Barriers to heat adaptation in at-risk groups in Germany: a qualitative study
Abstract
Background: Due to climate change, heat presents an increasing risk to public health. Heat protection measures addressing the general population and at-risk groups have received considerable policy attention. However, evidence on how risk perception translates into action across population groups, and on the underlying barriers to protective behaviour, remains limited. This study explores the perceptions of heat risk and barriers to protective behaviour in at-risk groups.
Methods: Eight focus groups were conducted in Germany (Aug–Oct 2025) with at-risk groups, including older adults, outdoor workers, pregnant individuals, athletes and people with a migration background. A vignette-based design guided the focus groups. Data were analysed using an iterative, inductive–deductive thematic approach, with codes subsequently clustered into themes.
Results: Participants (n = 38) reported awareness of heat-related health risks, but this did not consistently translate into protective behaviour. Self-identification as a risk group varied across participants. Participants further reported a wide range of structural and individual barriers, including work-related constraints, financial pressure, limited control over daily routines, inadequate housing conditions, lack of targeted information, language barriers, and limited institutional support. These factors reduced individuals’ capability to act, even when risk perception was present.
Conclusions: Heat adaptation behaviour is shaped not only by individual awareness but also by structural and contextual conditions. Public health interventions should move beyond information provision and address the diverse barriers faced by at-risk groups to enable effective and equitable adaptation.
Key messages: • Heat adaptation behaviour is shaped not only by individual awareness but also by structural and contextual conditions.
• Public health interventions should move beyond information provision and address the diverse barriers faced by at-risk groups to enable effective and equitable adaptation.
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BibTeX
@article{busalt2026barriers,
title = {{Barriers to heat adaptation in at-risk groups in Germany: a qualitative study}},
author = {SC Busalt and M Andreas and V Araújo-Soares and F Brune and A Frevert and MR Mahanani and FF Sniehotta},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1506},
url = {https://doi.org/10.1093/eurpub/ckag169.1506},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Barriers to heat adaptation in at-risk groups in Germany: a qualitative study
AU - SC Busalt
AU - M Andreas
AU - V Araújo-Soares
AU - F Brune
AU - A Frevert
AU - MR Mahanani
AU - FF Sniehotta
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1506
UR - https://doi.org/10.1093/eurpub/ckag169.1506
AB - Background: Due to climate change, heat presents an increasing risk to public health. Heat protection measures addressing the general population and at-risk groups have received considerable policy attention. However, evidence on how risk perception translates into action across population groups, and on the underlying barriers to protective behaviour, remains limited. This study explores the perceptions of heat risk and barriers to protective behaviour in at-risk groups. Methods: Eight focus groups were conducted in Germany (Aug–Oct 2025) with at-risk groups, including older adults, outdoor workers, pregnant individuals, athletes and people with a migration background. A vignette-based design guided the focus groups. Data were analysed using an iterative, inductive–deductive thematic approach, with codes subsequently clustered into themes. Results: Participants (n = 38) reported awareness of heat-related health risks, but this did not consistently translate into protective behaviour. Self-identification as a risk group varied across participants. Participants further reported a wide range of structural and individual barriers, including work-related constraints, financial pressure, limited control over daily routines, inadequate housing conditions, lack of targeted information, language barriers, and limited institutional support. These factors reduced individuals’ capability to act, even when risk perception was present. Conclusions: Heat adaptation behaviour is shaped not only by individual awareness but also by structural and contextual conditions. Public health interventions should move beyond information provision and address the diverse barriers faced by at-risk groups to enable effective and equitable adaptation. Key messages: • Heat adaptation behaviour is shaped not only by individual awareness but also by structural and contextual conditions. • Public health interventions should move beyond information provision and address the diverse barriers faced by at-risk groups to enable effective and equitable adaptation.
SN - 1101-1262
SN - 1464-360X
ER -