ABSTRACT
Background: African Americans are disproportionately affected by hypertension (HTN) and CKD and evidence suggests dietary modifications towards a more Dietary Approaches to Stop Hypertension (DASH)-accordant diet could improve outcomes for this population. We aimed to explicate barriers and facilitators of healthy eating, and the perceived benefits of the intervention among completed participants of a dietary intervention trial for African Americans with HTN and CKD. Participants were randomized to one of two groups: 1) Self-Shopping DASH (S-DASH) diet group with $30/week grocery allowance for 4 mo. but no specific guidance on purchases, followed by no food allowance for 8 mo.;or 2) Coaching DASH (C-DASH) diet advice group with a $30/week food allowance and assistance in purchasing foods for 4 mo., followed by intermittent coaching without food allowance for 8 mo. Methods: We performed a content analysis of transcripts from semi-structured interviews with participants who completed the trial (13 C-DASH;12 S-DASH were randomly selected). Thematic analyses followed 5 stages: 1) reading and rereading all transcripts and utilizing audio recordings as needed for clarity;2) three coders reading two of the same transcripts, coding them, and comparing codes which were then used to create the initial coding framework;3) defining codes, coding additional transcripts, discussing/ revising the coding framework;4) formulating initial themes and 5) diagramming relationships among initial themes to merge overlapping themes. Results: Participants were a mean age of 62 ± 9.3 years, 36% were male. Key themes included healthy diet facilitators (food tracking, motivation, social support, and perception of healthy foods);barriers (transportation, past eating habits, stress and COVID mitigation);and impact of the trial on knowledge and health. Conclusions: Participants of a dietary intervention trial for African Americans with HTN and CKD identified several facilitators and barriers to healthy eating that could inform future efforts to address disease burden in this population.