Research brief
Perceptions of Factors Influencing Healthful Food Consumption Behavior in the Lower Mississippi Delta: Focus Group Findings

https://doi.org/10.1016/j.jneb.2006.12.013Get rights and content

Abstract

Objective

To identify perceptions of Lower Mississippi Delta (LMD) residents regarding factors that influence a change in healthful food consumption behavior to assist in planning sustainable nutrition interventions in the LMD.

Design

Nine focus groups were conducted with LMD residents in 9 counties in Arkansas, Louisiana, and Mississippi. One focus group was held in each county on the topical area of behavioral change.

Setting

Nine counties in Arkansas, Louisiana, and Mississippi.

Participants

The study population included 91 persons, 85 females and 6 males (18-60+ years of age), of whom 71 were African Americans, 17 were Caucasians, and 3 were Hispanics, who participated in the focus group discussions.

Analysis

Data analyses were completed by general and specific content coding. Data were reviewed for emerging themes for each topic. The Social Cognitive Theory served as the framework for understanding the determinants of a change in healthful food consumption behavior.

Results

The study showed considerable variability in perceptions that are influenced by both personal and external factors. These factors include health concerns, family influence, and need for and availability of nutrition information. Participants were interested in learning about healthful eating, food preparation skills, and portion control.

Conclusions

Focus groups in the LMD identified many important themes relevant to the development of nutrition interventions in these communities. These data will be used to guide the community-based participatory interventions that will be developed and implemented in the LMD. The findings could be applicable to other researchers designing interventions for similar populations.

Introduction

Approximately 5.3 million people in Arkansas, Louisiana, and Mississippi live in the Lower Mississippi Delta (LMD) region.1 Similar to other rural areas, adults living in the LMD are more likely to experience higher rates of chronic diseases, such as type 2 diabetes, cancer, hypertension, and cardiovascular disorders.2, 3, 4 Mortality rates from these diseases are much higher in the LMD states than nationally.5, 6 High rates of food insecurity, poverty, unemployment, and lack of educational attainment further complicate efforts to improve health in this high-risk, predominantly minority population. Research and educational programs focusing on improving dietary knowledge and behaviors are critical to improving the health of residents in the LMD communities. Because of well-documented needs in the region, the Agricultural Research Service of the US Department of Agriculture (USDA) was directed by Congress in 1994 to study the effects of nutrition intervention on the health of the LMD population (US Senate Report 103-290).7

Initial research documented limited food variety and nutrient-dense food items consumed by the LMD residents. Researchers noted fruit and vegetable consumption below recommended levels; mean intakes were 0.9 servings of fruit and 2.8 servings of vegetables, with french fries accounting for 30% of the vegetable servings.8 Comparing nutrient intake of LMD and US adults, it was observed that LMD adults had lower intakes of nutrients considered essential for health and well-being, particularly calcium and iron. In addition, LMD adults had higher dietary fat intake than US adults.8 The region is characterized by limited availability of food choices, which may limit selection of a nutritionally adequate diet.9 These findings demonstrate a need for interventions that would help to improve the food availability, food choices, and nutrition practices of residents in the LMD. However, there is a lack of evidence-based information regarding successful approaches for improving dietary behaviors, knowledge, and attitudes about food and health among diverse population groups in rural areas.

The Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) Consortium is developing nutrition interventions in the LMD through community-based participatory research (CBPR). This methodology has shown promising results as an approach for bringing about sustainable change in communities. Community-based participatory research is characterized by community–research partnerships, where the residents play an active role in selecting, planning, implementing, and evaluating research interventions in their communities.10, 11, 12 Such an approach is based on the premise that health issues that affect individuals cannot be adequately addressed in exclusion of the individual’s social setting, and that solutions to problems lie within the community.

Before effective interventions can be designed and implemented in a community to improve food practices, program planners must know what factors will influence behavior change in the target population.13 Several psychosocial models of health behavior have been developed to explain beliefs and motivation of individuals for adopting preventive health behaviors. One example is Bandura’s Social Cognitive Theory (SCT),14, 15, 16 which has been widely used in dietary behavioral research.17, 18, 19, 20, 21 The SCT conceptualizes behavior in terms of a 3-way dynamic and reciprocal interaction between personal factors, environmental influences, and behavior. The reciprocal nature of the determinants of nutrition behavior in SCT makes it possible for nutrition intervention efforts to be directed at personal, external, or behavioral factors.

In the current study, focus groups were used to provide information to assess resources, needs, and opportunities for planning sustainable nutrition interventions in the LMD. The focus group method has been useful in determining beliefs about nutrition and health of various groups22, 23, 24, 25, 26 and in defining and planning nutrition education and intervention programs.27, 28, 29, 30, 31 Using this qualitative approach to elicit information from groups adds an important dimension in which perceptions are developed partly by interacting with others.32 The purpose of this study was to identify perceptions of factors that influence healthful food consumption among residents in the Delta.

Section snippets

Study Population and Study Design

Nine focus groups were conducted in 9 counties in Arkansas, Louisiana, and Mississippi. One focus group was held in each county to determine factors that influence behavior change in the consumption of healthful food. Counties were chosen randomly from the intervention counties in the 3 states selected in the FOODS 2000 study.5 FOODS 2000 was a cross-sectional telephone survey of a representative sample of the population 3 years of age and older in 36 Delta counties. Focus groups were conducted

Results

The study population included 91 participants. Focus groups ranged in size from 6 to 17 individuals, with a mean size of 10. The length of time per session ranged from 50 to 65 minutes, with an average of 58 minutes. A profile of the participants is presented in Table 2. Of the 91 participants, 37% were 18 to 44 years of age, and 63% were over 45 years of age. Most participants were female (93%) and African American (78%), and 47% had more than a high school education. The demographic

Discussion

Focus group discussions with LMD residents revealed a variety of motivations and behaviors associated with changing eating behaviors. The study showed considerable variability in perceptions that may be influenced by personal and external determinants. Influences include health concerns, family, need for and availability of nutrition information, and social support. These findings support the theoretical tenets underpinning SCT. The reciprocal nature of the determinants of nutrition behavior

Implications for Research and Practice

Social Cognitive Theory can be successfully used as a framework in planning nutrition-related, community-based participatory interventions. Program planners, physicians, and other practitioners should provide information about linkages between good nutrition and prevention of health problems. In addition, these individuals should highlight positive aspects of healthful traditional and cultural food items in the diet. Interventions directed toward preparation of healthful food and modification

Acknowledgment

This research was funded by the Agricultural Research Service, United States Department of Agriculture, Project No. 6251-53000-002-00D.

References (45)

  • K. Glanz et al.

    Why Americans eat what they do: taste, nutrition, cost convenience, and weight control concerns as influences on food consumption

    J Am Diet Assoc

    (1998)
  • M. Reicks et al.

    Factors affecting consumption of fruits and vegetables by low-income families

    J Am Diet Assoc

    (1994)
  • H. Henry et al.

    Identification of factors affecting purchasing and preparation of fruits and vegetables by stage of change for low-income African American mothers using the think-aloud method

    J Am Diet Assoc

    (2003)
  • Health, United States, 2001: Urban and Rural Chartbook

    (2001)
  • T.A. Pearson et al.

    Rural epidemiology: insights from a rural population laboratory

    Am J Epidemiol

    (1998)
  • J. Smith et al.

    Prevalence of self reported nutrition related health problems in the Lower Mississippi Delta

    Am J Public Health

    (1999)
  • Self reported health of residents of the Lower Mississippi Delta

    J Health Care Poor Underserved

    (2004)
  • I. Morgan et al.

    Health Care State Rankings 1997

    (1997)
  • United States Congress. Senate Committee on Appropriations. Agriculture, Rural Development, Food and Drug...
  • K. Yadrick et al.

    Limited availability of food choices in the Lower Mississippi Delta

    FASEB J

    (2004)
  • A. Kone et al.

    Improving collaboration between researchers and communities

    Public Health Rep

    (2000)
  • Cited by (0)

    This research was funded by the Agricultural Research Service, United States Department of Agriculture, Project No. 6251-53000-002-00D.

    View full text