Urban environment and dietary behaviours as perceived by residents living in socioeconomically diverse neighbourhoods: A qualitative study in a Mediterranean context.

Scholars have determined that low socioeconomic status (SES) is associated with unhealthy dietary behaviours and that local food environments shape food inequality. Less is known about how residents' perceptions of their food environment affect their dietary behaviours. We conducted 37 semistructured interviews and 29 focus groups in three socioeconomically distinct neighbourhoods in Madrid. We identified the following main categories related to social and physical food environments: (a) perceptions of healthy and unhealthy dietary behaviours, (b) children's relationships with food, (c) precariousness and (d) residential food retailer types. Older adults were perceived as healthier consumers, whereas younger people were identified as fast-food consumers. In the low- and middle-SES neighbourhoods, residents saw home-cooked legume-based stews as healthy food. In the high-SES neighbourhood, television cooking programs were highlighted as a positive influence. In the low- and middle-SES neighbourhoods, grandparents played an essential role in the transmission of healthy eating habits to their grandchildren. In the high-SES neighbourhood, children's diets at home were determined by school menus. In the low- and middle-SES neighbourhoods, participants talked about a black market where food could be purchased. Food retailers with low-quality foods were also highlighted. In all neighbourhoods, residents missed traditional food stores, and in the low- and middle-SES neighbourhoods, immigrant-run food stores were not well accepted. Our study presents the concepts shaping how neighbourhood SES differences affect dietary behaviours according to residents of a large Mediterranean city.

Conducting member checking within a qualitative case study on health-related behaviours in a large European city: Appraising interpretations and co-constructing findings.

Although member checking is a well-established strategy for appraising credibility, there is a lack of research reporting procedures and outcomes when using this strategy. In recent years, scholars have implemented new member checking strategies along with several epistemological stances. In this work, researchers conducted member checking in three neighbourhoods with different socioeconomic status in Madrid, Spain. Attendance at member checking meetings was lower than expected. Member checking meetings were conducted in public halls within each neighbourhood and lasted approximately 2 hours. During the first hour, researchers introduced the aim of the meetings and shared summarized research findings with attendees using a slideshow. During the second hour, attendees had the opportunity to comment on any aspect of the research. Researchers used grounded theory coding strategies and a constructivist approach informed the analysis of the transcribed member checking meetings. One core category emerged, and it was named 'Co-constructing findings and side effects of the interaction between researchers and participants in member checking'. Member checking attendees contributed to co-constructing findings by means of underscore and disagreement. It is possible that these meetings might have caused side effects such as unintended comparisons between neighbourhoods and negative health-related behaviours. Attendees wondered how the findings could improve their neighbourhoods. The meetings allowed interaction between participants and researchers and resulted in appraising and co-constructing qualitative research findings. More research is needed to advance knowledge about member checking.

Factors influencing dietary inequalities among adolescents in Madrid and Bilbao: a qualitative research project.

OBJECTIVE: To describe the design and methodology of a qualitative study to explore the main factors influencing dietary inequalities in adolescents in Madrid and Bilbao, Spain. METHOD: The study area included six neighborhoods (three in each city) of different socioeconomic status (SES): low, medium, and high. We sampled 12 secondary schools (six in each city: two per socioeconomic level). Our methodology comprised: 1) developing an ad hoc index to classify all neighborhoods according to their SES; 2) selecting the study area and sample; 3) conducting semi-structured interviews (n=36) and focus groups (n=24). Grounded theory and phenomenological analysis will be employed in data analysis. Initially, we found factors influencing in adolescents' diet such as gender, family environment, and SES. CONCLUSIONS: Systematizing the selection of neighborhoods and secondary schools, along with using appropriate methods, could serve as a foundation for future studies on health inequalities among adolescents.

Can we improve our neighbourhoods to be more physically active? Residents' perceptions from a qualitative urban health inequalities study.

The objective of our study was to identify neighbourhood factors which prevent and encourage physical activity, according to the residents' perspective. We used qualitative methods, conducting 37 semi-structured interviews and 29 focus groups. The main results were that the type of physical activity that took place in every neighbourhood was different; access to sports facilities varied due to prices and safety issues; garbage and obstacles on sidewalks were a serious limitation to physical activity; economic instability had an impact on physical activity. These results might lead the perception and insights of residents to be considered in public health interventions.

Qualitative examination of the perceived effects of a comprehensive smoke-free law according to neighborhood socioeconomic status in a large city.

Smoke-free legislations aim to protect non-smokers from second-hand smoke (SHS) exposure and improve population health outcomes. The aim of this study was to explore residents' perceptions to understand how people living in distinctive SES neighborhoods are differently affected by comprehensive smoke-free laws in a large city like Madrid, Spain. We conducted a qualitative project with 37 semi-structured interviews and 29 focus group discussions in three different SES neighborhoods within the city of Madrid. Constructivist grounded theory was used to analyze the transcripts. One core category arose in our analyses: Neighborhood inequalities in second-hand smoke (SHS) exposure in outdoor places. The enactment of the comprehensive smoke-free law resulted in unintended consequences that affected neighborhoods differently: relocation of smokers to outdoor setting, SHS exposure, noise disturbance and cigarette butt littering. Changes in the urban environment in the three neighborhoods resulted in the denormalization of smoking in outdoor public places, which was more clearly perceived in the high SES neighborhood. Changes in the built environment in outdoor areas of hospitality venues were reported to actually facilitate smoking. Comprehensive smoke-free laws resulted in denormalization of smoking, which might be effective in reducing SHS exposure. Extending smoking bans to outdoor areas like bus stops and hospitality venues is warranted and should include a public health inequalities perspective.

Factors influencing dietary inequalities among adolescents in Madrid and Bilbao: a qualitative research project / Factores que influyen en las desigualdades alimentarias en Madrid y Bilbao: un proyecto de estudio cualitativo

Objective: To describe the design and methodology of a qualitative study to explore the main factorsinfluencing dietary inequalities in adolescents in Madrid and Bilbao, Spain.Method: The study area included six neighborhoods (three in each city) of different socioeconomic status(SES): low, medium, and high. We sampled 12 secondary schools (six in each city: two per socioeconomiclevel). Our methodology comprised: 1) developing an ad hoc index to classify all neighborhoods accordingto their SES; 2) selecting the study area and sample; 3) conducting semi-structured interviews (n = 36)and focus groups (n = 24). Grounded theory and phenomenological analysis will be employed in dataanalysis. Initially, we found factors influencing in adolescents’ diet such as gender, family environment,and SES.Conclusions: Systematizing the selection of neighborhoods and secondary schools, along with usingappropriate methods, could serve as a foundation for future studies on health inequalities among adolescents.(AU)

Objetivo: Describir el dise ˜no y la metodología de un estudio cualitativo que explora los factores principalesque influyen en la desigualdad alimentaria en los adolescentes en Madrid y Bilbao, Espa ˜na.Método: Se seleccionaron seis barrios (tres en cada ciudad) de diferente estatus socioeconómico (ESE):bajo, medio y alto. Obtuvimos una muestra de 12 institutos (seis en cada ciudad y dos por nivel socioe-conómico). La metodología consistió en: 1) desarrollo de un índice ad hoc para clasificar los barrios segúnsu ESE; 2) selección de las áreas de estudio y de institutos; 3) realización de entrevistas semiestructuradas(n = 36) y grupos de discusión (n = 24). En el análisis se utilizarán la teoría fundamentada y el análisisfenomenológico. Inicialmente, encontramos factores que influyen en la alimentación de los adolescentes,como el género, el entorno familiar y el ESE.Conclusiones: La sistematización en la selección de barrios e institutos, y la utilización de metodologíaadecuada, pueden servir como base para futuros estudios sobre las desigualdades de salud en adolescentes.(AU)