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Zhao J, Wang Y, Wu J, Luo Q, Zhang B, Zhang M. Preliminary Insights on Barriers to and Facilitators of Healthy Eating for Rural Residents Emerging from Extreme Poverty: A Qualitative Study in Dafang, China. Healthcare (Basel) 2024; 12:1246. [PMID: 38998781 PMCID: PMC11241384 DOI: 10.3390/healthcare12131246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/07/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
The purpose of this study was to examine the dietary views and practices and to identify associated barriers to and facilitators of healthy eating of rural residents emerging from poverty in the context of rapid socio-economic development. A qualitative design with semi-structured interviews was utilized to collect detailed insights into the dietary behaviors of 22 rural residents from 10 villages in Fengshan town, Dafang county, Guizhou province, China. Thematic analysis was applied to interpret the interview data, guided by the socio-ecological model. Four themes were identified: traditional eating patterns, factors influencing food choice, limited knowledge of healthy diet, and lack of nutritional guidance. Barriers to healthy eating included traditional but unhealthy foods, limited nutritional knowledge, inadequate understanding of nutritional requirements, overwhelming nutritional information, and limited professional guidance. Facilitators encompassed healthy traditional eating patterns, household composition, home gardening, preference for traditional bean and soy products, improved food supply and availability owing to poverty alleviation efforts, and being open to receiving professional dietary guidance. As a preliminary investigation into the dietary views and practices of this population, the study highlights a significant gap in the nutritional knowledge and guidance available to rural residents in China, emphasizing the need for comprehensive strategies that address the complex socio-ecological factors influencing dietary behaviors.
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Affiliation(s)
- Jian Zhao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ye Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jing Wu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qianqian Luo
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bingxia Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Min Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Wekesa C, Ocama P, Parkes-Ratanshi R, Kirk GD. Burden and correlates of significant liver fibrosis among HIV-infected and uninfected adults in urban Uganda. DIALOGUES IN HEALTH 2022; 1:100027. [PMID: 38515903 PMCID: PMC10953957 DOI: 10.1016/j.dialog.2022.100027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 03/23/2024]
Abstract
Introduction Following chronic inflammation and other disease specific factors, the risk of liver disease is believed to be higher among HIV-infected patients than in the general population despite shared risk factors. Understanding this differentiated burden and its drivers will inform policy and priority populations for intervention. Methods This was a cross sectional study among 516 adults attending care clinics in Kampala Uganda. Significant liver fibrosis (SLF) was defined as liver stiffness measurement ≥7.2 KPa identified by Fibroscan®. Data analyses were stratified by HIV status and we performed logistic regression performed to identify correlates. Results The prevalence of SLF was higher among HIV un-infected patients ((24% Vs 14%; p0.004). Overall HIV-uninfected patients were more likely to be overweight and or obese, with elevated serum cholesterol levels. Elevated measurement of fatty change in the liver (CAP scores >248 dB/m) was associated with SLF among HIV un-infected patients (OR 2.3 CI (1.0-5.2); p = 0.046). Low nadir CD4 counts (200cell/mm3) was predictive of SLF among HIV-infected patients (OR 3.3 CI (1.0-10.7); p = 0.05). Conclusion The prevalence of SLF was unexpectedly higher among HIV un-infected than HIV affected patients attending care clinics in urban Uganda. This observed burden is most likely driven by non-alcoholic fatty liver disease (NAFLD) resulting from metabolic syndrome.
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Affiliation(s)
- Clara Wekesa
- Infectious Diseases Institute, Makerere University Kampala, Uganda
| | - Ponsiano Ocama
- Makerere University, College of Health Sciences Kampala, Uganda
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Mokaya M, Saruni E, Kyallo F, Vangoitsenhoven R, Matthys C. Perceived facilitators and barriers to healthy dietary behaviour in adults with type 2 diabetes mellitus in Kenya: A qualitative study. Public Health Nutr 2022; 25:1-24. [PMID: 36214084 PMCID: PMC9991632 DOI: 10.1017/s136898002200221x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to explore the facilitators and barriers to healthy dietary behaviour in adults with type 2 diabetes mellitus (T2DM) in Kenya. DESIGN A qualitative descriptive design using telephone interviews was applied. An interview guide was developed through a modified theoretical framework. SETTING This study was conducted in selected hospitals in Nakuru County, located in west-central Kenya. PARTICIPANTS A two-step sampling strategy was used to select hospitals and study participants. Adult participants aged 30 to 85 years old, with T2DM from six hospitals were selected based on their ability to openly elaborate on the theme of dietary behaviour. RESULTS Thirty respondents were interviewed (mean age 62 years; 43.3% females). The average duration of the interviews was 32:02 minutes (SD 17.07). The highest-ranking internal facilitators of healthy dietary behaviour were knowledge of healthy food choices, gardening, self-efficacy, food preparation skills and eating at home. External facilitators included inaccurate beliefs and information on food and diet, education by healthcare workers, food availability, proximity to food selling points and family support. Internal barriers included tastes and preferences, health conditions barring intake of certain foods, and random eating of unhealthy foods. External barriers included socioeconomic factors, seasonal unavailability of fruits and food safety concerns. CONCLUSIONS Facilitators and barriers to healthy dietary behaviour among Kenyan adults with T2DM are related to food literacy and include selection, preparation and eating. Interventions to enhance healthy dietary behaviour should target context-specific knowledge, skills and self-efficacy.
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Affiliation(s)
- Moses Mokaya
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, 3000Leuven, Belgium
| | - Eddah Saruni
- Department of Community Health Nursing, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Florence Kyallo
- Department of Human Nutrition Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Christophe Matthys
- Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, 3000Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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Liguori J, Pradeilles R, Laar A, Zotor F, Tandoh A, Klomegah S, Osei‐Kwasi HA, Le Port A, Bricas N, Aryeetey R, Akparibo R, Griffiths P, Holdsworth M. Individual-level drivers of dietary behaviour in adolescents and women through the reproductive life course in urban Ghana: A Photovoice study. MATERNAL & CHILD NUTRITION 2022; 18:e13412. [PMID: 35938776 PMCID: PMC9480960 DOI: 10.1111/mcn.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
Evidence on the individual-level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage of nutrition transition. The aim of this study was to identify individual-level factors (biological, demographic, cognitive, practices) influencing dietary behaviours among adolescent girls and women at different stages of the reproductive life course in urban Ghana with the goal of building evidence to improve targeted interventions. Qualitative Photovoice interviews (n = 64) were conducted in two urban neighbourhoods in Accra and Ho with adolescent girls (13-14 years) and women of reproductive age (15-49 years). Data analysis was both theory- and data-driven to allow for emerging themes. Thirty-seven factors, across four domains within the individual-level, were identified as having an influence on dietary behaviours: biological (n = 5), demographic (n = 8), cognitions (n = 13) and practices (n = 11). Several factors emerged as facilitators or barriers to healthy eating, with income/wealth (demographic); nutrition knowledge/preferences/risk perception (cognitions); and cooking skills/eating at home/time constraints (practices) emerging most frequently. Pregnancy/lactating status (biological) influenced dietary behaviours mainly through medical advice, awareness and willingness to eat foods to support foetal/infant growth and development. Many of these factors were intertwined with the wider food environment, especially concerns about the cost of food and food safety, suggesting that interventions need to account for individual-level as well as wider environmental drivers of dietary behaviours.
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Affiliation(s)
- Julia Liguori
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems)CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRDMontpellierFrance
| | - Rebecca Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public HealthUniversity of GhanaAccraGhana
| | - Francis Zotor
- Department of Family and Community Health, School of Public HealthUniversity of Health and Allied SciencesHoGhana
| | - Akua Tandoh
- Department of Population, Family & Reproductive Health, School of Public HealthUniversity of GhanaAccraGhana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public HealthUniversity of Health and Allied SciencesHoGhana
| | | | - Agnès Le Port
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems)CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRDMontpellierFrance
| | - Nicolas Bricas
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems)CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRDMontpellierFrance
| | - Richmond Aryeetey
- Department of Population, Family & Reproductive Health, School of Public HealthUniversity of GhanaAccraGhana
| | - Robert Akparibo
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Paula Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary centre on Sustainable Agri‐Food Systems)CIRAD, CIHEAM‐IAMM, INRAE, Institut Agro Montpellier, IRDMontpellierFrance
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Pradeilles R, Irache A, Wanjohi MN, Holdsworth M, Laar A, Zotor F, Tandoh A, Klomegah S, Graham F, Muthuri SK, Kimani-Murage EW, Coleman N, Green MA, Osei-Kwasi HA, Bohr M, Rousham EK, Asiki G, Akparibo R, Mensah K, Aryeetey R, Bricas N, Griffiths P. Urban physical food environments drive dietary behaviours in Ghana and Kenya: A photovoice study. Health Place 2021; 71:102647. [PMID: 34375838 PMCID: PMC8520917 DOI: 10.1016/j.healthplace.2021.102647] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/20/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods. Home gardening supplemented household nutritional needs, particularly in Nairobi. Policies to enhance food safety in neighbourhood environments are required. Home gardening, food pricing policies and social protection schemes could reduce financial barriers to safe and healthy diets.
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Affiliation(s)
- Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.
| | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Michelle Holdsworth
- IRD (French National Research Institute for Sustainable Development), NUTRIPASS Unit, Université de Montpellier-IRD, Montpellier, France
| | - Amos Laar
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Akua Tandoh
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Fiona Graham
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | | | | | - Nathaniel Coleman
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana; Department of Obstetrics and Gynaecology, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Mark A Green
- Department of Geography and Planning, University of Liverpool, UK
| | | | - Marco Bohr
- School of Art & Design, Nottingham Trent University, UK
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Robert Akparibo
- Public Health Section, School of Health and Related Research, University of Sheffield, United Kingdom
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, Accra, Ghana
| | - Richmond Aryeetey
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Nicolas Bricas
- UMR MOISA, CIRAD- Agricultural Research & International Cooperation Organization, Montpellier, France
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
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