Research with key BME communities around childhood obesity: Qualitative research
- There was a cultural context with regard to attitudes to health and weight, food and physical activity and health promotion perspectives.
- There were very strong cultural messages about these, some of them negative
- Typologies did not fit clusters found in earlier work with the general population
- There was a high awareness of the messages about obesity and healthy eating but a perceived difficulty in applying these to the family context
- Obesity was not seen as relevant by many – they did not see the potential risk. It only became a problem when children reached age 11 and started secondary school
- It would be easier to work on dietary messages than on those regarding physical activity
- A long-term strategy was needed to shift behaviour amongst children, parents and the extended family for both diet and physical activity. It will take time.
- Need to target both mothers and extended family members
- Many initiatives are already underway at the grassroots level
- Need to provide specific guidance for these groups to challenge their cultural views on overweight children
- Need specific tools to work at grassroots level
The purpose of this study was to provide practical guidelines on developing culturally appropriate interventions targeted at priority ethnic minority communities. It looked at understanding by the Black African, the Bangladeshi and the Pakistani communities in terms of:
- The issues relevant to obesity, such as eating a healthy diet and taking physical exercise, risks of childhood obesity and sources of information on these
- Current eating and physical activity behaviours
- How it would be possible to change behaviour
There has been concern regarding the rising number of overweight and obese people within the population which is having a profound affect on the nation’s health, with obesity affecting a growing number of children.
The Government’s Health White Paper, Choosing Health: making healthier choices easier sets out the commitment for action on obesity including stemming the rise in obesity amongst children under the age of eleven. This reflects the Public Service Agreement shared by the Department of Health, DCSF and DCMS to halt the year on year rise in obesity amongst children aged two to eleven years old by 2010 in the context of a wider strategy to deal with obesity in the population as a whole.
In March 2007 the Department of Health launched the Obesity Social Marketing Programme with an aim to reach families with children aged two to eleven with a series of messages and interventions. This programme relies on sound understanding of parental behaviours, attitudes and barriers to change. Research findings on these issues for the mainstream population include major quantitative and qualitative studies which aim to inform the delivery of the Marketing Plan.
People from ethnic minority communities have been recognised as a key audience for the various elements of the Social Marketing Programme as obesity related diseases e.g. coronary heart disease and diabetes are more prevalent amongst key ethnic minority groups. Childhood obesity amongst key ethnic minority communities is also a major concern. For example, the findings from the National Diet and Nutrition Survey of young people aged between four and eighteen found that Asian children are four times more likely to be obese than white children.
In 2007, the COI Diversity Unit conducted a scoping exercise to review parental attitudes towards diet and physical activity amongst a range of ethnic minority communities. This review identified the need for specific and detailed research amongst a number of priority ethnic minority communities to understand parental attitudes and behaviours towards their children’s diet and physical activity. The COI’s Diversity Team also highlighted the fact that mainstream messages and interventions may not be relevant or appropriate for ethnic minority audiences. It was felt to be important that future messages and interventions are culturally relevant and motivating to affect changes in attitudes and behaviour regarding healthy eating and exercise amongst the key ethnic minority groups. There was further need to research communications needs amongst these communities.
This study spoke to parents and children from the Black African, the Bangladeshi and the Pakistani communities and health professional working with these groups
The 3 ethnic groups targeted were:
- Black African
- Children aged 8-9
- Children aged 10-11
The research took place in 4 stages
Stage 1: Ethnographic family home visits
- Six home visits were conducted amongst each of the three ethnic minority communities. A total of eighteen home visits were completed. Before each visit, mothers and any children over the age of six were asked to complete a pre-task diary. The mothers’ task was designed as a record of the family’s mealsover a one week period. Children were asked to write and draw the foods they liked, foods they disliked, the things they liked to do and the things they did not enjoy. This would provide insights into the types of foods children would choose to eat; their preference for healthy versus less healthy foods and the things they did in their free time.
- This was followed by a home visit to each family and included an accompanied shopping trip with the family/family member responsible for the household’s groceries to any shops (including ethnic grocery stores) they routinely used. Each home visit took approximately five to six hours. The ethnographic element was designed to allow us to observe the family ‘going about their normal business’, to sit inon a family meal and to see how family members interacted with each other. The purpose of this was to allow actual behaviour to be observed rather than claimed behaviour. This was then followed by short discussions with parents as well as children over the age of six. Other family members living with the household were also interviewed where possible. These discussions elicited the attitudes of different family members to diet, food and physical exercise.
Stage 2: ‘Gallery Visits’
- These visits explored the responses of women and children between the ages of eight and eleven to a number of stimuli. They were taken (separately) around a number of ‘installations’ or visuals which comprised of: - a display of current health messages; - a collage of celebration foods and more ‘everyday’ foods (both ethnic and Western); - a collage of physical activities that were appropriate for women and children; - a visual display of a range of physical and sedentary activities for children to identify the types of activity they were involved with and those that they would like to participate in.
Stage 3: Small group discussions
- A number of mini group discussions were conducted amongst mothers of children between the ages of two and eleven as well as a number of paired depths with fathers. Propositions developed for the mainstream sample and adapted for the ethnic sample were tested as well as a number of other communications messages.
Stage 4: Health Expert Interviews
- A number of individual depth interviews were undertaken amongst health visitors and other professionals involved in health promotion work. These experts were identified as those who provided advice on diet, nutrition and health for families from the three ethnic minority communities.
- 18 home visits, involving the whole family
- 9 gallery visits with mothers
- 12 paired depths with children aged 8-11
- 6 mother’s mini groups
- 6 paired depths with fathers
- 4 depth interviews with health experts
- 5 depths interviews with community workers
Interviews took place in London, Birmingham, Oldham and Bradford
Nov 2007 – Jan 2008
This report is classified as sensitive as it deals with ethnic minorities.