### Abstract

The countless health benefits of adopting healthy eating habits have been well documented. It is troubling then that studies examining dietary behaviors among minority women find that compared with European American women, African American women practice poorer dietary habits. Given this reality, and the knowledge that poor nutrition is a contributing risk factor for chronic, cardiovascular and metabolic diseases, better understandings of minority women and their relationships with food are needed. This study aimed to contribute to this effort by surveying African Canadian women to explore both their eating habits and their perceptions of nutrition. Participants in this study were Canadian women of African ancestry who were 25 years old or older. Fifty of these women chose to participate and did so by completing a brief written survey and answering one open-ended question. Survey results revealed that the respondents rated their present eating habits as “excellent” (6%), “very good” (36%), “good” (40%), or “fair” (17%). Top dietary changes made by participants included reducing salt, fat and/or sugar intake, and/or increasing fruit and vegetable consumption. The open-ended question asked what supports could be put in place to encourage healthy eating and many of the respondents noted that nutritional classes/workshops for black women that could be offered through the community or the church would be beneficial. This study suggests increased efforts are required to further educate African Canadian women about healthy eating as poor nutrition is a significant risk factor for many of the diseases prevalent in black communities. It is imperative that any initiated nutritional education programmes be tailored to meet the cultural and linguistic background of the targeted group in question. Further research is warranted to expand our understandings of African Canadian women’s eating habits and how their food choices affect their overall health.

**Key Words:** minority women, nutrition, health status, diet-related illnesses

### Introduction

Many health professionals agree that the most significant and controllable risk factor affecting long-term health and well-being is diet. Indeed, the first steps commonly suggested for improving health and longevity are lifestyle changes like lowering salt intake, reducing total fat/saturated fat in our diets, increasing fibre intake and fruit and vegetable consumption, and integrating regular exercise into our daily routine. Without a doubt, there are countless benefits to adopting healthy eating habits. It is troubling then that studies in the United States examining dietary behaviors among minority women find that compared with European American women, African American women practice poorer dietary habits. In a number of recent studies for example, African American women were shown to consume less fruits and vegetables, and to eat more foods that were high in sodium and/or fat (1-3). The American Heart Association’s 2009 Heart Disease and Stroke Statistical Update (4) reported that on average, only three to five percent of adult African Americans consumed the recommended three or more daily servings of whole grains, only six to nine percent consumed four or more daily servings of fruit and only five to ten percent consumed five or more daily servings of vegetables.

Research also suggests that poor eating habits are a significant risk factor in the development of chronic illnesses (5) and are known to act as precursors for other risk factors, especially being overweight or obese (4). Not surprisingly then, poor nutrition among African American women is believed to contribute to the higher incidences of diabetes, hypertension and cardiovascular diseases they experience in comparison to White American women. Until minority women’s dietary habits are improved they will continue to be plagued by nutrition related illnesses.

Current literature provides limited explanation as to why African American women have poor dietary practices. What is known from the research is that health disparities, such as lack of access to proper preventative care, stressful lifestyles, lack of education about nutrition, inadequate housing, lower income and the lack of health insurance in the United States, are all believed to be factors in poor health outcomes among African Americans (6). The ongoing disparity in well-being between African Americans and their fellow citizens suggests further efforts are required to identify and implement appropriate strategies to improve this group’s nutritional and overall health status. This study aimed to contribute to this effort by surveying African Canadian women to explore both their eating habits and their perceptions of nutrition. The results of this study provide useful information for health care practitioners and educators seeking to improve health among minority populations.

### Methods

#### Participant Recruitment

The targeted participant group for this study were Canadian women of African ancestry who were 25 years of age or older. The recruitment process involved approaching African Canadian women in shopping malls, medical centers, universities/colleges and churches, providing them with a brief overview of the survey, and inviting them to participate. Those women who agreed to participate were given a consent form to read and sign. Recruitment was not stratified by socioeconomic status as many participants refused to fill out the survey or answer the open-ended question if their income, marital status or educational background was required. After one month of recruitment, 50 African Canadian women agreed to participate in the study.

#### Survey implementation

Each participant was given a written questionnaire to complete. On average, the questionnaire took participants approximately two minutes to finish. Participants were then asked an open-ended question and a digital recorder was employed to record their responses. This oral portion of the survey took approximately one and a half minutes to complete. For the purposes of confidentiality, all the respondents were assigned a file number.

#### Primary outcome measures

The primary outcome measures for the study were to provide some useful insights into African Canadian women’s dietary habits and their awareness of nutrition. It is hoped that these findings lead to open dialogues among health practitioners and educators on how best to promote healthier lifestyles among women of African descent in North America and beyond.

#### Procedures

The survey questionnaire used a likert scale to assess participant’s top dietary approaches to good nutrition; barriers to healthy eating; familiarity with Canada’s Food Guide and its recommendations; motivators in changing dietary habits; sources for nutrition information; nutrition concerns; importance of nutrition to improving Black women’s health and ratings of dietary habits. The open-ended question asked participants to indentify strategies they believed would be useful in promoting healthy eating habits among African Canadian women. With the exception of questions focusing on the link between nutrition and Black women’s health, the survey questions were adapted from the Canadian National Institute of Nutrition: Tracking Nutrition Trends series of surveys (7).

#### Statistical analysis

Analyses of the data were performed using the Statistical Package for the Social Sciences (SPSS) software version 13.0. Responses to the survey questions were coded, allowing the data to be converted into numbers. This descriptive data was then calculated and expressed as means, standard deviations, and percentage except where otherwise noted.

### Results

A total of 50 African Canadian women, ranging in age from 31 to 78 years, took part in the study. All 50 participants completed the survey questionnaire and answered the open-ended question. Based on analysis of survey results only 6% (n=3/50) of the respondents rated their present eating habits as “excellent”, whilst 36% (n=18/50) rated them as “very good”, 40% (n=20/50) as “good”, and 18% (n=9/50) as “fair.” (Table 1). Top dietary changes adopted by participants to improve their nutrition included reducing salt, fat and/or sugar intake, and/or increasing fruit and vegetable consumption.

When asked to identify barriers to adopting good eating habits the participants gave a variety of responses; 52% (n=26/50) of the women cited lack of time to prepare healthy meals, 26% (n=13/50) selected taste as an impediment and 22% (n=11/50) cited lack of desire as an obstacle. Affordability of healthy foods was not selected as a barrier to healthy eating, which may suggest that costs associated with buying healthy foods is not a concern for these women. Interestingly, only 38% (n=19/50) of the sampled women were aware of Canada’s Food Guide, whereas 62% (n=31/50) of the women were not familiar with the guide. Most women who knew of the guide also cited that they were familiar with some of its recommendations regarding daily nutritional needs. 52% (n=26/50) of the women also said that they considered themselves “somewhat knowledgeable” about nutrition, while 22% (n=11/50) reported they were “very knowledgeable”, 18% (n=9/50) “extremely knowledgeable” and 8% (n=4/50) “quite knowledgeable.”

On the topic of how important participants believed good nutrition was in maintaining or improving Black women’s health, 52% (n=26/50) of the respondents answered “extremely important,” 42% (n=21/50) said “very important” and 6% (n=3/50) recorded “somewhat important.” The top three nutritional concerns for participants were consuming too much fried foods (70%, n=35/50), consuming too much sodium (68%, n=34/50) and the presence of trans fat in foods (62%, n=31/50) (Figure 1). In terms of where they typically obtained nutritional information, 56% (n=28/50) of the women reported turning to standard nutrition leaflets/booklets, whereas 28% (n=14/50) consulted with their physician for dietary advice (Figure 2). Participants identified a number of key motivators to improving dietary habits, “having a health condition” (46%, n=23) and “to maintain health” (28% (n=14) were the top two motivators (Table 2).

#### Analysis of Open-ended Question

When asked what strategies could be employed to encourage African Canadian women to adopt healthy eating habits, a number of answers were given. Introducing nutritional workshops/classes through community-based (i.e. church) programs was a suggestion offered by many of the women. For example, one woman conveyed “if there were nutrition classes available in my church I would definitely go,” while another said “I think having some workshops to teach Black people more about good eating is a very good idea…I would go to the classes.” Still another woman echoed the idea of the church as an ideal place to deliver meaningful and effective health promotional messages within the Black community, explaining that “since a lot of black people do go to church, it would be a good thing to have nutrition classes there to learn more about nutrition.” One woman noted that she had heard of Black churches in the United States offering nutrition and exercise programs for their congregations and said “we need something like that in Canada…if we had our own nutrition or even fitness programs available in our community, a lot of us wouldn’t have all this sickness.”

Many of the participants also noted that any educational offerings about nutrition should be made culturally relevant for the African community. For instance, one woman stated, “if they have nutrition classes available for Black people, it should be cultural and to our needs…we eat different from White Canadians and we have different needs,” and another explained “we need our own diet classes to teach us [Black people] how to cook our own foods more healthy……. black people don’t realize that foods from our country are very healthy….we think that we have to eat Canadian foods to eat good.”

### Discussion

Findings from the survey and an open-ended question indicate that African Canadian women hold a variety of opinions about nutrition, and similarly, practice a variety of eating behaviors. A number of the women had made efforts to modify their current diets by either reducing salt and/or sugar intake or by choosing to consume more fruits and vegetables. Time constraints, lack of taste, and lack of desire were all noted as major barriers that prevented some of the women from adopting healthier diets.

One assumption that can be drawn from the survey findings is that reliance on physician advice about diet may not be sufficient (on its own) to produce desired and sustainable behavioral changes in food habits among African Canadian women. Indeed, many of the women in the survey had not sought or been offered advice on proper nutrition from their physicians. In their research, Podl et al. (8) assert that physicians often do not spend the extra time necessary to help their patients make lifestyle changes that could be beneficial to their health. In particular, physicians often do not give thorough advice or provide specific information on proper eating habits either because they have doubts in their ability to deliver this type of information, and/or doubts about its efficacy in leading to lifestyle change (8). A lack of training in or education about, behavioral counselling on healthy dietary practices among healthcare professionals is a major contributing factor to the reluctance in offering lifestyle advice to patients. Unfortunately, medical schools in and outside the United States only briefly cover nutrition in their curriculum, leaving medical doctors insufficient knowledge to provide assistance to patients with dietary and nutritional needs.

In spite of these challenges, it is essential for healthcare practitioners to provide counselling to their patients on preventative health measures (i.e. nutritional counselling) as health tracking studies continue to show a significant rise in nutrition-related illnesses like cardiovascular disease and diabetes in Canada (9).

The survey outcomes also suggest that more attention should be given to educating African Canadian and other minority women about Canada’s Food Guide. Many of the women in the study were unfamiliar with the guide and did not know the daily recommendations for a healthy diet. It is important that dieticians, nutrition educators and health agencies become more proactive in their attempts to promote Canada’s Food Guide in minority communities. Public service announcements from health agencies via local ethnic community newspapers, for example, could help to increase public exposure to Canada’s Food Guide among African Canadians and other minority populations who are thus far unfamiliar with it. More broadly, efforts should be made among healthcare professionals to identify and implement targeted strategies for improving dietary behaviors, and well-being in general, among minority populations in Canada.

It is important to note that there were a number of limitations and challenges with the present study. During the recruitment phase it became clear that participants were not willing to take part in the study if it required revealing their household income, educational or employment background, or marital status. Without this data, it is difficult to determine whether the sample participants were a representative reflection of the wider African Canadian community and to unravel in what ways the outcomes may have been tied to social class. A second challenge was that it was difficult to persuade participants to complete the survey. Concerns about a lack of cultural sensitivity in research studies and distrust of healthcare professionals (especially worries about being misrepresented or used for the benefit of researchers or for-profit companies) were reasons expressed by many of the women who chose not to complete the survey. These sentiments are in line with American studies that have investigated barriers that impede African American participation in clinical research (10). However, this challenge was somewhat overcome since the lead researcher is a members of the African Canadian community, and was able to connect with many of the women and convince them to participate. Nonetheless, the relatively small size of the sample population (50 women) is a limitation. Recruitment of a larger sample of participants, and a greater effort to include social class indicators, would be useful in further studies on this topic.

Finally, the methodology employed in this study did not include focus groups or detailed interviews. Focus groups are a common and useful method for understanding the perspectives of women of African descent as they allow participants to verbalize and express their opinions on selected subjects. In research undertaken by El-Kebbi et al. (11), for example, a focus group structure was employed to identify barriers to dietary self-management among a group of African Americans with type 2 diabetes (11). The resulting data yielded a wide range of identified barriers including the cost of special foods, poor taste of low fat foods, lack of family support, difficulty using the exchange system and reading food labels, and problems changing habitual patterns of behavior. A focus group or in-depth interviews would have been preferable for this study as it would likely have allowed for better insights into the participant’s dietary practices and nutritional beliefs. Thus it is suggested that future research on this topic use focus groups or detailed interviews in order to gain a deeper understanding of African Canadian women and diet.

### Conclusion

Despite the limitations discussed above, the survey did produce significant findings. For one, while African Canadian women are aware that healthy nutrition practices promote good health, it is also clear that more informed awareness, specific information and education would be beneficial. For instance, African Canadian women would benefit from information about how to be aware of portion size, how to read food labels and how to incorporate the Canada’s Food Guide recommendations into their daily meal plans. As the women identified themselves, introducing more community-based nutritional education programmes would be a good starting point for this kind of learning.

The study also reveals that if African Canadian women are to respond positively to any such nutritional education programs, these programs must be tailored to meet the cultural and linguistic background of these women. Initiating community-based dietary education programmes that are specifically for African Canadian women, for example, ought to include educational materials and resources that reflect this population’s cultural background. For instance, since taste was identified as a potential barrier to healthy eating by many of the women in the survey, the programs would need to encourage a consideration of healthier cooking methods, while at the same time, still allowing for the use and enjoyment of traditional foods and ingredients (12). The programs may also need to take into account economic factors affecting this group such as lack of time resulting from under-employment and low wage employment leading to the need to hold two or more jobs; indeed quite a few of the women cited time constraints as a major barrier to adopting healthy dietary practices. This factor would need to be taken into account in the scheduling of the program as well.

It is also suggested that any nutritional education programs be delivered by trained peer educators or volunteers from the African Canadian community. Given a history of past slavery and present racism, many African Canadian women are understandably distrustful and/or uncomfortable with mainstream institutions and experts, particularly when talking of topics as intimate as food and health. In addition, having trainers of African descent helps to ensure the validity of cultural elements and values in the program material/content and allows the trainers to serve as role models. Additionally, it would be helpful for any initiating nutritional programs to teach more African Canadian women about their African ancestors and how they ate, since they ate much more differently than African Canadians do today. With this knowledge, African Canadian women would not have to feel like they were giving up their traditional food. All of these measures increase the probability that African Canadian women would participate in, and be motivated to learn from, any community-based nutritional educational program offerings.

The higher prevalence and increasing rates of diet-related disease among women of African descent suggest that the need for this population to modify their diets is critical. Canada’s health care infrastructure can afford to, and should, expand health promotion programs encouraging healthy lifestyles among Africans Canadians. Designing and implementing culturally sensitive, community-based nutritional education programs would be a positive step in helping women of African descent and other minority communities in Canada adopt healthy diets, while still enjoying their traditional foods. Furthermore, it should be noted that the findings of this study provide some important, initial insights about African Canadian women and their dietary perceptions and practices, and these insights can be extended to women of African descent in North America and beyond. Further research is warranted to better understand African Canadian women’s eating habits and how these relate to their health and well-being. Equally, because physical activity and exercise are associated with dietary behavior, investigating African Canadian women physical activity level is also encouraged.

### Applications In Sport

Poor lifestyle choices increase the risk of developing a number of disease and health complications. However, a combination of regular exercise and/or physical activity along with good eating habits will significantly decrease the risk and is a primary defence for prevention. Very little information is available on African Canadian women as it relates to dietary habits and their exercise behavior. Further research is needed in this area to find effective intervention strategies and to understand African Canadian women lifestyle practices.

### Acknowledgements

The author would like to thank the subjects for their time and co-operation.

There were no specific funding sources for this research survey.

The author has no conflicts of interest to disclose.

### Tables

#### Table 1
Rating healthy habits

#### Table 2
Key motivators to change / improve diet

### Figures

#### Figure 1
Top Nutrition Concerns

#### Figure 2
Source of Nutrition Information

### References

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### Corresponding Author

Sherldine Tomlinson, M.Sc
2-440 Silverstone Drive
Toronto, Ont. M9V 3K8
<[email protected]>
1+ (416) 749-7723

Sherldine Tomlinson is the proprietor and a clinical exercise physiologist at the Centre of Chronic Disease & Health Inc. She is also a graduate student at the United States Sports Academy.