Dietary Trajectories in the Menopause Transition Among Québec Women

Salutogenic model of health to identify turning points and coping styles for eating practices in type 2 diabetes mellitus

BACKGROUND

It is important for people with Type 2 Diabetes Mellitus (T2DM) to eat healthily. However, implementing dietary advice in everyday life is difficult, because eating is not a distinguishable action, but a chain of activities, embedded in social practices and influenced by previous life experiences. This research aims to understand why and how eating practices are developed over the life-course by investigating influential life experiences - turning points - and coping strategies for eating practices of people with T2DM.

METHODS

The Salutogenic Model of Health guided the study's objective, study design and analysis. Seventeen interviews were performed and analysed based on the principles of interpretative phenomenological analysis. Narrative inquiry and the creation of timelines and food boxes were used as tools to facilitate reflection on turning points and eating practices.

RESULTS

Turning points for unhealthier eating were experiences that strongly disturbed the participants' emotional stability. These experiences included psychosocial trauma, physical health disorders, job loss, and smoking cessation. Turning points for healthier eating were experiences that significantly changed participants views on life and made participants reflective about the effects of current eating practices on future health and life goals. These turning points included confrontation with ill-health, becoming a parent, psychosocial therapy, and getting married. Notably, turning points for healthier eating seemed only to happen when life was relatively stress-free. All participants experienced turning points for healthier eating, yet, not all participants succeeded in improving their diets. Two coping styles were distinguished: active and passive coping. Active coping individuals were able to act in line with their personal intentions, whereas passive coping individuals could not. Differences between active and passive coping styles seemed to be explained by differences in available resources important for adapting and maintaining a healthy diet.

CONCLUSION

Disadvantaged childhood and later life adversities together with the inability to manage the mental stress explained the development unhealthier eating practices. All participants experienced turning points for healthier eating that caused eating to become a priority in their life. Yet, the fact that not all were able to eat as they intended, advocates for nutritional guidance for people with T2DM, with a greater emphasis on reflexivity, psycho-social well-being and social support.

How people interpret healthy eating: contributions of qualitative research

OBJECTIVE

To identify how qualitative research has contributed to understanding the ways people in developed countries interpret healthy eating.

DESIGN

Bibliographic database searches identified reports of qualitative, empirical studies published in English, peer-reviewed journals since 1995.

DATA ANALYSIS

Authors coded, discussed, recoded, and analyzed papers reporting qualitative research studies related to participants' interpretations of healthy eating.

RESULTS

Studies emphasized a social constructionist approach, and most used focus groups and/or individual, in-depth interviews to collect data. Study participants explained healthy eating in terms of food, food components, food production methods, physical outcomes, psychosocial outcomes, standards, personal goals, and as requiring restriction. Researchers described meanings as specific to life stages and different life experiences, such as parenting and disease onset. Identity (self-concept), social settings, resources, food availability, and conflicting considerations were themes in participants' explanations for not eating according to their ideals for healthy eating.

IMPLICATIONS

People interpret healthy eating in complex and diverse ways that reflect their personal, social, and cultural experiences, as well as their environments. Their meanings include but are broader than the food composition and health outcomes considered by scientists. The rich descriptions and concepts generated by qualitative research can help practitioners and researchers think beyond their own experiences and be open to audience members' perspectives as they seek to promote healthy ways of eating.

A biographical study of food choice capacity: standards, circumstances, and food management skills

OBJECTIVE

Conceptual understanding of how management of food and eating is linked to life course events and experiences.

DESIGN/SETTING

Individual qualitative interviews with adults in upstate New York.

PARTICIPANTS

Fourteen men and 11 women with moderate to low incomes. PHENOMENON: Food choice capacity.

ANALYSIS

Constant comparative method.

RESULTS

A conceptual model of food choice capacity emerged. Food choice capacity represented participants' confidence in meeting their standards for food and eating given their food management skills and circumstances. Standards (expectations for how participants felt they should eat) were based on life course events and experiences. Food management skills (mental and physical talents to keep food costs down and prepare meals) were sources of self-esteem for many participants. Most participants had faced challenging and changing circumstances (income, employment, social support, roles, health conditions). Participants linked strong food management skills with high levels of food choice capacity, except in the case of extreme financial circumstances or the absence of strong standards.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Recognizing people's experiences and perspectives in food choice is important. Characterizing food management skills as durable, adaptive resources positions them conceptually for researchers and in a way that practitioners can apply in developing programs for adults.

A life course perspective: understanding food choices in time, social location, and history

A life course perspective provides a framework for understanding how food choices develop in changing temporal, social, and historical contexts. This article describes the application of life course concepts to food choices, including trajectories, transitions, turning points, lives in place and time, and timing of events in lives. A life course approach to food choice can contribute to understanding the social and biological pathways of health risk and resilience over the life span. Life course analysis is a useful research and practice tool because of the many ways in which foods, the individuals choosing them, and food choice environments are changing.

Women's perspectives on nutrition, health, and breast cancer

OBJECTIVE

To explore women's beliefs about diet, health, and breast cancer.

DESIGN

Individual interviews exploring women's perceptions of their eating habits, health status, and diet, health, and breast cancer beliefs.

SETTING

Vancouver, British Columbia, Canada.

PARTICIPANTS

A culturally diverse convenience sample of women aged 40 to 60 years, including breast cancer survivors (n = 29) and women who had not had breast cancer (n = 32).

ANALYSIS

Verbatim interview transcripts were coded and themes developed by sorting and summarizing coded transcript segments.

RESULTS

Three perspectives on healthful eating were identified. A "traditional" perspective stressed regular meals of meat, potatoes, and vegetables and made no specific claims about the diet-breast cancer relationship. A "mainstream" perspective stressed increasing vegetables and fruits and decreasing fat intake to improve health, reduce cardiovascular disease risk, and, possibly, reduce breast cancer risk. An "alternative" perspective focused on the role of toxins, carcinogens, and protective factors in food in affecting cancer risk.

CONCLUSIONS AND IMPLICATIONS

Although overall perspectives on healthful eating were not related to participants' breast cancer status, they were related to how participants thought about the relationships between diet and breast cancer. Specific diet-cancer beliefs, degree of conviction about those beliefs, and reasons why foods are believed to be protective or harmful are indicative of overall nutrition perspectives.

Consistency in women's orientations to food and nutrition in midlife and older age: a 10-year qualitative follow-up

OBJECTIVE

The objective of this study was to discover and understand women's perceptions of stability and change in their orientations to food and nutrition during a time of physical, social, and psychological transitions.

DESIGN

A 10-year follow-up to a 1988 study was conducted. PARTICPANTS/SETTINGS: Seventeen women from a 1988 study in a semirural county in New York participated. They were well-educated, Caucasian mothers, aged 44 to 75 years in 1998.

METHODS

Semistructured, qualitative interviews in 1988 and 1998 were analyzed using grounded theory analysis. The 1998 and 1988 interviews with the same women were compared to understand patterns in orientations to food and nutrition. The life-course perspective was a conceptual guide.

RESULTS

Most women in this sample described consistent orientations to food and nutrition at interviews 10 years apart. Even in the face of expected and unexpected changes in healthy, social environment, and roles, 14 of the 17 women perceived that their thoughts, beliefs, and strategies related to food and nutrition had been consistent across 10 years. The few women who perceived that they had changed orientations attributed changes to debilitating disease and transitions in work and family roles.

IMPLICATIONS

Perceptions of consistency in their orientations to food and nutrition through midlife and older age among these women may be signs of stable trajectories that influence their response to nutrition education and their approach to dietary change.