A Multilevel Assessment of Barriers to Adoption of Dietary Approaches to Stop Hypertension (DASH) among African Americans of Low Socioeconomic Status

Abstract

Background We examined perceptions of Dietary Approaches to Stop Hypertension (DASH) and the food environment among African Americans (AA) with high blood pressure living in two low-income communities and objectively assessed local food outlets. Methods Focus groups were conducted with 30 AAs; participants discussed DASH and the availability of healthy foods in their community. Sessions were transcribed and themes identified. Fifty-four stores and 114 restaurants were assessed using the Nutrition Environment Measures Survey (NEMS). Results Common themes included poor availability, quality, and cost of healthy foods; tension between following DASH and feeding other family members; and lack of congruity between their preferred foods and DASH. Food outlets in majority AA census tracts had lower NEMS scores (stores: −11.7, p=.01, restaurants: −8.3, p=.001) compared with majority White areas. Conclusions Interventions promoting DASH among lower income AAs should reflect the food customs, economic concerns, and food available in communities.

Feasibility, acceptability, and fidelity evaluation of a contextualised physical activity and diet intervention for hypertension control in rural South African adults

“…Our findings that study participants faced challenges in adapting to recommended dietary changes—particularly due to long-standing habits of consuming high-salt foods and difficulty in knowing and measuring appropriate salt quantities when cooking for their households—corroborate previous findings reported in other settings [ 58 ]. There is limited research that shows the duration of habit formation related to dietary changes and physical activity, however, studies suggest that eating habit formation is estimated to take between two to eight months, with 66 days being an average [ 59 ].…”

Feasibility, acceptability, and fidelity evaluation of a contextualised physical activity and diet intervention for hypertension control in rural South African adults

“…Our findings that study participants faced challenges in adapting to recommended dietary changes—particularly due to long-standing habits of consuming high-salt foods and difficulty in knowing and measuring appropriate salt quantities when cooking for their households—corroborate previous findings reported in other settings [ 58 ]. There is limited research that shows the duration of habit formation related to dietary changes and physical activity, however, studies suggest that eating habit formation is estimated to take between two to eight months, with 66 days being an average [ 59 ].…”

Geospatial approach to study the food environment according to the DASH diet guidelines, an Argentinian experience

“…Soybean and corn oils, fresh seafood, chestnuts, poppy seeds, sunflower seeds, and fresh river fish (foods in the green group) were available in less than 8% of the establishments analyzed. These results were similar to other North American studies on the food environment of African American residents with HTN and perceptions of the DASH diet, where the availability of healthy foods (low-fat dairy products, fruits, vegetables, and lean meats) was limited in several stores and restaurants, regardless of location (43) . Therefore, this environment could negatively influence people's eating behavior.…”

Adaptation of a Modified DASH Diet to a Rural African American Community Setting

“…3 These studies suggested that these adherence differences were likely influenced by food availability, cost, and culture and that additional adaptations and multilevel interventions may therefore be necessary to maximize impact of the DASH diet in African American communities. 3,8 This is consistent with research that has concluded that, to be effective in decreasing disparities, nutrition interventions must address a combination of individual, social, cultural, and environmental determinants. 9–18 …”

Feasibility, acceptability, and fidelity evaluation of a contextualised physical activity and diet intervention for hypertension control in rural South African adults

“…Our findings that study participants faced challenges in adapting to recommended dietary changes—particularly due to long-standing habits of consuming high-salt foods and difficulty in knowing and measuring appropriate salt quantities when cooking for their households—corroborate previous findings reported in other settings [ 58 ]. There is limited research that shows the duration of habit formation related to dietary changes and physical activity, however, studies suggest that eating habit formation is estimated to take between two to eight months, with 66 days being an average [ 59 ].…”

Geospatial approach to study the food environment according to the DASH diet guidelines, an Argentinian experience

“…Soybean and corn oils, fresh seafood, chestnuts, poppy seeds, sunflower seeds, and fresh river fish (foods in the green group) were available in less than 8% of the establishments analyzed. These results were similar to other North American studies on the food environment of African American residents with HTN and perceptions of the DASH diet, where the availability of healthy foods (low-fat dairy products, fruits, vegetables, and lean meats) was limited in several stores and restaurants, regardless of location (43) . Therefore, this environment could negatively influence people's eating behavior.…”

Adaptation of a Modified DASH Diet to a Rural African American Community Setting

“…3 These studies suggested that these adherence differences were likely influenced by food availability, cost, and culture and that additional adaptations and multilevel interventions may therefore be necessary to maximize impact of the DASH diet in African American communities. 3,8 This is consistent with research that has concluded that, to be effective in decreasing disparities, nutrition interventions must address a combination of individual, social, cultural, and environmental determinants. 9–18 …”

Feasibility, acceptability, and fidelity evaluation of a contextualised physical activity and diet intervention for hypertension control in rural South African adults

“…Our findings that study participants faced challenges in adapting to recommended dietary changes—particularly due to long-standing habits of consuming high-salt foods and difficulty in knowing and measuring appropriate salt quantities when cooking for their households—corroborate previous findings reported in other settings [ 58 ]. There is limited research that shows the duration of habit formation related to dietary changes and physical activity, however, studies suggest that eating habit formation is estimated to take between two to eight months, with 66 days being an average [ 59 ].…”

Geospatial approach to study the food environment according to the DASH diet guidelines, an Argentinian experience

“…Soybean and corn oils, fresh seafood, chestnuts, poppy seeds, sunflower seeds, and fresh river fish (foods in the green group) were available in less than 8% of the establishments analyzed. These results were similar to other North American studies on the food environment of African American residents with HTN and perceptions of the DASH diet, where the availability of healthy foods (low-fat dairy products, fruits, vegetables, and lean meats) was limited in several stores and restaurants, regardless of location (43) . Therefore, this environment could negatively influence people's eating behavior.…”

Adaptation of a Modified DASH Diet to a Rural African American Community Setting

“…3 These studies suggested that these adherence differences were likely influenced by food availability, cost, and culture and that additional adaptations and multilevel interventions may therefore be necessary to maximize impact of the DASH diet in African American communities. 3,8 This is consistent with research that has concluded that, to be effective in decreasing disparities, nutrition interventions must address a combination of individual, social, cultural, and environmental determinants. 9–18 …”