An exploration of dietary practices and associated factors amongst Ghanaians living in Europe

Background: Migration from low to high-income countries is associated with dietary change, but the particular patterns of dietary change and the mechanisms underlying such change are poorly understood. This research seeks to explore dietary practices and associated factors amongst people of Ghanaian descent living in Europe. Methods: This PhD consists of three studies: a systematic mapping review of factors influencing dietary behaviour of ethnic minority groups in Europe more generally, followed by an empirical, mixed method study amongst people of Ghanaian descent living in Europe. The mixed methods study comprised qualitative in-depth interviews focussing on the experiences of participants living in Greater Manchester and secondary data analysis from a larger European study. Results: The mapping review identified a broad range of factors that influence dietary behaviours among ethnic minority groups that were sorted into seven clusters. The mixed method study showed bicultural dietary patterns were discernible among people of Ghanaian descent living in different European settings. In the qualitative study, three sets of dietary practices emerged amongst participants living in Greater Manchester. The three dietary practices reflected varying degrees of continuity or change from traditional Ghanaian dietary practices. The importance that participants associated with cultural identity, having Ghanaian social networks and the availability of ethnic shops in the UK were crucial in maintaining traditional dietary practices. Important factors that increased the likelihood of adopting UK dietary practices were being a second-generation migrant, having non-Ghanaian social networks and having a busy lifestyle. Analysis of secondary data showed differences between the dietary intake of Ghanaians living in Ghana and Ghanaians living in Europe; an indication of dietary change following migration. However, the quantitative secondary data analysis failed to find consistent evidence for the role of acculturation in dietary change amongst people of Ghanaian descent living in Europe based on the measures applied in this PhD. Furthermore, the study gave limited support to the differential changes in diet suggested by the predominant model for dietary pattern changes following migration. Conclusion: This PhD provides insights on the complexity of change in dietary practices following migration, indicating that it is not a linear process and it is dependent on several inter -related factors. The typologies of dietary practices and clusters of factors identified in this PhD offers a way for nutrition researchers and practitioners to understand the complexity of dietary change amongst West African migrants

Socioeconomic determinants of cardiovascular diseases, obesity, and diabetes among migrants in the United Kingdom: A systematic review

There has been little agreement on the role that socioeconomic factors play in the aetiology of cardiovascular diseases (CVDs), obesity, and diabetes among migrants in the United Kingdom (UK). We systematically reviewed the existing evidence on this association to contribute to filling this gap in the literature. Two reviewers were involved at each stage of the review process to ensure validity. We comprehensively searched through several electronic databases and grey literature sources to identify potentially eligible papers for our review. We extracted data from our finally included studies and appraised the methodological rigour of our studies. A narrative synthesis approach was used to synthesise and interpret the extracted data. We sieved through 2485 records identified from our search and finally obtained 10 studies that met our inclusion criteria. The findings of this review show that there is a trend towards an association between socioeconomic factors and CVDs, diabetes, and obesity among migrants in the UK. However, the picture was more complex when specific socioeconomic variables and migrant subgroups were analysed. The evidence for this association is inconclusive and its causal relationship remains speculative. There is, therefore, the need for further research to understand the exact association between socioeconomic factors and CVD, diabetes, and obesity among migrants in the UK

The influence of migration on dietary practices of Ghanaians living in the United Kingdom: A qualitative study

BACKGROUND: Previous studies have identified a process of dietary acculturation when migrant groups adopt the food patterns of the host country. AIM: The aim of this study was to explore the influence of migration on dietary practices and the process of dietary acculturation amongst Ghanaians living in the UK. SUBJECT AND METHODS: A qualitative study of adults aged ≥ 25yrs (n = 31) of Ghanaian ancestry living in Greater Manchester using face to face interviews. Participants varied in socioeconomic status, gender and migration status. Interviews were transcribed verbatim and analysed thematically. RESULTS: Three distinct dietary practice typologies were discernible that differed in terms of typical meal formats, meal contexts, structure and patterning of meals, food preparation and purchasing behaviours: i. continuity practices; ii. flexible practices; and iii. changed practices. The identified practices were shaped by interrelating factors that fell into four main clusters: social and cultural environment; accessibility of foods; migration context; and food beliefs/perceptions. CONCLUSION: Participants retained, to a varying degree, some aspects of Ghanaian dietary practices whilst adopting key features of UK food culture. This study demonstrates the complexity of dietary change, indicating that it is not a linear process and it is dependent on several factors

Developing a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe - a DEDIPAC study

Background: Some ethnic minority populations have a higher risk of non-communicable diseases than the majority European population. Diet and physical activity behaviours contribute to this risk, shaped by a system of inter-related factors. This study mapped a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe, to inform research prioritisation and intervention development. Methods: A concept mapping approach guided by systems thinking was used: i. Preparation (protocol and terminology); ii. Generating a list of factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe from evidence (systematic mapping reviews) and ‘eminence’ (89 participants from 24 academic disciplines via brainstorming, an international symposium and expert review) and; iii. Seeking consensus on structuring, rating and clustering factors, based on how they relate to each other; and iv. Interpreting/utilising the framework for research and interventions. Similar steps were undertaken for frameworks developed for the majority European population. Results: Seven distinct clusters emerged for dietary behaviour (containing 85 factors) and 8 for physical activity behaviours (containing 183 factors). Four clusters were similar across behaviours: Social and cultural environment; Social and material resources; Psychosocial; and Migration context. Similar clusters of factors emerged in the frameworks for diet and physical activity behaviours of the majority European population, except for ‘migration context’. The importance of factors across all clusters was acknowledged, but their relative importance differed for ethnic minority populations compared with the majority population. Conclusions: This systems-based framework integrates evidence from both expert opinion and published literature, to map the factors influencing dietary and physical activity behaviours in ethnic minority groups. Our findings illustrate that innovative research and complex interventions need to be developed that are sensitive to the needs of ethnic minority populations. A systems approach that encompasses the complexity of the inter-related factors that drive behaviours may inform a more holistic public health paradigm to more effectively reach ethnic minorities living in Europe, as well as the majority host population

The African urban food environment framework for creating healthy nutrition policy and interventions in urban Africa

This study developed, validated, and evaluated a framework of factors influencing dietary behaviours in urban African food environments, to inform research prioritisation and intervention development in Africa. A multi-component methodology, drawing on concept mapping, was employed to construct a framework of factors influencing dietary behaviours in urban Africa. The framework adapted a widely used socio-ecological model (developed in a high-income country context) and was developed using a mixed-methods research approach that comprised: i. Evidence synthesis consisting of a systematic review of 39 papers covering 14 African countries; ii. Qualitative interview data collected for adolescents and adults (n = 144) using photovoice in urban Ghana and Kenya; and iii. Consultation with interdisciplinary African experts (n = 71) from 27 countries, who contributed to at least one step of the framework (creation, validation/evaluation, finalisation). The final framework included 103 factors influencing dietary behaviours. Experts identified the factors influencing dietary behaviours across all the four levels of the food environment i.e. the individual, social, physical and macro levels. Nearly half (n = 48) were individual-level factors and just under a quarter (n = 26) were at the macro environmental level. Fewer factors associated with social (n = 15) and physical (14) environments were identified. At the macro level, the factors ranked as most important were food prices, cultural beliefs and seasonality. Factors ranked as important at the social level were household composition, family food habits and dietary practices. The type of food available in the neighbourhood and convenience were seen as important at the physical level, while individual food habits, food preferences and socioeconomic status were ranked highly at the individual level. About half of the factors (n = 54) overlap with those reported in an existing socio-ecological food environment framework developed in a high-income country context. A further 49 factors were identified that were not reported in the selected high-income country framework, underlining the importance of contextualisation. Our conceptual framework offers a useful tool for research to understand dietary transitions in urban African adolescents and adults, as well as identification of factors to intervene when promoting healthy nutritious diets to prevent multiple forms of malnutrition

“I cannot sit here and eat alone when I know a fellow Ghanaian is suffering”: Perceptions of food insecurity among Ghanaian migrants

In the UK, ethnic minority groups tend to have higher levels of poverty than the white British population and therefore may be at high risk of food insecurity. Ghanaians, living in Ghana or as migrants are thought to have a high level of social support in their communities, but the role of this resource in relation to food security is unknown. We explored participants’ perceptions of social and economic factors influencing food security among Ghanaian migrants in Greater Manchester. Participants aged ≥25 years (n = 31) of Ghanaian ancestry living in Greater Manchester were interviewed using a semi-structured interview guide developed by the researchers. Participants varied in socioeconomic status (SES), gender and migration status. Interviews were transcribed verbatim and analysed thematically using a framework approach. Participants offered similar accounts of the social and economic factors influencing food security. Accounts were based on participants' perceptions and/or personal experiences of food insecurity within the community. Participants indicated that they and their fellow Ghanaians can ‘manage’ even when they described quite challenging food access environments. This has negative implications on their food choices in the UK. Participants reported food insecure households may be reluctant to make use of food banks for fear of ‘gossip’ and ‘pride’. Paradoxically, this reluctance does not extend to close network. Many participants described the church and other social groups as a trusted base in which people operate; support given through these channels is more acceptable than through the ‘official context’. Government assisted food banks could partner with the social groups within this community given that these are more trusted. Keywords: food insecurity; food choice; social networks; Ghanaians; healthy eating; migrants

Transitioning food environments and diets of African migrants: implications for non-communicable diseases

3rd International Symposium on Nutrition: ‘Urban food policies for sustainable nutrition and health’, online conference, 27-28 January 2022.Symposium one: Better understanding urban nutrition and health problems and understanding their causeInternational audienceNon-communicable diseases disproportionately affect African migrants from sub-Saharan Africa living in high-income countries (HICs). Evidence suggests this is largely driven by forces that include migration, globalisation of unhealthy lifestyles (poor diet, physical inactivity and smoking), unhealthy food environments, socioeconomic status and population ageing. Changes in lifestyle behaviours that accompany migration are exemplified primarily by shifts in dietary behaviours from more traditional diets to a diet that incorporates that of the host culture, which promotes the development of obesity, diabetes, hypertension and CVD. The current paper presents a critical analysis of dietary change and how this is influenced by the food environment and the socioeconomic context following migration. We used a food systems framework to structure the discussion of the interaction of factors across the food system that shape food environments and subsequent dietary changes among African migrant populations living in HICs

Transitioning food environments and diets of African migrants: implications for non-communicable diseases

3rd International Symposium on Nutrition: ‘Urban food policies for sustainable nutrition and health’, online conference, 27-28 January 2022.Symposium one: Better understanding urban nutrition and health problems and understanding their causeInternational audienceNon-communicable diseases disproportionately affect African migrants from sub-Saharan Africa living in high-income countries (HICs). Evidence suggests this is largely driven by forces that include migration, globalisation of unhealthy lifestyles (poor diet, physical inactivity and smoking), unhealthy food environments, socioeconomic status and population ageing. Changes in lifestyle behaviours that accompany migration are exemplified primarily by shifts in dietary behaviours from more traditional diets to a diet that incorporates that of the host culture, which promotes the development of obesity, diabetes, hypertension and CVD. The current paper presents a critical analysis of dietary change and how this is influenced by the food environment and the socioeconomic context following migration. We used a food systems framework to structure the discussion of the interaction of factors across the food system that shape food environments and subsequent dietary changes among African migrant populations living in HICs

Public procurement for school meal programmes in Sub-Saharan Africa: nutritional outcomes, implementation challenges and programme enablers

Background and Objectives: School-focused public food procurement and service policies (SPFPs) are increasingly being recognised as interventions that can improve the nutritional quality of food served in schools amidst growing overweight/obesity and persistent micronutrient deficiencies, stunting and wasting in sub-Saharan Africa (SSA). The review aims to investigate the impact of such policies on school food environments and nutritional outcomes of children/adolescents (5–18 y) in SSA and explore challenges and facilitators to implementing effective procurement. Methods: A mixed methods systematic review of studies in SSA published between 2012 and February 2023 was conducted. Studies were included if they reported on a publicly funded school meal (e.g., breakfast, lunch, snack, take home ration) and a nutritional (anthropometric, micronutrient deficiencies, food consumed) or food environment outcome. Quantitative findings were synthesised descriptively. Qualitative evidence was synthesized using an adapted eight-step school food system framework to guide coding (food production, wholesale & trading, transportation & storage, processing & distribution, food preparation, distribution to students, student-stakeholders and community involvement). This framework, along with infrastructure support domains, namely leadership, governance and monitoring/evaluation, guided categorisation of authors’ policy-related recommendations. Results: A total of 33 studies (26 qualitative, 7 quantitative) were included from nine SSA countries. Evidence from the quantitative studies was mixed and did not demonstrate any measurable impact of SPFPs on nutritional outcomes. In total, 53 implementation challenges, particularly in food distribution, food preparation and wholesale & trading, and 37 implementation facilitators, notably student stakeholders, community involvement and processing & distribution, were identified across the school food system. Infrastructure support and policy recommendations from authors span across the school food system, particularly for improving food preparation and engaging students in programming. Discussion: While little evidence on the impact of publicly funded school meal programmes and nutrition outcomes was found (partly explained by inadequate research design to evaluate impact), qualitative evidence suggests that developing or revising SPFPs to include healthy (nutritious and safe) food at all levels of the school food system has much potential. The array of policy action needed to improve implementation of school meal programmes across the school food system calls for action at multiple scales of governance (national/local government), as well as engaging schools and local communities to strengthen stakeholder involvement

How do publicly procured school meals programmes in sub-Saharan Africa improve nutritional outcomes for children and adolescents: a mixed-methods systematic review

International audienceAbstract Objective: This review aimed to (i) synthesise evidence of the impact of publicly procured school meals programmes on nutritional outcomes of children/adolescents (5–18 years) in sub-Saharan Africa and (ii) identify challenges and facilitators to implementing effective school meals programmes. Design: Mixed-methods systematic review ( n 7 databases). Nutritional outcomes assessed were anthropometrics (underweight, stunting, wasting, overweight/obesity), micronutrient deficiencies, food consumed and food environment. Qualitative findings were coded using a nine-step school food system framework: production of food, wholesale and trading, transportation and storage, processing and distribution, food preparation, distribution to students, student stakeholders, community involvement and infrastructure support . Setting: Sub-Saharan Africa. Participants: Children/adolescents (5–18 years), parents, school personnel and government officials. Results: Thirty-three studies (twenty-six qualitative, seven quantitative) from nine sub-Saharan African countries were included. Six studies found a positive impact of publicly procured school meals programmes on nutritional outcomes (wasting ( n 1), stunting ( n 3), underweight ( n 1), vitamin A intake ( n 1) and dietary diversity ( n 1)). Fifty-three implementation challenges were identified, particularly during food preparation (e.g. training, payment), distribution to students (e.g. meal quantity/quality/diversity, utensils) and infrastructure support (e.g. funding, monitoring, coordination). Implementation facilitators were identified ( n 37) across processing and distribution (e.g. programme coordination), student stakeholders (e.g. food preferences, reduced stigma) and community involvement (e.g. engagement, positive perceptions). Included policy recommendations targeted wholesale and trading , food preparation , student stakeholders and infrastructure support in nine, fifteen and twenty-five studies, respectively. Conclusions: As many challenges remain, strengthening implementation (and therefore the nutritional impact) of school meals programmes in sub-Saharan Africa requires bold commitment and improved coordination at multiple levels of governance