The Effects of the COVID-19 Pandemic on Nutrition, Health and Environment in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Experts

Abstract

Objectives: The COVID-19 pandemic impacted food systems, health systems and the environment globally, with potentially greater negative effects in many lower-middle income countries (LMICs) including Indonesia. The purpose of this qualitative study was to investigate the potential impacts of the COVID-19 pandemic on diets, health and the marine environment in Indonesia, based on the perspectives of a multidisciplinary group of informants. Methods: We conducted remote in-depth interviews with 27 key informants from many regions of Indonesia, who are either healthcare providers, nutrition researchers or environmental researchers. Interview question guides were developed based on a socio-ecological framework. We analyzed the data using a qualitative content analysis approach. Results: Informants suggested that while the COVID-19 brought increased awareness about and adherence to good nutrition and health behaviors, the impact was transitory. Informants indicated that healthy food options became less affordable, due to job losses and reduced income, suggesting a likely increase in food insecurity and obesity. Environmental researchers described higher levels of marine pollution from increase in hygienic wastes as well as from plastic packaging from food orders. Conclusions: Our findings reveal perceptions by informants that the increased awareness and adherence to health behaviors observed during the pandemic was not sustained. Our results also suggest that the pandemic may have exacerbated the double-burden paradox and marine pollution in Indonesia. This study offers information for generating hypotheses for quantitative studies to corroborate our findings and inform policies and programs to mitigate the long-term impacts of the COVID-19 on diets, health, and the marine environment in Indonesia.

Fish—To Eat or Not to Eat? A Mixed-Methods Investigation of the Conundrum of Fish Consumption in the Context of Marine Pollution in Indonesia

“…The qualitative data was extracted from a larger qualitative study based on the socioecological model (SEM) [ 49 ]. We sought the perspectives of key-informants on diets and health outcomes, particularly risk factors for cardiovascular disease (CVD) in Indonesia [ 23 , 40 ]. The research guidelines of the Consolidated Criteria for Reporting Qualitative (COREQ) were used to report this study [ 50 ].…”

“…The team was multi-disciplinary, with many years of research experience in the fields of nutrition, epidemiology, public health, and environmental health. Details of roles and the contributions of each team member to the study have been previously documented [ 23 , 40 ].…”

“…Additionally, microplastics can interact with heavy metals and increase health risks for humans [ 38 , 39 ]. However, all these studies used quantitative approaches and did not address the socio-cultural context of marine pollution in Indonesia [ 40 ]. Further, little is known in the literature about the level of awareness among Indonesians concerning marine pollution and its impact on fish availability and quality.…”

The Socio-Ecological Context of the Nutrition Transition in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Stakeholders

“…The composition of the research team has been previously described [ 35 ]. The study was conducted by a multidisciplinary team of Ph.D. level academic researchers from Tufts University, Boston MA and Universitas Diponegoro (UNDIP), Semarang Indonesia, who have many years of teaching and research experience (ENN, VRC, FFZ, KC, MIK and SCF), and one doctoral student (OAA), who coordinated the study as part of her doctoral dissertation project.…”

“…The recruitment, sampling strategies and interview procedures have been previously described [ 35 ]. The first author (OAA) and a trained research assistant conducted in-depth interviews online with a purposive sample of key informants from across Indonesia ( n = 27), who are either healthcare providers, public health nutrition researchers or environmental researchers, between April and June 2021, a period when Indonesia had just emerged from the first wave of the COVID-19 pandemic and when the social restriction policies imposed by the Indonesian government were starting to ease.…”