Research Brief

Knowledge of Food Production Methods Informs Attitudestoward Food but Not Food Choice in Adults Residingin Socioeconomically Deprived Rural Areas withinthe United KingdomMaria Barton, PhD1; John Kearney, PhD2; Barbara J. Stewart-Knox, PhD1

1NorthernIreland, Un2Dublin InAddress fofor Food &Kingdom;ac.uk�2011 SOdoi:10.1016

374

ABSTRACT

Objective: Understand food choice, from the perspective of people residing in socioeconomicallydeprived rural neighborhoods.Methods: Focus groups (n¼ 7) were undertaken within a community setting involving 42 adults (2 malesand 40 females) recruited through voluntary action groups. Data were recorded, transcribed verbatim, andcontent analyzed.Results: Attitudes to food and health were influenced by knowledge of food production and processing.Healthful foods were considered those which were fresh and unprocessed, and taste was taken as anindicator of how the food had been produced. Despite negative views of food production, processed foodswere consumed. Explanations for this tension between what people wanted to eat (unprocessed food) andwhat they actually chose to eat (processed food) were attributed to lifestyle compression.Conclusions and Implications: Dietary health promotion initiatives targeted at deprived rural dwellersshould consider perceived issues regarding food production and processing that may influence views onfood.Key Words: food choice, food processing, attitudes, poverty, focus group (J Nutr Educ Behav. 2011;43:374-378.)

INTRODUCTION

Despite an abundance of evidence toindicate that people living under socio-economically disadvantaged condi-tions are more likely to have a lesshealthful diet,1-3 the reasons for thisdeficit are not clearly understood.Recent qualitative studies of thoseliving in deprived circumstances havesuggested that, apart from cost, lack oftime is perceived as a main barrier topreparing fresh food.4,5 Anotherexplanation provided for unhealthfuleating practices among those living insocioeconomically deprived areas isthat such neighborhoods are ‘‘fooddeserts,’’ or unsupportive food

Ireland Centre for Food and Healthited Kingdomstitute of Technology, Dublin 8, Rer correspondence: Barbara J. StewHealth, University of Ulster, Cole

Phone: þ44 (0) 2870324781; Fax: þ

CIETY FOR NUTRITION EDUC/j.jneb.2009.12.010

environments within which residentsexperience difficulty in accessinghealthful food. This situation can leadto ‘‘food insecurity,’’ which is a lack ofaccess to safe and nutritious food andconsidered both an antecedent anda consequence of poor health status.6-8

Research carried out mostly in theUnited States has suggested that ruraldwellers in particular may experiencefood insecurity.9,10

Much research investigatingdiet andhealth inequalityhas tendedto focusonurban communities.4,11,12 This researchmeets a need for qualitative researchdirected toward understanding thereasons underpinning apparent healthinequality related to socioeconomic

, University of Ulster, Coleraine, Northern

public of Irelandart-Knox, PhD, Northern Ireland Centreraine, Northern Ireland BT521SA, United44 (0) 2870324965; E-mail: b.knox@ulster.

ATION

Journal of Nutrition Education and Beh

deprivation in rural communities.13

The aim of this study was to explore,via qualitative methods, perceived fac-tors determining food choice and bar-riers to healthful eating in adultsresiding in socioeconomically disad-vantaged rural areas within the UnitedKingdom.

METHODSSampling

Socioeconomically deprived areaswere identified by the NorthernIreland Multiple Deprivation Measure(NI MDM). The NI MDM providesa ranking of Super Output Areas,which takes into account spatial orsmall area (average population of1,800) deprivation. These rankingscan be useful in targeting health-related intervention projects.14 Thereare 890 such areas in NorthernIreland. The northern area, CountyAntrim, where the research tookplace, is ranked second of 5 levels ofdeprivation. Although there is no uni-versally agreed definition of ‘‘rurality,’’a locality can be considered urban or

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Journal of Nutrition Education and Behavior � Volume 43, Number 5, 2011 Barton et al 375

rural on the basis of multiple factors,including population size and den-sity; service provision; and demo-graphic, cultural, historical and/orgeographic profile.14,15 Applyingthese criteria, County Antrim couldbe considered as well provided withsocial and commercial services asmore urban areas. For the purpose ofthis research, however, the studyarea was considered ‘‘rural,’’ as itincludes small, relatively sparselypopulated communities with stronghistorical and cultural links tofarming and with a large proportionof land therein devoted to farming.

Contact was made initially withcoordinators of voluntary commu-nity action groups based in the se-lected study locality, who thenrequested participation directly ofindividuals among the residents’groups. No incentive was offeredfor participation. A number of thoseinvited (about 5) declined to partic-ipate for reasons not declared tothe researchers. Equating to 80%compliance, 42 adults (2 males and40 females) from 18-74 years old(mean 48.5) took part in the discus-sions. Of these participants, 13%were in some form of employment,and 45% had left school at the ageof 16 with no formal academicor vocational qualifications. Themajority were unable or unwilling(possibly owing to employment inthe ‘‘black economy’’) to give anapproximate figure of their weeklyincome.

To prompt a range of opinion,focus groups were mixed and weredefined as: (1) Mother and Toddlergroup (n ¼ 6); (2) Focus on Familygroup (n ¼ 6); (3 & 4) Resident’s Asso-ciation (n ¼ 6; 7); (5) Cooking Skillsclass (n ¼ 5); and (6 & 7) other com-munity center attendees (n ¼ 5; 7).The Focus on Family Project offers ser-vices such as child care facilities, com-plementary therapies, parenting, andskill-based courses. The Mother andToddler and the Cooking Skills groupswere affiliated with the Focus on Fam-ily initiative. The Focus on Family andthe Mother and Toddler groups werecomposed of mothers. Of the 7groups, 5 (focus groups 1, 2, 5, 6,and 7) were composed entirely of fe-males. The Residents groups (focusgroups 3 and 4) each contained 1male.

Procedure

Ethical approval was granted by theUniversity of Ulster Ethical Commit-tee. Prior to each focus group session,volunteers read and signed an infor-mation and consent form. A question-naire was administered to collectdemographic and anthropometric in-formation. Refreshments were not of-fered during the focus group session,so as not to bias discussion, but wereprovided afterwards. The focus groupswere facilitated by the first author(MB) in a quiet area of the host com-munity center. The sessions, whichlasted approximately 45 minutes,were audiotaped. To guide discussion,provisional topics included: percep-tions of health; dietary habits; factorsdetermining food choice; food label-ing; and barriers to healthful eating.When all topics had reached satura-tion, discussion was drawn to a close.

Data Analysis

Discussions were transcribed verbatimusing a dictaphone. The data werethen analyzed according to groundedtheory principles. Grounded theory isa methodology for developing theorythat provides a specific set of steps tofollow in gathering and analyzing qual-itative data.16 A grounded theory ap-proach requires constant comparisonbetween individuals, groups, and con-cepts for themes. Accordingly, the au-thors read and reread the transcriptsso that they could become familiarwith and immersed in the data. Thedata were analyzed inductively by theauthors (MB and BSK), who agreed oncommon themes andany interrelation-ships therein. The Qualitative ResearchSolutions and Research Non-NumericalUnstructured Data Indexing Searchand Theorizing software package (ver-sion N6, QSR International, Victoria,Australia, 2003) was used to store thedata. Indented quotes illustratingthemes thatarose spontaneously (with-out prompting) out of the discussionsare presented in the following section.‘‘Fg’’ denotes focus group, and the num-ber refers to the session.

RESULTSPerspectives onHealthful Eating

When asked about healthful eating,discussion referred not to dietary

recommendations, but to food pro-vided during childhood, ‘‘traditional’’meals such as soups and stewscontaining fresh vegetables andmeat: ‘‘The older generation alwaysmade sure there were vegetables’’(fg1); ‘‘Every day there was meat orsome sort of stew and cabbage, car-rots, or parsnips’’ (fg6); ‘‘You just eatthe food you were brought up with’’(fg7). Reflecting upon early experi-ences with food, healthful food wasperceived to be ‘‘fresh food,’’ particu-larly that which contains fruit andvegetables: ‘‘So fresh food, althoughit does cost more, is better’’ (fg2);‘‘Fruit and veg’’ (fg3). Taste was re-garded as an indicator of the degreeto which food had been processed:‘‘If it tastes good, it hasn’t been recon-stituted’’ (fg2); ‘‘We always get themeat from the butchers because ittastes nicer’’ (fg4). Meat purchasedfrom the local butcher was regardedas better quality (less processed by vir-tue of being unpackaged) and lessexpensive than that available in thesupermarket:

I get my meat out of the butchersand cook that way. The stuff inthe supermarket is packed funnyand doesn’t look as good. It goesoff very quickly too. It’s better valuein the butcher’s too (fg1);

‘‘When you get it (meat) in thesupermarket it costs about 4 pound.But if you go to the butchers it costs2 pound’’ (fg3). Chicken productionand processing was one of the mainindustries in the area in which partic-ipants resided. Perspectives reflectedexperiences and knowledge of poultryprocessing:

You know the way you get that oldminced chicken . . . It’s the left-overchicken that goes into chickenburgers and chicken fingers (fg3);

‘‘They pump the chicken breasts upwith water; I do that as a job. Themore expensive have less water’’ (fg4).

Barriers to Healthful Eating

Barriers to ‘‘healthful’’ (fresh) foodchoice included the lack of flavor, par-ticularly the blandness of fresh fruitand vegetables, the taste of whichwas perceived to have changed: ‘‘Ifyou buy a turnip there’s no taste of itnow’’ (fg3); ‘‘Food’s very bland now

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. . . today I can’t find a good potato’’(fg4). Lack of flavor was attributed toout of season production andprocesses:

When I was growing up there wasa lovely taste of cabbage, now thereis nothing. I can’t even eat a savoy(cabbage) now . . . it must be thestuff they put in it when they aregrowing it (fg3);

‘‘You can get strawberries at any time ofyear when they’re not in season, butthey’re tasteless’’ (fg4). Knowledge offood production methods appeared todirect what information was derivedfrom food labels: ‘‘I would always makesure it said 100% chicken, especiallywhen I’m giving it to the wean (child)’’(fg3); ‘‘It says on the back (of the label)that it’s shaped and that. It’s calledreconstituted stuff and is about 20%chicken’’ (fg4). Producers were per-ceived to use nutritional labeling infor-mation to ‘con’ the public, particularlyto make products appear more healthfulthan they are: ‘‘The like of those fruitshots, there’s only 6% real fruit in it’’(fg2);

The difference in sugar and fat con-tent is often minimal and meansnothing unless you’re eating inlarge quantities. But yet the com-panies are pushing that they’vemade a big change (fg4).

The cost of fresh food wasperceived as a barrier to healthfuleating. Take-away food, in certain cir-cumstances, was perceived to cost lessthan a home-prepared meal:

I have 5 of a family, myselfincluded, and it takes me more topay out for a salad than it doesfor burger and chips . . . that’s thebottom line. A salad and a pieceof decent meat with it costs at least15 quid for a family, but I can get 5portions of chicken goujons(breaded reconstituted chickenbreast) and chips (fries) from thechippy for a fiver (fg2);

‘‘The ‘weans’ (children), it’s the par-ents that are sending them to thechippie with a couple of pound fortheir dinner’’ (fg6). There was alsoa consensus that fresh food costsmore than processed food: ‘‘Freshvegetables cost more than frozen veg-etables’’ (fg2); ‘‘Folk with a crowd ofweans (children) have to go for pre-

packed foods and they have to gofor the frozen chips for it’s allcheaper’’ (fg3). Despite the apparentcontempt for processed food, accord-ing to the participants, lifestylecompression drove regular consump-tion of processed, convenience, andfast food, particularly for workingmothers: ‘‘If you’re committing a lotof time to work sometimes it’s easierand quicker to use processed food’’(fg4);

Young ones that are out workingand can’t be bothered coming inand cooking. A thing out of thefridge and into the microwavetakes a couple of minutes (fg6).

Choice of convenience food alsoappeared driven by a perceived needto create more time for leisure andsocial activities: ‘‘Things havechanged, there’s more access to leisurefacilities but people have less time’’(fg4); ‘‘It’s got a lot to do with thefast pace of life. Everything’s moreconvenient now and it gives youmore time to do things socially’’(fg7). And their children:

And there’s another thing. Notevery child gets the chance to eat(school lunches). By the time theyget in and they queue and then goout to play. They get less time toplay. They just throw you out thedoor before you’re finished. Soeven if they did want to eat thecrap on their plate, they can’t,‘cause they haven’t the time (fg2);

‘‘Like kids have got youth clubs andthat to go to. It’s the time element. Itall depends on how much time youhave’’ (fg4). Explanations of un-healthful eating went beyond knowl-edge of food and health and timeand economic constraints. Lack ofpsychological well-being was a per-ceived barrier to healthful eating:

If somebody hasn’t enough moneythey go into depression, and what’sthe first thing you do if you’redown, eat. And you eat all thewrong stuff, and the next thingyou put on weight (fg3);

People get into a vicious circlewhere they’re not working andthey’re not having any outside ac-tivity so they become depressed.Through that depression they can

start smoking and drinking, goingto bingo and that then has an im-pact on the money that they haveto spend on food (fg4).

DISCUSSION

Perceptions of food and healthappeared profoundly slanted byknowledge and understanding of thefood-processing industry, reflectinga local economy largely devoted tofarming and where food has immensecultural significance. Food-processingtechniques were referred to spontane-ously and recurred as a themethroughout discussion of other topicsassociated with food and health.Packaging labels, for example, wereread to determine how the food hadbeen processed. Even how the foodtasted was perceived to reflect thedegree to which the food had beenprocessed. This finding fits witha model of food choice that holdsthat attitudes and other psychologicalfactors toward food and health arelinked to the physical environmentin which the person resides.17 Previ-ous research conducted in the UnitedStates has suggested that those dwell-ing in socioeconomically deprivedconditions, especiallywithin rural areas,can experience difficulty in accessinghealthful food.9,10 Participants in thepresent study made no mention ofaccess to food, suggesting that this wasnot perceived as a barrier to healthfuleating. This finding agrees withprevious findings, which havesuggested that access to food is seldoma problem for the disadvantaged inthe United Kingdom.1,18

Previous research has suggestedthat people think of food choice interms of strategies or schemata.19

The dominant food choice schemaamong the participants in this studyappeared to be to choose fresh, notprocessed food, yet, according to theparticipants, it was not one that deter-mined which food items were chosenfor consumption. Perhaps the mostnovel finding of this research, there-fore, was the apparent tensionbetween the expressed concept thathealthful food is fresh, unprocessedfood and the perceived inability tochoose such food. Perceived lack oftime to prepare meals dominated dis-cussion. The lack of time that drives

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use of convenient, usually processedfood, however, is not peculiar todisadvantaged groups.12,20-23 Thepresent data go further in suggestingthat the problem was not one of lackof time per se, but rather of howtime was used. Healthful eating wasconsidered less of a priority thanwork and other family needs,particularly children’s activities(youth club), and food preparationwas cut back to free up time forleisure. As previously found amongthose living in deprived areas,24 therewas the notion that fast and conve-nient food was less costly than prepar-ing a meal from scratch. Otherqualitative studies that have observedan apparent contradiction betweenknowledge and behavior havesuggested that individuals from socio-economically disadvantaged groupsmake ‘‘tradeoffs’’ between perceivedproduct quality and price and conve-nience in making food choices suchthat more time spent on family andwork roles meant less effort was putinto making healthful foodchoices.2,3,13,25 The finding thateating practices were associated withpsychological well-being also agreeswith previous qualitative studies ofdeprived groups, suggesting thateating is perceived to be emotionallydriven.12,26,27 Together, these dataimply that food, leisure, andpsychological well-being were intrin-sically linked in the minds of theseparticipants.

Choice of socioeconomic indicatoris likely to be important for the selec-tion of appropriate informants forthe study of food and health issues.Although different indicators of socio-economic status are important intheir own right, they are not necessar-ily interchangeable.11 A strength ofthis research, therefore, was that so-cioeconomically deprived areas wereidentified using multiple indicatorsof deprivation that included factorsrelated to ‘‘rurality,’’ suggesting thatthe appropriate population studygroup was targeted and that one canhave confidence in these data. A limi-tation of any focus group discussion,however, is that of group consensus.The likelihood of such consensusmay have been increased by the factthat those who took part in thepresent study may have known each

other and that the groups werepredominantly female. Another possi-ble limitation of the study was that itwas not possible to ascertain whetherthose who refused to take part in thestudy differed in any way from thosewho agreed. Controlling for suchbias, however, can be considered lessimportant than ensuring the highquality and depth of the informationprovided.16 The rich data suggest animperative for future quantitativeresearch that takes ‘‘rurality’’ intoaccount when attempting to under-stand health-related behavior.

IMPLICATIONS FORRESEARCH ANDPRACTICE

This enquiry has been novel inproviding an in-depth understandingof the complex issues relating tofood choice in those who live in socio-economically deprived rural commu-nities in Northern Ireland and whomay have dietary health promotionneeds that are different from those re-siding in urban deprived areas. Healthpromotion efforts should attempt toaddress the complex interplaybetween contextual/environmental,social, experiential, and psychologicalfactors determining food choice.28,29

Of concern is the finding that eatingcompetes with and has come to beperceived as less of a priority thanother leisure activities. That food,leisure, and psychological well-beingappear conceptually linked suggestsa need to research ways of portrayinghealthful eating as fun. Meanwhile,there is an apparent need for low-cost, convenient, clearly labeled, freshfood products among disadvantagedrural dwellers in Northern Ireland.

ACKNOWLEDGMENTS

This study was funded by SafeFood,Ireland.

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