Abstract

BackgroundUnhealthy eating patterns and a lack of physical activity (PA) are highly prevalent in most Western countries, especially among lower-educated people, including people of non-Western origin. The aim of this study was to investigate and compare the beliefs and barriers that underlie socio-cognitive and planning constructs related to healthy eating and PA among lower-educated Dutch, Turkish, and Moroccan adults.MethodsFocus group interviews were conducted with 90 Dutch, Turkish, and Moroccan lower-educated adults between March and August 2012. Five semi-structured group interviews were conducted with Dutch participants, five with Turkish participants, and four with Moroccan participants. Men and women were interviewed separately. The question route was based on the Theory of Planned Behavior and self-regulation theories. The theoretical method used for the qualitative data analysis was content analysis. The interviews were recorded, transcribed, and analyzed by applying the framework approach.ResultsSome participants seemed to lack knowledge of healthy eating and PA, especially regarding the health consequences of an unhealthy lifestyle. Important attitude beliefs concerning healthy eating and PA were taste and health benefits. Participants suggested that social support can encourage the actual performance of healthy behavior. For instance, exercising with other people was perceived as being supportive. Perceived barriers to PA and cooking healthily were a lack of time and tiredness. These previously mentioned beliefs arose in all the ethnic groups. Differences were also found in beliefs between the ethnic groups, which were mainly related to religious and cultural issues. Turkish and Moroccan participants discussed, for example, that the Koran contains the recommendation to eat in moderation and to take care of one’s body. Furthermore, they reported that refusing food when offered is difficult, as it can be perceived as an insult. Finally, men and women usually cannot exercise in the same location, which was perceived as a barrier. These factors did not emerge in the Dutch groups.ConclusionsThe same cognitive beliefs were discussed in all three ethnic groups. The importance of cultural and religious factors appeared to be the most significant difference between the Turkish/Moroccan groups and the Dutch groups. Accordingly, interventions for all three ethnic groups should focus on socio-cognitive beliefs, whereas interventions for Turkish and Moroccan populations can additionally take religious and cultural rules into account.

Highlights

  • Introductory question for topic 1aTell us your name and what you favorite dish is

  • To develop an effective intervention, insight is needed into the antecedents and specific beliefs related to healthy eating and physical activity (PA) among the members of this group

  • We developed a theoretical framework consisting of the Theory of Planned Behavior (TPB) and planning elements from self-regulation theories to guide this qualitative study and future intervention development

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Summary

Introduction

Introductory question for topic 1aTell us your name and what you favorite dish is. What is healthy eating for you?Transition questions for topic 1Is it important for you to eat healthily? Why yes/no?Key questions for topic 1What makes it easy for you to eat healthily?What makes it difficult for you to eat healthily?Do you think that you will succeed in eating more healthily? Why yes/no?Checklist for topic 1Concepts from TPB. Unhealthy eating patterns and a lack of physical activity (PA) are highly prevalent in most Western countries, especially among lower-educated people, including people of non-Western origin. Unhealthy dietary habits and a lack of physical activity (PA) can cause serious health problems, such as cardiovascular diseases, type 2 diabetes, cancer, being overweight, and obesity [1,2,3,4] These risk behaviors are highly prevalent in most Western countries, among lowereducated people, increasing their risk of health problems [5,6,7,8,9]. Most of the Turkish and Moroccan people in the Netherlands have a lower education level [11], and unhealthy dietary and PA patterns have been reported among them [12,13,14,15]. We included Dutch, Turkish, and Moroccan participants in this study

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