Lawrence, Wendy Turvill
Food choices of young women with lower educational attainment.
University of Southampton, School of Medicine,
Poorly nourished women are more likely to give birth to smaller babies, as nutrients supplied to the fetus determine growth and development of key organs and systems. Children born to poor and disadvantaged women are particularly at risk, as these women are themselves born less able to nourish their babies in utero and are more likely to be eating unbalanced diets. The literature supports the hypothesis that the inadequate supply of nutrients to the fetus and in early infancy will increase the risk of ill health in later life. The Southampton Women’s Survey (SWS) found that education was the strongest predictor of consuming a diet in line with current government recommendations. Women of lower educational attainment ate the poorest quality diets. The current study aimed to understand why women of lower educational attainment have less balanced diets than women of higher educational attainment, and how we can use this knowledge to develop an intervention to improve their diets. Three phases of data collection were undertaken. First, a focus group study showed that a range of psychological and social factors influenced young women’s food choices, with differences emerging between women of lower and higher educational attainment. Social cognitive theory structured the interpretation of the findings. Women of lower educational attainment had lower perceived control over food choices; fewer appropriate mastery and vicarious experiences to provide them with food management, preparation and cooking skills; more negative affect; more impediments to eating healthily; less social support for eating healthily; and ambivalent views about the diet-disease relationship. Some women of lower educational attainment managed the food choices for themselves and their families better than others. In phase two a survey quantified the relationship between diet and these psychological and social factors in Southampton women. Questionnaire development was guided by findings from the focus group study and social cognitive theory. Eating a poor diet was associated with four factors: lower perceived control over life, fewer positive outcome expectancies, less social support for healthy eating and lower food involvement. Bandura’s construct of self-efficacy was less important than perceived control in predicting quality of diet. In phase three an expert panel focus group gauged the views of practitioners working with our target population on how to improve the diets of disadvantaged women. Three themes emerged from the discussion: trust, meeting needs, and barriers to change. The practitioners gave us insight into the challenges they face, the barriers to changing women’s dietary behaviour and what their role might be in bringing about change. This research has increased our understanding of what influences women’s food choices and what we need to do in order to improve the diets of young women with lower educational attainment. Increasing a woman’s sense of control over her life may be the key to empowering her to improve her own and her family’s diets. The next step is to work with key personnel in the City to develop an intervention for Sure Start Children’s Centre staff, who already engage with the most vulnerable populations, and are thus best placed to support women to improve their diets
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