Exploring Influences of Eating Behaviors Among Emerging Adults in the Military.

OBJECTIVE: Identify factors influencing eating behaviors among emerging adults in the military. DESIGN: Focused ethnography using interviews, observations, and artifacts for data. SETTING: Three US Naval installations. PARTICIPANTS: Thirty-two active-duty Sailors aged 18-25 years. ANALYSIS: Qualitative data were organized in NVivo and analyzed sequentially to categorize culturally relevant domains and themes using a social ecological model (SEM). Descriptive statistics were used to describe questionnaire data in SPSS (version 27.0, IBM, 2020). RESULTS: Leaders encouraged healthy eating through policies and messages, but cultural contradictions and environmental barriers undermined Sailors' efforts to eat healthily. Stress and resource constraints (intrapersonal), peer pressure (social), unhealthy food environments and lack of access to food preparation (environmental), and eating on the go because of mission-first norms (cultural) promoted unhealthy eating behaviors. Nutrition and culinary literacy (intrapersonal); peer support and leadership engagement (social); access to healthy, convenient, and low-cost foods (environmental); and indoctrination to healthy eating during recruit training (cultural) positively influenced eating behaviors. CONCLUSION AND IMPLICATIONS: The eating behaviors of service members are influenced by many modifiable factors. Targeted education, leadership engagement, and policies that make nutritious foods easily accessible, appealing, and preferred are needed.

Use of a focus group-based cognitive interview methodology to validate a cooking behavior survey among African-American adults.

Disparities in diet-related diseases persist among African-Americans despite advances in risk factor identification and evidence-based management strategies. Cooking is a dietary behavior linked to improved dietary quality and cardiometabolic health outcomes. However, epidemiologic studies suggest that African-American adults report a lower frequency of cooking at home when compared to other racial groups, despite reporting on average cooking time. To better understand cooking behavior among African-Americans and reported disparities in behavior, we sought to develop a survey instrument using focus group-based cognitive interviews, a pretesting method that provides insights into a survey respondent's interpretation and mental processing of survey questions. A comprised survey instrument was developed based on input from a community advisory board, a literature review, and a content review by cooking behavior experts. The cognitive interview pretesting of the instrument involved African-American adults (n = 11) at risk for cardiovascular disease who were recruited from a community-based participatory research study in Washington, D.C., to participate in a focus group-based cognitive interview. Cognitive interview methodologies included the verbal think-aloud protocol and the use of retrospective probes. Thematic analysis and evaluation of verbalized cognitive processes were conducted using verbatim transcripts. Five thematic themes related to the survey were generated: (1) Clarity and relevancy of question items; (2) influence of participants' perspectives and gender roles; (3) participant social desirability response to questions; (4) concern regarding question intent. Eleven survey items were determined as difficult by participants. Cooking topics for these items were: cooking practices, cooking skills, cooking perception (how one defines cooking), food shopping skills, and socialization around cooking. Question comprehension and interpreting response selections were the most common problems identified. Cognitive interviews are useful for cooking research as they can evaluate survey questions to determine if the meaning of the question as intended by the researcher is communicated to the respondents-specific implications from the results that apply to cooking research include revising questions on cooking practice and skills. Focus-group-based cognitive interviews may provide a feasible method to develop culturally grounded survey instruments to help understand disparities in behavior for culturally relevant diet behaviors such as cooking.

Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study.

BACKGROUND: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. OBJECTIVE: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. METHODS: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants' experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. RESULTS: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). CONCLUSIONS: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population.