Perceived Barriers to the Consumption of Fruits and Vegetables in Middle Age: Qualitative Ecological Study
Authors
-
Sharareh Bagheri
Ph.D. student of health education and health promotion, Vice-Chancellor for Health Affairs, Kurdistan University of Medical Sciences, Sanandaj, Iran.
https://orcid.org/0000-0003-2511-1930
-
Khadije Ezzati Rastegar
Ph.D. of Health education and health promotion, Vice-Chancellor for Health Affairs, Hamedan University of Medical Sciences, Hamedan, Iran.
https://orcid.org/0000-0002-3503-5532
-
Aysan Setayesh
Nursing student, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran.
https://orcid.org/0000-0003-2511-1930
DOI:
https://doi.org/10.22100/ijhs.v8i1.889Keywords:
Ecological model, Qualitative studyAbstract
Background: Consumption of fruits and vegetables is associated with reduced occurrence of mortality stemming from a variety of chronic diseases. This study, employing the environmental model of health behaviors, aimed to investigate the perceived barriers to the consumption of fruits and vegetables in middle-aged individuals.
Methods: This is a qualitative study of content analysis, conducted through eight focus group discussions targeting middle-aged individuals, and five individual interviews with the key individuals in 2017. A framework of factors altering the nutritional behaviors of individuals who were classified into four levels was recognized via employing the ecological model. Results: Barriers to consuming fruits and vegetables at the individual level included beliefs, nutritional awareness, and eating habits of the past. At the interpersonal level, family and social support were the major barriers. At the community level, socio-cultural values and norms, environmental components such as accessibility, quality of fruits and vegetables, media, and prices were also among the major barriers. At the public policies level, not monitoring the production and supply of quality products were among the barriers the participants stated.
Conclusions: Politicians should weigh upon support programs to reduce the production cost of high-quality fruits and vegetables in low-income communities, and adopt the necessary laws and policies to discuss the production and supply of quality, toxin-free fruits, and vegetables at the macro level.
Keyword: Fruits, Vegetables, Ecological model, Qualitative study, Focus group
References
1. Slavin J.L, Lloyd B. Health benefits of fruits and vegetables. Advances in nutrition 2012; 3(4):506-16.
2. Nour M, Lutze SA, Grech A, Allman-Farinelli M. The relationship between vegetable intake and weight outcomes: a systematic review of cohort studies. Nutrients 2018; 10(11):1626. https://doi. 10.3390/nu10111626
3.World Health Organization. Promoting fruit and vegetable consumption around the world. Available in: [http://www who int/dietphysicalactivity/fruit/en html] [Consulta 11 Agosto 2017]. 2017.
4. Dhandevi P, Jeewon R. Fruit and vegetable intake: Benefits and progress of nutrition education interventions-narrative review article. Iranian journal of public health 2015; 44(10):1309.
5. Kiadaliri A.A. Demographic and socioeconomic differences in fruit and vegetables consumption, 2007-2009: a province-level study in Iran. International journal of preventive medicine 2013; 4(7):831.
6. Pelau C, Sarbu R, Serban D. Cultural Influences on Fruit and Vegetable Food-Wasting Behavior in the European Union. Sustainability 2020; 12(22):9685.
7. Webber C.B, Sobal J, Dollahite J.S. (2010) Shopping for fruits and vegetables. Food and retail qualities of importance to low-income households at the grocery store. Appetite 2010; 54(2):297-303.5. https://doi. 10. 1016/j.appet.2009.11.015
8. Santos G.M.G.C.d., Silva A.M.R., Carvalho W.O.d., Rech C.R., Loch M.R. Perceived barriers for the consumption of fruits and vegetables in Brazilian adults. Ciencia & saude coletiva 2019; 24:2461-70. https://doi. 10.1590/1413-81232018247.19992017
9. Timmermans Y, van de Kant K, Krumeich J, Zimmermann L, Dompeling E, Kramer B et al. Socio-ecological determinants of lifestyle behavior of women with overweight or obesity before, during and after pregnancy: qualitative interview analysis in the Netherlands. BMC pregnancy and childbirth 2020; 20(1):105. https://doi. 10.1186/s12884-020-2786-5
10. Erlingsson C, Brysiewicz P. A hands-on guide to doing content analysis. African Journal of Emergency Medicine 2017; 7(3):93-9. https://doi. 10.1016/j.afjem.2017.08.001
11. O. Nyumba T, Wilson K, Derrick C.J., Mukherjee N. The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and evolution 2018; 9(1):20-32.
12. Kreausukon P, Gellert P, Lippke S, Schwarzer R. Planning and self-efficacy can increase fruit and vegetable consumption: a randomized controlled trial. Journal of behavioral medicine 2012; 35(4):443-51. https://doi. 10.1007/s10865-011-9373-1. Epub 2011 Aug 7.
13.Skreden, M., Bere, E., Sagedal, L.R., Vistad, I., Qverby, N.C. (2017) Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women. BMC pregnancy and childbirth, 17(1):1-9. https://doi. 10.1186/s12884-017-1291-y
14. Clear J. How to Break a Bad Habit (and Replace it With a Good One). James Clear 2013.
15. Wijesinha-Bettoni R, Orito A, Lowik M, Mclean C, Muehlhoff E. Increasing fruit and vegetable consumption among schoolchildren: efforts in middle-income countries. Food and nutrition bulletin 2013; 34(1):75-94. https://doi. 10.1177/156482651303400109
16. Schmidt S.K, Hemmestad L, MacDonald C.S, Langberg H, Valentiner L.S. Motivation and Barriers to Maintaining Lifestyle Changes in Patients with Type 2 Diabetes after an Intensive Lifestyle Intervention (The U-TURN Trial): A Longitudinal Qualitative Study. International Journal of Environmental Research and Public Health 2020; 17(20):7454. https://doi. 10.3390/ijerph17207454
17. Nathan N, Wolfenden L, Butler M, Bell A.C, Wyse R, Campbell E et al. Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies. Health education research 2011; 26(4):722-31. https://doi. 10.1093/her/cyr033. Epub 2011 May 13
18. Roudsari A.H, Vedadhir A, Amiri P, Kalantari N, Omidvar N, Eini-Zinab H et al. Psycho-socio-cultural determinants of food choice: A qualitative study on adults in social and cultural context of Iran. Iranian journal of psychiatry 2017; 12(4):241.
19. Kazemi A, Zahraei N.N, Nazarian N. The relation between intra-and interpersonal factors and food consumption level among Iranian adolescent girls. Iranian journal of nursing and midwifery research 2016; 21(2):147. https://doi. 0.4103/1735-9066.178235
20. Wang M.C, Naidoo N, Ferzacca S, Reddy G, Van Dam R.M. The role of women in food provision and food choice decision-making in Singapore: a case study. Ecology of food and nutrition 2014; 53(6):658-77. https://doi. 10.1080/03670244.2014.911178
21. Hanson A.J, Kattelmann K.K, McCormack L.A, Zhou W, Brown O.N, Horacek T.M, et al. Cooking and meal planning as predictors of fruit and vegetable intake and BMI in first-year college students. International journal of environmental research and public health 2019; 16(14):2462. https://doi. 10.3390/ijerph16142462
22. Monsivais P, Aggarwal A, Drewnowski A.Time spent on home food preparation and indicators of healthy eating. American journal of preventive medicine 2014; 47(6):796-802.
21. Galick A. Women's Roles in Families. Encyclopedia of Family Studies 2016; 1-3.
24. Haynes-Maslow L, Parsons S.E, Wheeler S.B, Leone L.A. Peer reviewed: a qualitative study of perceived barriers to fruit and vegetable consumption among low-income populations, North Carolina 2013; 2011. Preventing chronic disease, 10. https://doi. 10.5888/pcd10.120206
25. Nago E.S, Verstraeten R, Lachat C.K, Dossa R.A, Kolsteren P.W. Food safety is a key determinant of fruit and vegetable consumption in urban Beninese adolescents. Journal of nutrition education and behavior 2012; 44(6):548-55. https://doi. 10.1016/j.jneb.2011.06.006. Epub 2011 Nov 23
26. Siegel K.R. Insufficient consumption of fruits and vegetables among individuals 15 Years and older in 28 low-and middle-income countries: what can Be done? The Journal of nutrition 2019; 149(7):1105-6. https://doi. 10.1093/jn/nxz123
27. Risica P.M, Gorham G, Dionne L, Nardi W, Ng D, Middler R et al. A multi-level intervention in worksites to increase fruit and vegetable access and intake: Rationale, design and methods of the ‘Good to Go’cluster randomized trial. Contemporary clinical trials 2018; 65:87-98. https://doi. 10.1016/j.cct.2017.12.002
28. Khashroom A.O, Saewan S.A, George S.S, Hamad H.J. Chemical and Microbial Environmental Contaminants in Fruits and Vegetables and their Effects on Health: A Mini Review. Journal of Environmental Science, Toxicology and Food Technology 2019; 13(4): 70-76.
29. Rai P.K, Lee S.S, Zhang M, Tsang Y.F, Kim K.H.Heavy metals in food crops: Health risks, fate, mechanisms, and management. Environment international 2019; 125:365-85. https://doi. 10.1016/j.envint.2019.01.067
30. Sogari G, Velez-Argumedo C, Gomez M.I, Mora C. College students and eating habits: A study using an ecological model for healthy behavior. Nutrients 2018; 10(12):1823. https://doi. 10.3390/nu10121823
2. Nour M, Lutze SA, Grech A, Allman-Farinelli M. The relationship between vegetable intake and weight outcomes: a systematic review of cohort studies. Nutrients 2018; 10(11):1626. https://doi. 10.3390/nu10111626
3.World Health Organization. Promoting fruit and vegetable consumption around the world. Available in: [http://www who int/dietphysicalactivity/fruit/en html] [Consulta 11 Agosto 2017]. 2017.
4. Dhandevi P, Jeewon R. Fruit and vegetable intake: Benefits and progress of nutrition education interventions-narrative review article. Iranian journal of public health 2015; 44(10):1309.
5. Kiadaliri A.A. Demographic and socioeconomic differences in fruit and vegetables consumption, 2007-2009: a province-level study in Iran. International journal of preventive medicine 2013; 4(7):831.
6. Pelau C, Sarbu R, Serban D. Cultural Influences on Fruit and Vegetable Food-Wasting Behavior in the European Union. Sustainability 2020; 12(22):9685.
7. Webber C.B, Sobal J, Dollahite J.S. (2010) Shopping for fruits and vegetables. Food and retail qualities of importance to low-income households at the grocery store. Appetite 2010; 54(2):297-303.5. https://doi. 10. 1016/j.appet.2009.11.015
8. Santos G.M.G.C.d., Silva A.M.R., Carvalho W.O.d., Rech C.R., Loch M.R. Perceived barriers for the consumption of fruits and vegetables in Brazilian adults. Ciencia & saude coletiva 2019; 24:2461-70. https://doi. 10.1590/1413-81232018247.19992017
9. Timmermans Y, van de Kant K, Krumeich J, Zimmermann L, Dompeling E, Kramer B et al. Socio-ecological determinants of lifestyle behavior of women with overweight or obesity before, during and after pregnancy: qualitative interview analysis in the Netherlands. BMC pregnancy and childbirth 2020; 20(1):105. https://doi. 10.1186/s12884-020-2786-5
10. Erlingsson C, Brysiewicz P. A hands-on guide to doing content analysis. African Journal of Emergency Medicine 2017; 7(3):93-9. https://doi. 10.1016/j.afjem.2017.08.001
11. O. Nyumba T, Wilson K, Derrick C.J., Mukherjee N. The use of focus group discussion methodology: Insights from two decades of application in conservation. Methods in Ecology and evolution 2018; 9(1):20-32.
12. Kreausukon P, Gellert P, Lippke S, Schwarzer R. Planning and self-efficacy can increase fruit and vegetable consumption: a randomized controlled trial. Journal of behavioral medicine 2012; 35(4):443-51. https://doi. 10.1007/s10865-011-9373-1. Epub 2011 Aug 7.
13.Skreden, M., Bere, E., Sagedal, L.R., Vistad, I., Qverby, N.C. (2017) Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women. BMC pregnancy and childbirth, 17(1):1-9. https://doi. 10.1186/s12884-017-1291-y
14. Clear J. How to Break a Bad Habit (and Replace it With a Good One). James Clear 2013.
15. Wijesinha-Bettoni R, Orito A, Lowik M, Mclean C, Muehlhoff E. Increasing fruit and vegetable consumption among schoolchildren: efforts in middle-income countries. Food and nutrition bulletin 2013; 34(1):75-94. https://doi. 10.1177/156482651303400109
16. Schmidt S.K, Hemmestad L, MacDonald C.S, Langberg H, Valentiner L.S. Motivation and Barriers to Maintaining Lifestyle Changes in Patients with Type 2 Diabetes after an Intensive Lifestyle Intervention (The U-TURN Trial): A Longitudinal Qualitative Study. International Journal of Environmental Research and Public Health 2020; 17(20):7454. https://doi. 10.3390/ijerph17207454
17. Nathan N, Wolfenden L, Butler M, Bell A.C, Wyse R, Campbell E et al. Vegetable and fruit breaks in Australian primary schools: prevalence, attitudes, barriers and implementation strategies. Health education research 2011; 26(4):722-31. https://doi. 10.1093/her/cyr033. Epub 2011 May 13
18. Roudsari A.H, Vedadhir A, Amiri P, Kalantari N, Omidvar N, Eini-Zinab H et al. Psycho-socio-cultural determinants of food choice: A qualitative study on adults in social and cultural context of Iran. Iranian journal of psychiatry 2017; 12(4):241.
19. Kazemi A, Zahraei N.N, Nazarian N. The relation between intra-and interpersonal factors and food consumption level among Iranian adolescent girls. Iranian journal of nursing and midwifery research 2016; 21(2):147. https://doi. 0.4103/1735-9066.178235
20. Wang M.C, Naidoo N, Ferzacca S, Reddy G, Van Dam R.M. The role of women in food provision and food choice decision-making in Singapore: a case study. Ecology of food and nutrition 2014; 53(6):658-77. https://doi. 10.1080/03670244.2014.911178
21. Hanson A.J, Kattelmann K.K, McCormack L.A, Zhou W, Brown O.N, Horacek T.M, et al. Cooking and meal planning as predictors of fruit and vegetable intake and BMI in first-year college students. International journal of environmental research and public health 2019; 16(14):2462. https://doi. 10.3390/ijerph16142462
22. Monsivais P, Aggarwal A, Drewnowski A.Time spent on home food preparation and indicators of healthy eating. American journal of preventive medicine 2014; 47(6):796-802.
21. Galick A. Women's Roles in Families. Encyclopedia of Family Studies 2016; 1-3.
24. Haynes-Maslow L, Parsons S.E, Wheeler S.B, Leone L.A. Peer reviewed: a qualitative study of perceived barriers to fruit and vegetable consumption among low-income populations, North Carolina 2013; 2011. Preventing chronic disease, 10. https://doi. 10.5888/pcd10.120206
25. Nago E.S, Verstraeten R, Lachat C.K, Dossa R.A, Kolsteren P.W. Food safety is a key determinant of fruit and vegetable consumption in urban Beninese adolescents. Journal of nutrition education and behavior 2012; 44(6):548-55. https://doi. 10.1016/j.jneb.2011.06.006. Epub 2011 Nov 23
26. Siegel K.R. Insufficient consumption of fruits and vegetables among individuals 15 Years and older in 28 low-and middle-income countries: what can Be done? The Journal of nutrition 2019; 149(7):1105-6. https://doi. 10.1093/jn/nxz123
27. Risica P.M, Gorham G, Dionne L, Nardi W, Ng D, Middler R et al. A multi-level intervention in worksites to increase fruit and vegetable access and intake: Rationale, design and methods of the ‘Good to Go’cluster randomized trial. Contemporary clinical trials 2018; 65:87-98. https://doi. 10.1016/j.cct.2017.12.002
28. Khashroom A.O, Saewan S.A, George S.S, Hamad H.J. Chemical and Microbial Environmental Contaminants in Fruits and Vegetables and their Effects on Health: A Mini Review. Journal of Environmental Science, Toxicology and Food Technology 2019; 13(4): 70-76.
29. Rai P.K, Lee S.S, Zhang M, Tsang Y.F, Kim K.H.Heavy metals in food crops: Health risks, fate, mechanisms, and management. Environment international 2019; 125:365-85. https://doi. 10.1016/j.envint.2019.01.067
30. Sogari G, Velez-Argumedo C, Gomez M.I, Mora C. College students and eating habits: A study using an ecological model for healthy behavior. Nutrients 2018; 10(12):1823. https://doi. 10.3390/nu10121823
Published
2021-08-24
Issue
Section
Articles
License
The Copyright Form should be downloaded and signed by corresponding author in the fourth step "upload supplementary files" during submission process.
After acceptance, copyright form should be downloaded and signed by all authors one by one ( "summery --> supp. file" part and click on "add a supplementary file" link).
How to Cite
Perceived Barriers to the Consumption of Fruits and Vegetables in Middle Age: Qualitative Ecological Study. (2021). International Journal of Health Studies (Undergoing Change to Shahroud Journal of Medical Sciences), 8(1), 32-37. https://doi.org/10.22100/ijhs.v8i1.889
