Barriers to healthful eating among midlife women during eating occasions focused on nurturing family
Vani Chopra
Department of Food Science and Nutrition
University of Minnesota
Abby Gold
Health, Nutrition and Exercise Sciences
North Dakota State University and University of Minnesota
Marla Reicks
Department of Food Science and Nutrition
University of Minnesota
Abstract
Women tend to gain weight at midlife based on less healthful eating habits, thereby increasing risk of chronic diseases. This study prioritized barriers to healthful eating among midlife women (40 to 60 years old; mean 48.8 ± 5.4 years) by degree of importance during eating occasions focused on nurturing family (that is, occasions characterized by a specific set of situation-based needs and having at least one other adult or child household member present). A convenience sample (n=37) of women in Minnesota and North Dakota met in seven group sessions (three to ten women per session) using a nominal group technique to identify and rank barriers. The majority of participants were white, 65 percent had a college degree, and 35 percent had some college education. Sixty percent were employed full time, while 16 percent were employed part-time, and 24 percent were not employed. Self-reported height/weight data indicated a mean BMI of 28.6 ± 6.0 kg/m2. Thematic analysis methods were used, and rankings were summed. The most important barriers to their eating healthfully were time and budgetary constraints, where perceived lack of time limited healthful meal planning and food preparation, and healthier food options were perceived to be more expensive. Activities and work and family schedules played a role by influencing time available for meal planning and food preparation. The need to consider family members’ food preferences was also ranked highly as a barrier to their own healthful eating, but was secondary to time and budgetary constraints. Several additional barriers were reported as being less important. Information from this study can be used to tailor nutrition education for midlife women providing family meals to improve the frequency of healthful meals for themselves and to manage their weight.
Keywords
midlife women, situation-based needs, barriers to healthful eating, family systems theory, meal planning, food preparation, food preferences, food cost, nominal group technique
Introduction
Among adult women, weight gain is a major risk factor for pre-hypertension (Yang et al. 2007), stroke (Saito et al. 2011), type 2 diabetes (Morimoto et al. 2011), and cardiovascular disease mortality (Nanri et al. 2010). Studies have shown that women are likely to experience a gradual increase in weight with age (Mozaffarian et al. 2011; Williams, Germov, and Young 2011; Wang et al. 2010; Kawai et al. 2010). Modification of eating habits is a strategy to prevent weight gain with age, thereby reducing risk of associated chronic disease.
Women typically play an important role in food provisioning (acquisition, preparation, and serving) for their families (DeVault 1991) while other family members participate in food decision-making by communicating their preferences and priorities (Gillespie and Johnson-Askew 2009). A family systems approach can be used to understand how eating habits of midlife women may be positively or negatively influenced by family members. Several researchers have described this approach from the perspective of the theoretical underpinnings of family therapy (Broderick 1993), family food and nutrition management systems (Ahye et al. 2006), and the family food decision-making system (Gillespie and Johnson-Askew 2009). The family systems approach is based on family structure including interdependent marital and parental subsystems. Within these subsystems, family members learn rules for interactions that influence family functions such as food choices and eating behaviors.
Results from several qualitative studies summarized below suggest that women may consider family food needs and preferences before their own diet and health needs, based on interactions with family members. Women expressed feelings of frustration when they were unable to fulfill an expected nurturing role because their children had strong food preferences (Vue, Degeneffe, and Reicks 2008). Focus group findings have indicated that low-income women considered child or partner preferences to be barriers to intake of fruits and vegetables (Dharod, Drewette-Card, and Crawford 2011). Henry et al. (2003) identified a strong influence of family preferences in the purchase and preparation of vegetables using a think-aloud approach during food shopping and preparation by low-income women. Interviews with women conducted by Beagan and Chapman (2004) suggested that they were willing to change their own diets to accommodate less healthful food preferences of children and partners. Similarly, individual interviews with women who had completed cooking lessons indicated that the major factor keeping them from making healthier food preparation changes were negative reactions of family members (Abbott et al. 2012). Interview results indicated that women reported taking on the identity of “good mothers” and frequently put their own preferences aside at mealtimes, resulting in their over consuming less healthful foods including convenience foods or restaurant foods (Slater et al. 2011). A previous study using nationally representative dietary intake data showed that when adults ate with children, their diets were higher in total and saturated fats compared to adults not eating with children (Laroche, Hofer, and Davis 2007).
Other reported barriers to healthful eating among women include limited time (Rolnick et al. 2009; Welch et al. 2009) and money (Rolnick et al. 2009; Folta et al. 2008; Marcy, Britton, and Harrison 2011). Perceptions of the high cost of healthful foods such as fruits and vegetables were associated with lower intakes of these foods by women (Williams, Ball, and Crawford 2010). Other important barriers include concerns about wasting food (Folta et al. 2008) and availability of healthful foods (Rolnick et al. 2009). Lack of knowledge, lack of self-control to eat appropriately, and lack of time were associated with a compromised ability to maintain energy restriction during a weight-loss trial among women and men (Welsh et al. 2011).
Studies that have prioritized the importance of barriers to healthful eating when women are focused on nurturing family members could not be found. Therefore, the purpose of this study was to identify and prioritize barriers to healthful eating in order of importance to midlife women during eating occasions focused on nurturing family members. The resulting information will facilitate the development of nutrition education programs to address the most meaningful impediments to healthful eating and weight management for midlife women.
Methods
Food decisions are based on goals/needs that vary with eating occasion context. Eating occasion context may include the rational and emotional influences on food decisions, such as who is present at the meal; the meal type; money and time available to purchase and prepare foods; and feeling hungry, tired, or stressed. Combinations of situation-based needs/goals within specific eating occasions have been characterized for midlife women in a feasibility study (Sudo et al. 2008) and in a larger study, which replicated these findings (Perry 2011). Six clusters of eating occasions were identified by various combinations of situation-based needs experienced among a national sample of midlife women. One combination focused on nurturing family by providing a meal for the family, serving the needs of the family as a unit, and expressing love. This set of situation-based needs is consistent with the family systems approach, where the meal serves as an opportunity for family bonding and must be enjoyable with minimal complaints from family members (which means appealing to the taste preferences of children or others present). Other needs in this set include balance from a nutritional standpoint and staying within the family budget. Eating occasions characterized by this set of situation-based needs were named “nurturing family meals” and were most often evening dinner meals, with at least one other adult or child present. They were high in energy, total fat, cholesterol, and sodium compared to eating occasions characterized by different sets of situation-based needs (Perry 2011). Among a national sample of women (n = ~1800), about one third experienced “nurturing family meals” occasions as a dinner meal on a daily basis.
Subjects
Women were recruited based on reporting that they regularly experienced eating occasions focused on nurturing family members. A convenience sample of women (n = 37) (in groups of three to ten) from metropolitan areas in two Midwestern states (Minnesota and North Dakota) participated in a structured group discussion lasting approximately 60-90 minutes at local community centers based on the nominal group technique (Van de Ven and Delbecq 1972). Women were recruited through fliers distributed via e-mail to University Extension program participants including 4-H and food assistance program education; or posted at community sites such as food pantries, community centers, or low-income housing; and via snowball sampling techniques (Heckathorn 2011). Women were screened over the phone according to the following inclusion criteria: 40-60 years of age; not currently pregnant or breastfeeding; free of major chronic disease including heart disease, diabetes, cancer, pulmonary, and renal disease; able to read and speak English; and indicating that they experienced eating occasions with “nurturing family meals” situation-based needs three to four times a week after hearing a brief description of this type of eating occasion read to them (Perry 2011) as follows:
“For some family meals, women focus on providing a meal for their family and serving the needs of the family as a unit. The meal they provide is a means of nurturing the family and an expression of love. The meal serves as an opportunity for family bonding, so it must be enjoyable with minimal complaints from family members. This usually means appealing to the taste preferences of children or others, and it also must be balanced from a nutritional standpoint and within the family budget.”
The study was approved by the University of Minnesota Institutional Review Board with informed consent obtained prior to data collection. Women were compensated for their time with a $30 gift card.
Group sessions
Picture activity
At the beginning of each session, an activity was used to explore emotions and imagery (Bystedt, Lynn, and Potts 2003) related to “nurturing family meal” eating occasions. The moderator read the brief description of the “nurturing family meals” eating occasions and asked each participant to review about thirty pictures and select one that best represented “nurturing family meals” eating occasions for her. The pictures were expected to evoke various feelings and images, for example, pictures of a rainbow or footsteps in the sand might suggest peaceful or calm feelings, whereas pictures of a traffic jam or a snowstorm might call to mind feelings of frustration or concern. After selecting a picture, each participant was asked to tell the group about the associations she made between the picture selected and her typical “nurturing family meals” eating occasions.
Nominal Group Technique (NGT) process
The Nominal Group Technique (NGT) sessions were conducted in four steps that combined individual reflection and creativity, information sharing, and group prioritization (Van de Ven and Delbecq 1972). The sessions were moderated by two researchers who had previously attended training regarding focus group methodology (Krueger and Casey 2009). They conducted several practice NGT sessions with graduate students who were also parents. One researcher served as an assistant moderator to take notes during the discussions. All sessions were audio-taped and transcribed verbatim for analysis.
The four steps were based on the central question that followed the reading of the brief description of the “nurturing family meals” eating occasions: “What keeps this type of family meal from being healthy for you?” The first step involved brainstorming. Each participant was asked to think of as many answers as possible to the central question on an individual basis and to list them on an empty sheet of paper. The next step consisted of a round-robin oral presentation of individual responses, with the moderator recording each on a white board or flip chart. The third step allowed for clarification of each response among all participants. The moderator asked participants to indicate if there were comments or questions about each response to make sure everyone understood each response in the same way. Lastly, each woman was asked to identify her top three responses and then rank them according to degree of importance for what keeps “nurturing family meals” from being healthful for her, where 3 = most important, 2 = second, and 1 = least important. Additional open-ended questions were asked to explore ideas that women had regarding intervention strategies that could address important barriers identified in each group (e.g., What type of information or activities would help you overcome this problem?). No barriers were identified in the seventh session that had not already been identified in previous sessions, indicating data saturation.
Data analysis
Descriptive statistics were used to characterize the sample regarding demographic characteristics (SAS, version 9.2, The SAS Institute, Inc., Cary, NC, copyright 2002-2007). All barriers to healthful eating among women during “nurturing family meals” eating occasions resulting from the clarification step were sorted into similar categories independently by two investigators. In the case of divergence of opinion, agreement was reached through open discussion. Sums of ranks were calculated within each group and across groups based on the number of women per session identifying a barrier as important (3 = most important, 2 = second, and 1 = least important). The total sum of ranks was used to classify barriers into three logical tiers by degree of importance. The first tier (sum of ranks >30) was based on having about half of the women in five or more groups rank the barrier as most, second, or least important. For the second tier (sum of ranks >10 and ≤30), at least one woman in four or more groups ranked the barrier as most, second, or least important. For the third tier (sum of ranks <10), at least one woman in at least one group ranked the barrier as most, second, or least important. For the remainder of the discussion transcripts, coding categories were created according to the questions regarding intervention strategies, and other categories were based on the picture activity (Krueger and Casey 2009). Codes were applied to a transcript from one session independently by two researchers and modified upon discussion prior to application to the remaining transcripts. Transcript segments were sorted according to coding categories and read for common themes independently by two researchers (Miles and Huberman 1994). Discrepancies in themes were reconciled upon discussion.
Results
A total of thirty-seven women participated in the seven NGT sessions with a range of three to ten women per session. Mean session length was ~75 minutes and the range of time for sessions was 60-90 minutes. Four sessions were conducted in Minnesota and three in North Dakota. The majority of women were white (87 percent), with more than half having a four-year college degree (65 percent) and being employed full-time (60 percent). The remaining women had some college education (35 percent) and were employed part-time (16 percent) or not employed (24 percent). Most (84 percent) women had at least one child under the age of 18 in the household, and 84 percent had one other adult in their household. The average number of children per participant was 1.5 ± 1.0 (range of 0-4). Mean BMI based on self-reported height and weight was in the overweight range (28.6 ± 6.0 kg/m2). Mean age was 48.8 ± 5.4 years.
Picture responses. Women chose pictures that described three primary characteristics when asked to select a picture associated with feelings or images regarding her “nurturing family meals” eating occasions. These included a physical description, feelings the meal evoked, and the situational context surrounding the meal. Several women across most sessions chose a picture that depicted physical characteristics based on color, nutritional properties such as balance, and aspects of food quality such as being natural or wholesome. The most common descriptor involved color. For example, one participant selected a picture of a colorful dress flowing during a dance and said, “It’s colorful, lively, and [has] lots going on.” In each group, several women spoke of feelings of calmness or peacefulness based on pictures of footprints in the sand, a rainbow, or a farm field. Several women also mentioned combining feelings of peace with contrasting feelings of strife. One woman selected a picture of rushing water and said, “Could be peaceful and calm, but could also be chaotic.” In each group, several women chose pictures that represented feeling tense based on the need to manage food preferences of family members. For one woman, a picture of a traffic jam was selected with the accompanying comment: “. . . when cooking for three or four people, everyone has different likes and dislikes, and I am the one to make the final decision.” Another chose a picture of two bison engaged in conflict with the following explanation, “My daughter doesn’t like eating vegetables and my husband likes them, and when we eat all together, it’s like a fight as in the picture. And I am kind of in the middle.”
The context in which the meal took place was commonly based on families spending time with each other enjoying the meal. For example, one woman chose a picture of six jets flying in formation and indicated, “When I eat together with family, it’s unity, all together.” Another situation was related to busy family schedules, as described by one woman who chose a picture of a chessboard and said, “Reminds me of thinking ahead and planning the day. Planning the day with the different meetings and activities in the deal.”
Barriers to healthful eating. Table 1 shows the common barriers keeping “nurturing family meals” from being healthful for women, as prioritized in order of importance. Two barriers were identified as being the most important and pervasive based on the sum of ranks across all seven sessions (≥30) with women in each session identifying these barriers as important. The number of women who ranked these two barriers as important was 19-22. Lack of time to plan and prepare foods for healthful meals, and lack of money to buy more expensive, healthier foods were the two most important barriers reported. Examples of comments that explained how lack of time affected intake include: “Something that is easy and quick to cook is not always healthy,” “I usually buy fresh produce, but because of lack of time we end up getting fast-food and the fresh produce gets spoiled,” And, “When its late I need to just grab something.” Responses related to how lack of money affected intake include: “ … fruits and vegetables which are supposed to be healthy choices are costly,” “I don’t like making things out of a can, but the healthier stuff seems more expensive,” and “Inexpensive choices are not healthy.”
A second tier of barriers had a sum of ranks in an intermediate range (>10 and ≤30), with four suggested as important barriers by women in four to five of the seven groups. The number of women who ranked these four barriers as important was 8-13. These barriers included the need to cater to preferences or expectations of family members; activities and family and work schedules; lack of planning and preparation to have healthy food available for a meal based on factors other than lack of time (such as lack of motivation or energy); and lack of creative ideas, healthful recipes, or ways to use leftovers. Comments indicating that the need to cater to preferences of family members affected intake include the following: “Too much salt, fat, or calories, dinner guilt, this means that what I am trying to cook may not be healthy for me, due to the family;” “Me and my daughter can have something simple, but my husband wants a complete meal like meat and potatoes;” “Making something everyone likes but me. Just easier;” and “I am actually thinking about what others need rather than thinking about my meal. I look at my plate, saying, ‘Did I really eat that?’ Not focusing on [me].” Comments regarding work and family schedules included the following: “If I am late at work, I would tend to pick up something on the way [home], which may not be healthy” and “We have teenagers. Everyone is running around, coming and going. Have so much to do and we want to have time for being healthy and bonding but everyone is pulled in different directions.” Lack of planning to have healthy food available for a meal was thought to inhibit healthy eating as follows: “. . . if you’re not organized, you end up eating something which may not be healthy,” “Like you come back from work and look at your cabinets and think what to make for supper. It’s lack of pre-planning,” and “You could have had it but it could be missing for some reason. I think it is based on planning.” Lack of creative ideas or healthy recipes was perceived to be related to the ability to prepare healthful meals. For example, comments included “It could be lack of ideas for recipes. Or cooking something unhealthy because you wish to try something new. Ready for something different that may not be healthy,” and “Lack of recipes that are healthy ones.”
A third group of barriers had a sum of ranks ≤10 (data not shown) and were only ranked as one of the top three barriers by women in one to three sessions. These included the need to use convenience foods, which were considered less healthful than foods prepared from scratch (sum of ranks = 10); feeling that fast food was an easier and quicker option than home-prepared foods (sum of ranks = 5); and physical considerations such as being too tired to cook (sum of ranks = 9); being stressed (sum of ranks = 8); eating too much (sum of ranks = 8); not having ingredients on hand (sum of ranks = 4); and having food allergies (sum of ranks = 2). Several of these barriers are directly related to lack of time to prepare foods from scratch or to prepare foods at home, reinforcing the importance of lack of time as the most significant barrier. Other barriers cited in the NGT process but not ranked as important by any women as to what keeps “nurturing family meals” from being healthful for them included snacking while preparing the meal, baking too much, eating away from home, and lack of adequate space or equipment for food preparation.
Suggested intervention strategies. In general, women in all groups suggested that efforts to manage time to allow for pre-planning and preparing food were important, and that their organization and motivation were necessary for the best management of time. As one woman suggested, “We have over-scheduled our lives, so we lack the motivation for cooking a healthful meal for the family. It comes down to how motivated you are … to sit down and plan with your family.” The most common ideas for managing time were to plan menus on the weekends for the rest of the week and to make food ahead of time and freeze or portion out for later meals. Across most groups, women focused on strategies that involved family members in planning efforts to address time management. Comments regarding these strategies include “My kids are at that age where they can help me. Maybe everyone together could plan;” “. . . everyone could come together and decide on the menu for the week;” and when asked what would help women to plan ahead, one women mentioned “delegating [menu planning] to family members.”
Common cost-saving strategies were discussed, such as using coupons and buying products when on sale or through a buying club. In several sessions, women spoke of using a website to inform them of foods that were currently the most inexpensive in particular stores, along with potential recipes and meal plans to include the least costly foods. For example, women asked for a website with a weekly list of inexpensive foods and related recipes. As one woman asked, “Could there be a magic cheat sheet?” Other money-saving ideas included classes or web-based assistance with planning to help food last over the month and ideas for healthy recipes to make with inexpensive foods such as “buy cheaper foods and convert them into healthier stuff” or “get cheap recipes online, with ingredients.”
Women agreed that an optimum way to address the need to cater to family preferences involved “making family friendly recipes, making what everyone likes and is healthy too.” Many women addressed the importance of cooking skills, with some women indicating they liked to cook while others either did not like to cook or mentioned they could use further information on food handling procedures such as defrosting meat or stir-frying vegetables. Women in most groups also indicated a need for quick, easy, and healthful recipes. As one woman mentioned, “Master the basics, keep it simple, and then master it over time. The recipe needs to be easy and quick and also nutritious.”
Discussion
Results from the current study examining what keeps “nurturing family meals” from being healthful for women in midlife underscored the common perceived barriers of limited time to plan and prepare foods for healthful meals and lack of money to buy healthful foods that have been identified in other studies (Rolnick et al. 2009; Folta et al. 2008). On a national level, perceived lack of time plays a major role in the increasing percentage of total household food dollars spent on food eaten away from home. From 1970 to 2010, this percentage increased from 33 to 47 percent (Clausen 2011). Mancino and Newman (2011) showed that time spent preparing food decreased as time spent working outside the home increased, and that having more children in a household increased the time women spend preparing food. Given that the majority of participants in this study indicated they worked full- or part-time and had children or another adult in their household, lack of time may have superseded in importance other barriers such as lack of creative ideas. Devine et al. (2009) found that food choice˗coping strategies among employed mothers often involved family meals that were quick to prepare and the use of convenience entrées, with negative implications for the healthfulness of the meals. Among mothers of school-aged children, perceived time pressure was negatively associated with confidence in the ability to prepare a healthful meal (Beshara, Hutchinson, and Wilson 2010). Survey results with mothers of early adolescent and adolescent children showed that mothers’ perceptions of time pressures resulted in less meal planning (McIntosh et al. 2010).
Cost was identified as a second major barrier to healthful eating by women in the current study. Recruitment for this study was done through university Extension programs including education for food assistance participants, food pantries, and low-income housing. This resulted in a sample including about one-third (35 percent) with less than a four-year degree, and employment levels where 40 percent had part-time employment or were not employed. Therefore, the sample makeup and the fact that the data were collected in 2010 when many Americans were facing financial hardships because of the recession would indicate that budgetary considerations would have been expected to be important. Indeed, cost was ranked highly as an important perceived barrier to keeping family meals from being healthful for midlife women. The finding is consistent with the perception that healthful foods are more expensive than less-healthful foods, which is commonly held among low-income adults as well as adults from a wide range of income and education levels (Marcy, Britton, and Harrison 2012; Williams, Thornton, and Crawford 2012). Despite the popularity of this perception, the Economic Research Service of the U.S. Department of Agriculture recently reported that some healthier foods were more expensive than less healthful alternatives, and in other cases, healthier foods were less expensive, with prices varying across regions of the United States (Todd, Leibtag, and Penberthy 2011). These findings indicate that the ranking of cost as an important barrier to healthful eating for midlife women participating in the current study, especially for women in the sample who had lower incomes, is in line with prices for at least some healthful foods.
Because women needed to experience “nurturing family meals” eating occasions often to be included in the study, it was also expected that important barriers for them to eat healthfully would reflect the reciprocal influence of family members on behaviors of these women providing the meal. The need to cater to family preferences or expectations regarding foods served was ranked highly as an important barrier to healthful eating, consistent with family systems theory (Broderick 1993). Reciprocal influences based on interactions across parental and marital subsystems predict that women will suppress their own healthier food behavior to serve foods according to preferences and expectations of family members (Broderick 1993; Ahye et al. 2006). This concept was also supported by results obtained from the picture activity. Women indicated that while they were hoping that family meals could be peaceful and a time to enjoy the company of family members, often times this was not possible because of the need to consider food preferences of family members. Similar to results from the current study, focus groups findings from parents of school-aged children regarding family meals indicated that parents were frustrated with the small number of food items preferred by children and their attempts to get their children to eat a wider variety of foods (Fulkerson et al. 2011). These authors reported that parents would like to have greater involvement of their children in meal planning and food preparation activities. In the current study, women also indicated that involvement of spouses and children in meal planning and pre-preparation would be beneficial in addressing the need to consider taste preferences of family members.
Lack of creative ideas and healthful recipes was identified as a barrier to the women eating healthful “nurturing family meals” along with their reports that fast food was an easy or convenient option. In addition, a range of cooking skills was described among the women in this study, indicating that some lacked skills needed to prepare meals at home. This could also contribute to being overly dependent on prepared convenience or fast foods. Among adults, ready-meal consumption (defined as complete meals requiring few or no extra ingredients, prepared externally, and replacing homemade main dishes) has been negatively associated with cooking skills (van der Horst, Brunner, and Seigrist 2011). Similarly, fast food consumption was associated with dislike toward cooking and perceived convenience of fast foods among adults (Dave et al. 2009), while healthful snack consumption was correlated with being able to overcome barriers related to preparation, convenience, and availability among midlife women (Schunk, McArthur, and Maahs-Fladung 2009). An inability to routinely overcome the barriers identified in the current study could be related to a generally less healthful food intake with negative implications for weight management. Concerns were raised by our participants that the use of less healthful convenience foods to save time, and the lack of money to purchase healthier and more expensive food options, limited the availability of healthful foods in their physical environments.
The strengths of the study include the use of in-depth qualitative data from midlife women who specifically indicated they experience “nurturing family meals” eating occasions regularly. Limitations of the study include use of a simple subjective assessment to screen women according to whether they experienced “nurturing family meals” three to four times a week. A more rigorous quantitative assessment may have been better able to determine whether women commonly experienced “nurturing family meal” occasions. Additionally, in two of the seven sessions, only three and four women participated, which may have limited the number of barriers identified because of limited group dynamics. The study was completed among a convenience sample of women in two neighboring states in the Midwest, and women in other regions of the United States may experience different barriers to eating healthful family meals based on variability in food access and cost.
The findings from this study have implications for tailoring nutrition guidance for midlife women based on the need to nurture family members through family meals. While the issues of time and money management should be addressed as the most important topics in educational sessions, information on women protecting their own nutritional needs should also be included. Many current nutrition education programs and resources are available that consider the issues of time and budget management. However, fewer resources are available to help women maintain the healthfulness of meals for themselves while managing family food preferences and expectations when experiencing “nurturing family meal” eating occasions. Since women feel a strong moral obligation to ensure family health (Nettleton 1991), program objectives should also focus on providing foods that are healthful, tasty, quick, and inexpensive yet still meet family food preferences, as suggested by women in the current study. Recipes for such should be made available. Program objectives should also focus on allowing women to reflect on the underlying reasons for placing family food preferences above their own nutritional needs, based on family systems theory (Broderick 1993). In addition, motivation to provide healthier foods for all family members needs to be in place before time management and food resource reallocation can be accomplished. Program objectives should include motivational materials or activities that allow women to simplify meal planning and encourage family involvement.
Further research should involve quantitative studies to determine associations between barriers to “nurturing family meals” and diet quality, weight, and health of midlife women. Studies should also be conducted to determine how food preparation time may be influenced by education to improve cooking and food budgeting skills.
Table 1. Perceived importance of barriers that keep “nurturing family meals” from being healthful for participants
| Barriers generated in the NGT process | Group Number (number/group) | Sum of ranks across groups | ||||||
| 1 (n=5) | 2 (n=5) | 3 (n=6) | 4 (n=10) | 5 (n=5) | 6 (n=4) | 7 (n=3) | ||
| Number of women selecting response 1, 2, or 3 (sum of ranks for each topic) | ||||||||
| Lack of time to plan and/or prepare foods for healthful meals | 3 (7) | 3 (6) | 4 (7) | 2 (5) | 4 (7) | 2 (2) | 4 (9) | 43 |
| Lack of money to buy more expensive healthier options | 2 (3) | 3 (5) | 4 (8) | 3 (5) | 1 (3) | 4 (10) | 2 (6) | 40 |
| Need to cater to different taste preferences and expectations of family members | 1 (3) | 1 (3) | 2 (6) | 7 (12) | 2 (4) | 0 (0) | 0 (0) | 28 |
| Work and family schedules/activities | 4 (7) | 0 (0) | 2 (3) | 1 (3) | 1 (2) | 2 (4) | (0) | 19 |
| Lack of planning/ preparation to have healthful food available for a meal | 3 (6) | 3 (7) | 1 (3) | (0) | 1 (1) | 0 (0) | 1 (1) | 18 |
| Lack of creative ideas, healthful recipes, ways to use leftovers | 1 (1) | 2 (5) | (0) | 4 (6) | 1 (2) | (0) | (0) | 14 |
Sum of ranks across groups was calculated by summing the rankings where 3 = most important, 2 = second and 1 = least important. Total possible sum of ranks across all groups = 222.
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