A focus group study of healthy eating knowledge, practices, and barriers among adult and adolescent immigrants and refugees in the United States.

Kristina Tiedje,Christine M Formea,Mark L Wieland,Jennifer A Weis,Julie A Nigon,Ahmed A Mohamed,Ginny Boyum,Christi A Patten,Jennifer L Ridgeway,Gladys B Asiedu,Sonja J Meiers,Irene G Sia

doi:10.1186/1479-5868-11-63

Abstract

BackgroundImmigrants and refugees to the United States exhibit lower dietary quality than the general population, but reasons for this disparity are poorly understood. In this study, we describe the meanings of food, health and wellbeing through the reported dietary preferences, beliefs, and practices of adults and adolescents from four immigrant and refugee communities in the Midwestern United States.MethodsUsing a community based participatory research approach, we conducted a qualitative research study with 16 audio-recorded focus groups with adults and adolescents who self-identified as Mexican, Somali, Cambodian, and Sudanese. Focus group topics were eating patterns, perceptions of healthy eating in the country of origin and in the U.S., how food decisions are made and who in the family is involved in food preparation and decisions, barriers and facilitators to healthy eating, and gender and generational differences in eating practices. A team of investigators and community research partners analyzed all transcripts in full before reducing data to codes through consensus. Broader themes were created to encompass multiple codes.ResultsResults show that participants have similar perspectives about the barriers (personal, environmental, structural) and benefits of healthy eating (e.g., ‘junk food is bad’). We identified four themes consistent across all four communities: Ways of Knowing about Healthy Eating (‘Meanings;’ ‘Motivations;’ ‘Knowledge Sources’), Eating Practices (‘Family Practices;’ ‘Americanized Eating Practices’ ‘Eating What’s Easy’), Barriers (‘Taste and Cravings;’ ‘Easy Access to Junk Food;’ ‘Role of Family;’ Cultural Foods and Traditions;’ ‘Time;’ ‘Finances’), and Preferences for Intervention (‘Family Counseling;’ Community Education;’ and ‘Healthier Traditional Meals.’). Some generational (adult vs. adolescents) and gender differences were observed.ConclusionsOur study demonstrates how personal, structural, and societal/cultural factors influence meanings of food and dietary practices across immigrant and refugee populations. We conclude that cultural factors are not fixed variables that occur independently from the contexts in which they are embedded.

Highlights

Immigrants and refugees to the United States exhibit lower dietary quality than the general population, but reasons for this disparity are poorly understood
Participants In total, 127 people participated in 16 focus groups (FGs), four from each immigrant community (Somali, Mexican, Cambodian, Sudanese), respectively
The total number of participants who participated across all 16 groups were as follows: a) Somali adolescents ages 14.3 ± 1.1 (n = 21, 43% female), b) Somali adults ages 40.2 ± 11.3 (n = 15, 47% female), c) Mexican adolescents ages 14.8 ± 1.7 (n = 22, 59% female), d) Mexican adults ages 42.8 ± 5.4 (n = 14, 50% female), e) Cambodian adolescents ages 14.6 ± 1.5 (n = 15, 60% female), f) Cambodian adults ages 58.8 ± 13.2 (n = 14, 71% female), f) Sudanese adolescents ages 14.3 ± 1.9 (n = 15, 53% female), g) Sudanese adults ages 47.7 ± 12.2 (n = 11, 45% female)

Summary

Introduction

Immigrants and refugees to the United States exhibit lower dietary quality than the general population, but reasons for this disparity are poorly understood. We describe the meanings of food, health and wellbeing through the reported dietary preferences, beliefs, and practices of adults and adolescents from four immigrant and refugee communities in the Midwestern United States. While recent immigrant and refugee populations may still benefit from the “healthy migrant phenomenon” [7,8,9] showing a better health status than native-born residents [10,11,12], immigrants with 15 years of residence or longer and their children are affected by the obesity epidemic [13,14,15]. Second and third generation immigrants are associated with increased body size and cardiovascular disease risk [15,16,17,18,19]

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Conclusion