How people interpret healthy eating: contributions of qualitative research.

OBJECTIVE: To identify how qualitative research has contributed to understanding the ways people in developed countries interpret healthy eating. DESIGN: Bibliographic database searches identified reports of qualitative, empirical studies published in English, peer-reviewed journals since 1995. DATA ANALYSIS: Authors coded, discussed, recoded, and analyzed papers reporting qualitative research studies related to participants' interpretations of healthy eating. RESULTS: Studies emphasized a social constructionist approach, and most used focus groups and/or individual, in-depth interviews to collect data. Study participants explained healthy eating in terms of food, food components, food production methods, physical outcomes, psychosocial outcomes, standards, personal goals, and as requiring restriction. Researchers described meanings as specific to life stages and different life experiences, such as parenting and disease onset. Identity (self-concept), social settings, resources, food availability, and conflicting considerations were themes in participants' explanations for not eating according to their ideals for healthy eating. IMPLICATIONS: People interpret healthy eating in complex and diverse ways that reflect their personal, social, and cultural experiences, as well as their environments. Their meanings include but are broader than the food composition and health outcomes considered by scientists. The rich descriptions and concepts generated by qualitative research can help practitioners and researchers think beyond their own experiences and be open to audience members' perspectives as they seek to promote healthy ways of eating.

Eating maps: places, times, and people in eating episodes.

This project developed a method for constructing eating maps that portray places, times, and people in an individual's eating episodes. Researchers used seven consecutive days of qualitative eating recall interviews from 42 purposively sampled U.S. adults to draw a composite eating map of eating sites, meals, and partners for each person on a template showing home, work, automobile, other homes, and other places. Participants evaluated their own maps and provided feedback. The eating maps revealed diverse places, times, and partners. Eating maps offer a flexible tool for eliciting, displaying, validating, and applying information to visualize eating patterns within contexts.

Work conditions and the food choice coping strategies of employed parents.

OBJECTIVE: How work conditions relate to parents' food choice coping strategies. DESIGN: Pilot telephone survey. SETTING: City in the northeastern United States (US). PARTICIPANTS: Black, white, and Hispanic employed mothers (25) and fathers (25) randomly recruited from low-/moderate-income zip codes; 78% of those reached and eligible participated. MAIN OUTCOME MEASURES: Sociodemographic characteristics; work conditions (hours, shift, job schedule, security, satisfaction, food access); food choice coping strategies (22 behavioral items for managing food in response to work and family demands (ie, food prepared at/away from home, missing meals, individualizing meals, speeding up, planning). ANALYSIS: Two-tailed chi-square and Fisher exact tests (P < or = .05, unless noted). RESULTS: Half or more of respondents often/sometimes used 12 of 22 food choice coping strategies. Long hours and nonstandard hours and schedules were positively associated among fathers with take-out meals, missed family meals, prepared entrees, and eating while working; and among mothers with restaurant meals, missed breakfast, and prepared entrees. Job security, satisfaction, and food access were also associated with gender-specific strategies. CONCLUSIONS AND IMPLICATIONS: Structural work conditions among parents such as job hours, schedule, satisfaction, and food access are associated with food choice coping strategies with importance for dietary quality. Findings have implications for worksite interventions but need examination in a larger sample.

Employed parents' satisfaction with food-choice coping strategies. Influence of gender and structure.

This study aimed to understand parents' evaluations of the way they integrated work-family demands to manage food and eating. Employed, low/moderate-income, urban, U.S., Black, White, and Latino mothers (35) and fathers (34) participated in qualitative interviews exploring work and family conditions and spillover, food roles, and food-choice coping and family-adaptive strategies. Parents expressed a range of evaluations from overall satisfaction to overall dissatisfaction as well as dissatisfaction limited to work, family life, or daily schedule. Evaluation criteria differed by gender. Mothers evaluated satisfaction on their ability to balance work and family demands through flexible home and work conditions, while striving to provide healthy meals for their families. Fathers evaluated satisfaction on their ability to achieve schedule stability and participate in family meals, while meeting expectations to contribute to food preparation. Household, and especially work structural conditions, often served as sizeable barriers to parents fulfilling valued family food roles. These relationships highlight the critical need to consider the intersecting influences of gender and social structure as influences on adults' food choices and dietary intake and to address the challenges of work and family integration among low income employed parents as a way to promote family nutrition in a vulnerable population.

Eating routines. Embedded, value based, modifiable, and reflective.

Eating routines are a compelling issue because recurring eating behaviors influence nutrition and health. As non-traditional and individualized eating patterns have become more common, new ways of thinking about routine eating practices are needed. This study sought to gain conceptual understanding of working adults' eating routines. Forty-two purposively sampled US adults reported food intake and contextual details about eating episodes in qualitative 24-h dietary recalls conducted over 7 consecutive days. Using the constant comparative method, researchers analyzed interview transcripts for recurrent ways of eating that were either explicitly reported by study participants as "routines" or emergent in the data. Participants' eating routines included repetition in food consumption as well as eating context, and also involved sequences of eating episodes. Eating routines were embedded in daily schedules for work, family, and recreation. Participants maintained purposeful routines that helped balance tension between demands and values, but they modified routines as circumstances changed. Participants monitored and reflected upon their eating practices and tended to assess their practices in light of their personal identities. These findings provide conceptual insights for food choice researchers and present a perspective from which practitioners who work with individuals seeking to adopt healthful eating practices might usefully approach their tasks.

How adults construct evening meals. Scripts for food choice.

The evening meal is an important regular event in the lives of many people. Understanding how people cognitively construct evening meals can provide insight into social and behavioral processes that are used in food choice. Schema theory provided a framework to explore cognitive constructions as scripts that guide behavior for the evening meal. A grounded theory approach was used to explore participants' evening meal scripts. Qualitative interviews with 32 adults were conducted and analyzed using the constant comparative method. Analysis revealed that participants' evening meal scripts were guided and shaped by dominant values and general expectations about food and eating in this context. Evening meal scripts included sequentially ordered behaviors characterized as strategies providing a general guide for behaviors and procedures that include relatively specific details about how the behavior will occur within the context. Eight different kinds of scripts emerged from the analysis including Provider, Family Cook, Head of the table, Egalitarian, Struggler, Just eat, Anything goes, and Entertainer. The exploration of food choice scripts provides insight into links between cognitions and behaviors that may influence dietary intake. Future investigations should examine these scripts with different participants, in different settings, and for different eating contexts.

Trying to find the quickest way: employed mothers' constructions of time for food.

OBJECTIVE: The study sought to develop an understanding of how employed mothers constructed time for food provisioning for themselves and their families. DESIGN: A grounded theory approach and semistructured, in-depth interviews. SETTING: A metropolitan area of approximately 1 million people in the northeastern United States. PARTICIPANTS: Thirty-five low-wage employed mothers were purposively recruited to vary in occupation, race/ethnicity, education, household composition, and age using workplace, community, convenience, and snowball sampling. PHENOMENON OF INTEREST: Low-wage employed mothers' constructions of time for food. ANALYSIS: Interview transcripts were analyzed using the constant comparative method. RESULTS: Most mothers expressed feelings of time scarcity. Mothers described 3 timestyles that reflected how they constructed time. Timestyles reflected mothers' experiences of strain and time scarcity, usual time management strategies, and sense of control over time. Mothers prioritized feeding their children but wanted to complete meals quickly in order to move on to other tasks. CONCLUSIONS AND IMPLICATIONS: Recognizing issues of time scarcity and individual differences of timestyles and time management strategies can help researchers better understand food choice practices and assist practitioners in identifying practical food provisioning strategies for low-wage employed mothers. Food policies and recommendations should be evaluated for their relevance to the time scarcity and work strain issues that these mothers faced.

Dimensions of everyday eating and drinking episodes.

This study sought to gain conceptual understanding of the situational nature of eating and drinking by analyzing 7 consecutive, qualitative 24-h recalls of foods and beverages consumed from 42 US adults who worked in non-managerial, non-professional positions. Participants were purposively recruited to vary in age, gender, occupation, and household composition. For each recall, participants described foods and beverages consumed, location, people present, thoughts and feelings, and activities occurring at that time. Analysis of verbatim transcripts of interviews identified 1448 eating and drinking episodes. Constant comparative analysis of participants' descriptions for episodes resulted in a conceptual framework that characterizes eating and drinking episodes as holistic and as having eight interconnected dimensions (food and drink, time, location, activities, social setting, mental processes, physical condition, recurrence). Each dimension has multiple features that can be used to describe the episodes. In recalling episodes, participants used conventional labels (e.g. "dinner") as well as modified-conventional labels (e.g. "birthday dinner") and uniquely constructed labels (e.g. "unwind time"). Labels provided insights into the dimensions of the episodes. Results suggest approaches for researchers and practitioners who seek to understand how people manage everyday eating at a time when traditional meal patterns are changing.

"A lot of sacrifices:" work-family spillover and the food choice coping strategies of low-wage employed parents.

Integrating their work and family lives is an everyday challenge for employed parents. Competing demands for parents' time and energy may contribute to fewer meals prepared or eaten at home and poorer nutritional quality of meals. Thus, work-family spillover (feelings, attitudes, and behaviors carried over from one role to another) is a phenomenon with implications for nutrition and health. The aim of this theory-guided constructivist research was to understand how low-wage employed parents' experiences of work-family spillover affected their food choice coping strategies. Participants were 69 black, white and Latino mothers and fathers in a Northeastern US city. We explored participants' understandings of family and work roles, spillover, and food choice strategies using open-ended qualitative interviews. Data analysis was based on the constant comparative method. These parents described affective, evaluative, and behavioral instances of work-family spillover and role overload as normative parts of everyday life and dominant influences on their food choices. They used food choice coping strategies to: (1) manage feelings of stress and fatigue, (2) reduce the time and effort for meals, (3) redefine meanings and reduce expectations for food and eating, and (4) set priorities and trade off food and eating against other family needs. Only a few parents used adaptive strategies that changed work or family conditions to reduce the experience of conflict. Most coping strategies were aimed at managing feelings and redefining meanings, and were inadequate for reducing the everyday hardships from spillover and role overload. Some coping strategies exacerbated feelings of stress. These findings have implications for family nutrition, food expenditures, nutritional self-efficacy, social connections, food assistance policy, and work place strategies.

It just really clicked: participant-perceived outcomes of community nutrition education programs.

OBJECTIVE: To understand participant-perceived outcomes of community nutrition education programs by low income adults. DESIGN: A grounded theory approach using qualitative interviews. SETTING: Rural and urban communities in New York State and Pennsylvania. PARTICIPANTS: 18 current and past participants in nutrition education programs for low income adults. PHENOMENA OF INTEREST: Participants' perceived outcomes of community nutrition education programs. ANALYSIS: Qualitative analysis derived from the constant comparative method. RESULTS: Participants described program experiences in three linked thematic areas: (1) a range of motives for program enrollment; (2) current roles, challenges and resources as program contexts; and (3) participant-perceived outcomes experienced throughout the program that were linked to their motives for enrolling. Short- and medium-term outcomes, especially social outcomes, were important to participants; positive experiences were linked to later behavior change by participants, even among those who did not initially report change. CONCLUSIONS AND IMPLICATIONS: Participant-perceived outcomes and program satisfaction were linked to enrollment motives and modified by whether participants' current worlds provided resources to put learning into practice. Participant inputs such as enrollment motives and resources should be included in planning models, assessed at multiple points, matched to expected program outcomes, and used to guide teaching.

A biographical study of food choice capacity: standards, circumstances, and food management skills.

OBJECTIVE: Conceptual understanding of how management of food and eating is linked to life course events and experiences. DESIGN/SETTING: Individual qualitative interviews with adults in upstate New York. PARTICIPANTS: Fourteen men and 11 women with moderate to low incomes. PHENOMENON: Food choice capacity. ANALYSIS: Constant comparative method. RESULTS: A conceptual model of food choice capacity emerged. Food choice capacity represented participants' confidence in meeting their standards for food and eating given their food management skills and circumstances. Standards (expectations for how participants felt they should eat) were based on life course events and experiences. Food management skills (mental and physical talents to keep food costs down and prepare meals) were sources of self-esteem for many participants. Most participants had faced challenging and changing circumstances (income, employment, social support, roles, health conditions). Participants linked strong food management skills with high levels of food choice capacity, except in the case of extreme financial circumstances or the absence of strong standards. IMPLICATIONS FOR RESEARCH AND PRACTICE: Recognizing people's experiences and perspectives in food choice is important. Characterizing food management skills as durable, adaptive resources positions them conceptually for researchers and in a way that practitioners can apply in developing programs for adults.

On the front line: practice satisfactions and challenges experienced by dietetics and nutrition professionals working in community settings in New York State.

The goal of this study was to understand dietetics and nutrition professionals' experiences of their practice roles. Qualitative interviews using a grounded theory design covered practitioners' perceptions of their professional roles, role enactment, and practice context. Twenty-four dietetics and nutrition practitioners varying in their work settings, length of professional experience, education, and community type were recruited through professional contacts in New York State. Interview transcripts were analyzed using the constant comparative method of qualitative data analysis. An ecological model of practice in context emerged in which participants described daily practice satisfactions and challenges arising out of interactions among their personal characteristics, client characteristics, the work setting, and the food and nutrition and health care systems. Practice satisfactions related to positive interactions and measurable outcomes of work with clients and coworkers, recognition for expert and helper roles, and involvement in disease prevention. Practice challenges centered on others' misunderstandings of the dietary change process, assessment of practice outcomes, others' respect for expertise, keeping up-to-date, client and coworker expectations, isolation from peers, and the food environment. An ecological model of dietetics and nutrition practice as experienced in community settings draws attention to the need to address challenges in the multiple contexts that frame that practice.