Mixed Method Approaches to Understanding Cancer-Related Dietary Risk Reduction among Public Housing Residents

Abstract

Improving diet is one important pathway for addressing cancer disparities. We conducted mixed-method analyses of 468 24-h dietary recalls from 156 AfricanAmerican women residents of Washington DC public housing to better understand dietary patterns. Recalls were rated for five cancer-related preventive characteristics (adequate fruits/vegetables, moderate fat, moderate calories, no alcohol, and adequate Healthy Eating Index score), combined as a scale. Bivariate and multivariate analyses identified psychosocial and dietary characteristics associated with scale scores. Qualitative analyses of dietary records identified contextual aspects of food patterns within and across score groups. Sixty-one percent of respondents met zero or one dietary goal; alcohol abstention was most common (64%). Only 12% achieve either three (6%), four (4%), or all five (G1%) goals; five fruit and vegetable servings were least common (15%). The underlying scalar structure of responses suggests that fruit and vegetable consumption is seldom achieved in this population without other scale components. Poorer scores were associated with younger age, depressive symptoms, stressful life events, smoking, and food-purchasing practices. Qualitative analyses identified eight themes related to differences between dietary patterns. Findings reinforce the value of nonreductionist approaches to cancer-related nutrition intervention.

Concepts of Healthy Diet Among Urban, Low-Income, African Americans

“…Thus, our findings might be generalized with caution. Although our dietary assessment was blunt, our dietary findings are consistent with prior studies [6,[45][46][47] (and impressive in that social desirability would tend to attenuate-or even reverse-the marked excess of choosing fast foods over fruits and vegetables that we report). Our sample size was relatively small, but adequate in that we reached thematic saturation: later interviews generated few new ideas as compared to earlier ones.…”

Best practices in mixed methods for quality of life research

“…These qualitative approaches are often combined with data from clinical trials, surveys of attitudes and beliefs, economic or medical data to better understand health problems [1]. Evidence in the published literature attests to the current use of mixed methods approaches in health-related research, from cardiology [2], pharmacy [3], family medicine [4], pediatric oncology nursing [5], mental health [6,7], disabilities [8] and nutrition [9], in both clinical settings [10] and in the social context of daily activities and relationships [11].…”

Resolving the qualitative-quantitative debate in healthcare research

“…This is made possible by the fact that the use of mixed methods improves the quality and scientific power of data in healthcare research, e.g. poor adherence to treatment thought to be effective, behavioural factors contributing to disability and translational needs of health (Almarsdóttir and Traulsen, 2009;Creswell and Zhang, 2009;Klassen et al, 2009).…”