Understanding the Meaning of Food in People With Type 2 Diabetes Living in Northern Appalachia

A Qualitative Study of the Meaning of Food and Religious Identity

OBJECTIVE

To identify common themes of the meaning of food among people who identify with a specific religious tradition, particularly focusing on potential applications for nutrition education and professional practice at multiple levels of the Social-Ecological Model.

DESIGN

Virtual and in-person focus groups were used to collect qualitative data.

SETTING

A midsized city in eastern Washington State.

PARTICIPANTS

Nine focus groups (n = 35), each representing a distinct religious congregation.

PHENOMENON OF INTEREST

Meaning of food in the context of religion.

ANALYSIS

Qualitative, reflexive thematic analysis using web-based software to organize data.

RESULTS

Four key themes were identified that applied to both of the overarching focus group topic areas (general and religious): (1) food fosters connection, (2) food influences health, (3) relationships with food are complicated, and (4) food choices reflect values. Subthemes were specific to topic areas. In religious contexts, the meaning of food was more likely understood at a community level in addition to individual and relational levels of the Social-Ecological Model.

CONCLUSIONS AND IMPLICATIONS

Acknowledgment and consideration of the religious identities of patients and clients may provide greater opportunities for community connection, which may have potential implications for community-level nutrition interventions.

A Phenomenological Investigation Into the Meaning of Food in Palliative Care Patients With Anorexia

Little has been published on the meaning of food to palliative care patients with anorexia. Our study aims to investigate the meaning of food in palliative patients with anorexia. Fifteen patients with anorexia were recruited from the Palliative Care Unit of an acute hospital in Singapore from August 2018 to August 2021. A phenomenological methodology was employed to study the lived experience of anorexia and the meaning of food to palliative care patients. Our study findings revealed that food has social, physical, and emotional meaning in palliative care patients with anorexia. The social meaning of food was the predominant theme. Food was viewed as an important tool to bond and connect with their loved ones. It was perceived to be more important than the food itself and the taste of food was enhanced through social interactions. Food intake was related to physical strength and health status. Patients regarded eating as a way to improve their health status. Emotionally, eating was associated with positive feelings like enjoyment and freedom. Half of our participants felt that anorexia contributed to their low mood. Therefore, unlike the traditional focus of modifying the taste and quality of food in patients with anorexia, the authors recommended a focused assessment and management of the social aspect of anorexia on individual. This is important to mitigate the negative impact of anorexia, thus improving the quality of life and increasing their dignity towards the end of their lives.

Living with type 2 diabetes mellitus in the Kingdom of Tonga: a qualitative investigation of the barriers and enablers to lifestyle management

BACKGROUND

Despite the increasing prevalence of Type 2 Diabetes Mellitus (T2DM) in the Kingdom of Tonga, little is known of non-communicable disease experiences among adults living in this location. This investigation aimed to explore the barriers and enablers to healthy lifestyle in a group of men and women living with T2DM residing in this Pacific Island nation.

METHODS

This qualitative study consisted of three semi-structured focus groups (n = 16), conducted at the only Tongan Public Hospital located at Nuku'alofa, capital of Tonga (north coast of the island of Tongatapu). Discussions were audio-recorded, transcribed, cross-checked for consistency, and entered into a word processing document for analysis. Thematic analysis was employed to synthesise results.

RESULTS

Four main themes were identified: (1) Knowledge and Support; (2) Fear and Motivation; 3) Physical and Psychological Environment; and (4) Faith and Culture.

CONCLUSIONS

The qualitative findings from this study will assist the future development and information dissemination of culturally appropriate lifestyle-related for men and women living with T2DM in the Kingdom of Tonga. The need for collaboration between practitioners at the hospital, the church, family members, and local traditional healers is important if the lifestyle-related needs and wants of this group of people are to be met.

Diabetes detachment: How cultural, contextual, and personal barriers influence low-income young women with diabetes in Appalachia

AIM

This study explored the experiences of young low-income women with type 2 diabetes (T2D) in Appalachia, Tennessee.

BACKGROUND

Diabetes care remains suboptimal across the United States particularly in underserved communities.

METHODS

The study employed a descriptive qualitative case study collecting data using in-depth interview of a group of low-income women in their 20s with T2D. Data was analyzed using qualitative content analysis.

RESULTS

The findings identified three themes: "frustration and stigma lead to detachment care," "frozen by fear and unable to overcome resource limitations" and "social support and an empowered perspective lead to a positive outlook." Cultural barriers combined with contextual and personal barriers resulted in detachment from diabetes care among study participants.

CONCLUSION

Within Appalachia, leveraging the existing familism values along with culturally congruent education and support can help alleviating the burden of diabetes care.

Geographic Differences in the Dietary Quality of Food Purchases among Participants in the Nationally Representative Food Acquisition and Purchase Survey (FoodAPS)

Objective grocery transactions may reflect diet, but it is unclear whether the diet quality of grocery purchases mirrors geographic and racial/ethnic disparities in diet-related diseases. This cross-sectional analysis of 3961 households in the nationally representative Food Acquisition and Purchase Survey evaluated geographic and racial/ethnic disparities in grocery purchase quality. Respondents self-reported demographics and recorded purchases over 7 days; the Healthy Eating Index (HEI) 2015 assessed diet quality. Survey-weighted multivariable-adjusted regression determined whether there were geographic and racial/ethnic differences in HEI-15 scores. Respondents were, on average, 50.6 years, non-Hispanic white (NHW) (70.3%), female (70.2%), and had attended some college (57.8%). HEI-15 scores differed across geographic region (p < 0.05), with the highest scores in the West (57.0 ± 0.8) and lowest scores in the South (53.1 ± 0.8), and there was effect modification by race/ethnicity (p-interaction = 0.02). Regionally, there were diet disparities among NHW and non-Hispanic black (NHB) households; NHWs in the South had HEI-15 scores 3.2 points lower than NHWs in the West (p = 0.003). Southern NHB households had HEI-15 scores 8.1 points lower than Western NHB households (p = 0.013). Racial/ethnic disparities in total HEI-15 by region existed in the Midwest and South, where Hispanic households in the Midwest and South had significantly lower diet quality than NHW households. Heterogeneous disparities in the diet quality of grocery purchases by region and race/ethnicity necessitate tailored approaches to reduce diet-related disease.