Culture and Diet: Food Choice among Black African and African-Caribbean Women with Type 2 Diabetes

People of Black African heritage in the UK have increased susceptibility of being diagnosed with Type 2 Diabetes Mellitus (T2DM) compared to the general White population. Nutrition is central in halting T2DM and the progression of complications such as cardiovascular diseases. However, little is known about the factors influencing the diet of women of Black African heritage with T2DM. In addition, clinical and public health conceptions of the problem tend to be individualistic in orientation. This study is an exploratory and in-depth inquiry into food choice and the implications of dietary change for women of Black African heritage who self-manage T2DM by diet alone. Eight participants were recruited using purposive sampling. Recruitment sites included Black and Minority Ethnic charities in Norfolk and Suffolk. Data was derived from direct observation using the ‘Accompanied Shopping Task’, combined with a ‘Think Aloud Technique’ called a ‘Product Choice Reasoning Task’. In-depth interviews were undertaken and transcribed verbatim. Framework Analysis was used to provide a procedure to manage data analysis, which was informed by the PEN-3 public health cultural model which moves beyond overly individualistic conceptions of the issues. The study showed that six participants prioritised the disease and used what I have called a ‘Disease Focused Approach’ to self-manage T2DM. Two used a ‘Family Focused Approach’, as family played a crucial role in T2DM self-management. All participants undertook T2DM self-care by following a culturally appropriate diet. Their least preferred options for managing T2DM were medical therapy and physical activity. The study showed that although food choice is influenced by many factors, culture was particularly important. Moreover, participants showed greater knowledge than had been anticipated about the role of nutrition to prevent progression of T2DM. Results are explored and presented for three main domains of experience for the participants: first, food shopping and decision-making; second, diet choice and lifestyle; and third, the interface with health services. For each of these the culture was found to be of paramount importance. The implications of the findings are presented in relation to the importance of culturally appropriate advice; culturally sensitive service provision; and the significance of household composition in managing the illness, especially for people with T2DM who have young children living at home.