Barriers to heat adaptation in at-risk groups in Germany: a qualitative study

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.