(intervention vs control)x 2(pre-intervention vs post-intervention)mixed design was used,with the dependent variables being the “shift-and-persist” strategy,allostatic load,self-rated health,depression and anxiety stress,and subjective well-being scores.After 5 weeks of online intervention,the level of “shift-and-persist” strategy was significantly higher in the intervention group than in the control group.For the remaining key variables,the intervention group showed improvements in adaptive load,self-rated health,and negative mental health indicators,but differed significantly from the control group only in the positive mental health indicator subjective well-being.The results of the present study are the first to examine the protective effect of the “shift-and-persist”strategy on the self-rated health and psychological well-being of lower-class people in the socio-cultural context of China,to establish the mediating role of allostatic load in this process,and to significantly improve the self-rated health and psychological well-being of low-class people after the integrated program intervention.The results of this study showed that the level of “shift-and-persist” strategy was significantly improved in the lower-class after the intervention of the integrated program.The conclusion of this study can provide new ideas for improving the health of disadvantaged groups and narrowing the health gap in practice during the period of building a healthy China,and provide preliminary theoretical reference and countermeasure basis for the government to realize the grand goal of healthy China.