Use of the Nominal Group Technique (NGT) to understand the perceptions of the healthiness of foods associated with African Americans

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Abstract

Purpose

To determine the degree of overlap between foods considered part of African American (AA) culture and those considered to be healthy.

Methods

A total of 44 AA men and women were recruited from the Birmingham, AL area, 25 years of age and older to participate in four Nominal Group Technique (NGT) meetings. Participants from the first two groups generated 90 unique food items in response to the question “What are the foods you associate with being African American?” Participants individually ranked their top three most unhealthy foods. The next two groups generated 116 unique food items in response to the question “What foods do you consider to be healthy?” Participants individually ranked their top three foods that were considered most associated with AA.

Results

The top five foods associated with AA were chitterlings, fried chicken, pig parts, greens prepared with ham hock, and pork ribs. Of the foods associated with AA, chitterlings, pig parts, fatback, fried chicken, and greens prepared with ham hocks were ranked as the unhealthiest. The top five healthy foods were broccoli, boiled greens, baked fish, grapefruit, and broiled fish. From these top five healthy foods, only boiled greens were considered to be associated with AA.

Conclusions

Many of the foods AA consider as traditional foods are also perceived as unhealthy. On the contrary, foods perceived to have the most health value may not be a routine part of AA food patterns. Understanding AA perceptions of the healthfulness of foods can be informative for culturally appropriate nutrition intervention development.

Introduction

Many African Americans face major health challenges. Rates of heart disease, stroke, end-stage renal disease, diabetes and hypertension are higher in African Americans than in European Americans, and obesity and physical inactivity, which are known to worsen the impact of other major risk factors, show a higher prevalence in African American populations (AHA, 2005, Chobanian et al., 2003, Douglas et al., 2003). Behavioral interventions for overweight and obesity can produce improvements in associated risk factors for disease such as cholesterol, blood pressure and blood glucose, but subgroup analyses have demonstrated decreased weight loss for African Americans compared to European Americans, resulting in diminished risk reduction (Kumanyika et al., 1991, Wing and Anglin, 1996). While there may be many causes for the poorer health status of African Americans, nutrition and eating habits are likely to be contributing factors (Adrogue and Wesson, 1996, Miller et al., 1996). Excessive consumption of foods high in calories, fat, cholesterol and sodium, along with too little consumption of fruits, vegetables, and other high fiber foods, may contribute to an excess risk of chronic disease in this population (Ascherio et al., 1992, Ascherio et al., 1996, Glore et al., 1994, Krauss et al., 1996).

A variety of behaviors—influenced by the personal, cultural, and environmental context—place African Americans at high risk for chronic disease. There are attempts to eat ‘healthy’, but these were often overcome by traditions, social influences, habits and price. It is important to study the perceptions that African Americans have about their diets to determine how these eating patterns may be contributing to chronic disease. In the past, focus groups or interviews have provided descriptions of health perceptions, health practices, and health needs, and while each of these studies contributes to an understanding of dietary practices of African Americans, other factors need to be explored.

The purpose of this study was to better understand the perception that African Americans have of the healthfulness of their dietary choices as a cultural group. We utilized the Nominal Group Technique to elicit information from a group of African American volunteers to determine what foods African Americans most associate with their culture and if they consider these foods as healthy or unhealthy.

Section snippets

Methods

The sample consisted of 44 African American men and women recruited from advertisements in and around the metro-Birmingham, AL area. To be eligible, participants had to self-identify as African American and be at least 25 years of age. All participants provided informed consent and received $25 for taking part in the study. This study was approved by the University of Alabama at Birmingham (UAB) institutional review board.

The Nominal Group Technique (NGT), which is a qualitative method of data

Results

A total of 44 African American men and women participated in the four NGT groups. The majority of participants were women with a mean age less than 40 years old. Most of the participants were employed full time and had some college education. Complete demographic characteristics of the group are indicated in Table 1.

In response to the first question, “What are the foods you associate with being African American?” participants provided a wide variety of food and beverage items. Most participants

Discussion

This study was conducted to identify associations between cultural food items and their perceived healthiness among African Americans. Our results indicate that young, well-educated African Americans in the Southeast continue to identify traditional African American food items and habits as a relevant part of their cultural identity. The uniqueness of this study is captured in the follow-up questions and rankings that were a part of the NGT process. Among the healthy food items, there was

Acknowledgments

This project was funded in part by grant number U01 HL079171 from the National Heart, Lung, and Blood Institute and by grant number 051894 from the Robert Wood Johnson Foundation.

Wendy K. Jefferson, MA.Ed, is a clinical research study coordinator at Department of Nutrition Sciences, Clinical Nutrition and Dietetics Division, University of Alabama at Birmingham. She currently has a master's degree in Health Education/Health Promotion combined with 5 years of community outreach experience and clinical research in hypertension, diabetic, weight loss and dietetics therapeutic areas.

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  • Cited by (0)

    Wendy K. Jefferson, MA.Ed, is a clinical research study coordinator at Department of Nutrition Sciences, Clinical Nutrition and Dietetics Division, University of Alabama at Birmingham. She currently has a master's degree in Health Education/Health Promotion combined with 5 years of community outreach experience and clinical research in hypertension, diabetic, weight loss and dietetics therapeutic areas.

    Christie Zunker, PhD, is at Department of Nutrition Sciences, Clinical Nutrition and Dietetics Division, University of Alabama at Birmingham. She has a doctoral degree from the Department of Health Behavior in the School of Public Health at the University of Alabama at Birmingham. Her dissertation focused on how women maintain their weight after completing a physician-supervised weight management program. In addition, she is a Certified Health Education Specialist (CHES) with experience working with high risk individuals.

    Jennifer C. Feucht, is a UAB medical student.

    Stephanie L. Fitzpatrick, MPH, is a PhD candidate at the University of Miami

    Lori F. Greene, MS, RD, LD, is a UA coordinator of nutrition and health services, a registered dietitian of the American Dietetic Association, a licensed dietitian of the Alabama Board of Examiners for Dietetic/Nutrition Practice and has a certificate of training in adult weight management.

    Richard M. Shewchuk, PhD, is a professor at Health Administration, Department of Health Services Administration, University of Alabama at Birmingham. He teaches courses in quantitative methods and long-term care administration. He serves as an associate director of the Gerontology Education Program at the University of Alabama at Birmingham and holds appointments as a scholar in the Lister Hill Center for Health Policy and the Center for Aging. His research focuses on issues related to the provision of services to persons with chronic health conditions. His research has been funded by grants from the Centers for Disease Control and the National Institute on Disability and Rehabilitation Research. He has been published in such journals as Hospital and Health Services Administration, Health Care Management Review, The Counseling Psychologist, The Journal of Health Care Marketing, The Journal of the American Geriatrics Society, Health Psychology, Rehabilitation Psychology, and Professional Psychology: Research and Practice.

    Monica L. Baskin, PhD, is an Associate Professor of Public Health, School of Public Health, Department of Health Behavior, University of Alabama at Birmingham. Her research focuses on childhood obesity prevention, particularly among African Americans. Much of her work links academic partners to community- and faith-based networks. She has led research projects focusing on individual, family, and environmental factors associated with healthy eating, physical activity, and/or obesity. As part of a diversity supplement to the UAB Deep South Network for Cancer Control, she has recently begun a study in which community members residing in rural Alabama will be trained to assess the nutrition and physical activity environments in their communities and use this information for advocating change in the built environment to reduce cancer health disparities. In addition, she is leading a community-based participatory project that is examining the influence of the food marketing environment on calorie overconsumption among African American children and their families. She has published in the areas of obesity, culturally competent interventions, health promotion programs in Black churches, and motivational interviewing (MI). She is also a member of the Alabama Obesity Task Force, the Alabama Chapter of Action for Healthy Kids, and the Jefferson County, Alabama Health Action Committee.

    Norman W. Walton is a dermatologist and the president, Mineral District Medical Society.

    Beatrice Phillips, EdD, RD, LD, Tuskegee University, BS, food administration, MS, human nutrition, RD, dietetic internship, LD, dietetics/nutrition Auburn University, EdD, nutrition education. She is an associate professor, nutrition and director, didactic program in dietetics at Tuskegee University 1991–present. She was an assistant professor and director of coordinated undergraduate program in dietetics at Dept. of Home Economics, Tuskegee 1976–1990.

    Jamy D. Ard is an Associate Professor at School of Health Related Professions, Department of Nutrition Sciences, Clinical Nutrition and Dietetics Division, University of Alabama at Birmingham. His Current research interests include behavioral therapies that are focused on cardiovascular risk reduction. I have a special interest in the African American population and developing strategies for behavior modification that are culturally appropriate for this group. I also have a general interest in developing strategies that will improve African American participation and outcomes in clinical trials that deal with cardiovascular disease risk. He has worked on several trials that deal with the above issues including DASH, DASH-Sodium, PREMIER and currently Weight Loss Maintenance (WLM). As a co-investigator on the WLM study, he serves as a member of the minority implementation committee, working to ensure that the interventions are culturally appropriate for our minority participants. We have also devised unique strategies for recruitment and retention of African American participants. Many of these strategies involve making community ties and developing relationships with influential community leaders that serve as a source of guidance and information.

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