Barriers, facilitators, and strategies to support healthy eating among recent Hispanic immigrants mothers living in a food swamp: a Photovoice project

Abstract

ObjectiveFollowing the social‐ecological framework, we aimed to identify barriers and facilitators that Hispanic primary caregivers living in a “food swamp” experience when providing foods for their children, and their strategies to overcome those barriers. “Food swamp” is a term referring to low‐income areas with high concentrations of food stores, including convenience stores and fast‐food outlets.MethodsUsing a purposive sampling design, we identified 15 Hispanic mothers of young children (< 10 years old) living in a neighborhood characterized as a “food swamp” in the metropolitan area of Washington DC. Semi‐structured, in‐depth interview guides were used to ask mothers to describe: (a) their typical day, (b) whether they were able to feed their children the foods they would like to, and (c) what made it easier or harder for them to provide the foods they would like to provide for their children. Mothers were also asked to take pictures of those factors. A community organizer led a participatory workshop to display all the pictures, each with a descriptive title and paragraph crafted by the mothers. The workshop sought to identify common barriers and their strategies to overcome them. Interviews from all sessions were recorded, transcribed verbatim, and analyzed systematically using a codebook that followed broad categories of the social‐ecological framework (ATLAS.ti version 5).ResultsMothers were immigrants (<15 years in US) mostly El Salvador and Guatemala. The divide between children's food preferences and parent's rules and preferences around eating emerged as a common barrier. For example, mothers wanted to feed their children typical foods based on soups, rice, and tortillas from their home country, while the children preferred to eat foods that mothers perceived were common to the receiving country (pizza, fries, fried chicken). Mothers perceived that foods and drinks served at school were of low nutritional value and were concerned that this exposure reinforced preferences for these foods in their children. Eating at fast‐food restaurants as a family was common only when the monthly budget allowed. The high price for some meats, fruits, and vegetables was a common barrier cited, but mothers’ reported that their ability to manage the family budget and to find less expensive alternatives to these items enabled them to feed their children how they wanted throughout the month. WIC food vouchers also allowed mothers to purchase fruits and vegetables that they otherwise would not have been able to afford. The advice of health professionals (doctors, dentists, nutritionists) emerged as a key factor in deciding what to feed their children. Strategies identified in the workshop included: education on how to incorporate local fruits and vegetables (perceived as less expensive than imported ones), parent involvement in the school lunch options.ConclusionThe mothers were strict gatekeepers of their children's diets, following health professionals’ advice and using budgeting strategies throughout the month to cope, regardless of what was available in the environment surrounding their homes. Exposure to foods perceived as unhealthy in the school was seen as a major barrier to feeding their children what they preferred.Support or Funding InformationGW Center for Civic Engagement, and Centers for Disease Control and Prevention (Racial and Ethnic Approaches to Community Health).