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A focus group study of healthy eating knowledge, practices, and barriers among adult and adolescent immigrants and refugees in the United States

Kristina Tiedje1, Mark L Wieland2*, Sonja J Meiers3, Ahmed A Mohamed4, Christine M Formea5, Jennifer L Ridgeway6, Gladys B Asiedu6, Ginny Boyum7, Jennifer A Weis8, Julie A Nigon9, Christi A Patten10 and Irene G Sia2

Author Affiliations

1 Department of Anthropology, Sociology and Political Science, Université Lumière Lyon 2, Campus Porte des Alpes, Bâtiment K 5, Lyon, France

2 Department of Medicine, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA

3 Department of Nursing, Winona State University, 859 30th Ave SE, Rochester, MN 55904, USA

4 Michigan State University College of Human Medicine, 1355 Bogue St, East Lansing, MI 48824-1317, USA

5 Department of Pharmacy, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA

6 Department of Health Sciences Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA

7 Rochester Community and Technical College, Rochester, MN 55904, USA

8 Center for Translational Science Activities, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA

9 Hawthorne Education Center, 700 4th Ave SE, Rochester, MN 55904, USA

10 Department of Psychiatry and Psychology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA

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International Journal of Behavioral Nutrition and Physical Activity 2014, 11:63  doi:10.1186/1479-5868-11-63

Published: 16 May 2014



Immigrants and refugees to the United States exhibit lower dietary quality than the general population, but reasons for this disparity are poorly understood. In this study, we describe the meanings of food, health and wellbeing through the reported dietary preferences, beliefs, and practices of adults and adolescents from four immigrant and refugee communities in the Midwestern United States.


Using a community based participatory research approach, we conducted a qualitative research study with 16 audio-recorded focus groups with adults and adolescents who self-identified as Mexican, Somali, Cambodian, and Sudanese. Focus group topics were eating patterns, perceptions of healthy eating in the country of origin and in the U.S., how food decisions are made and who in the family is involved in food preparation and decisions, barriers and facilitators to healthy eating, and gender and generational differences in eating practices. A team of investigators and community research partners analyzed all transcripts in full before reducing data to codes through consensus. Broader themes were created to encompass multiple codes.


Results show that participants have similar perspectives about the barriers (personal, environmental, structural) and benefits of healthy eating (e.g., ‘junk food is bad’). We identified four themes consistent across all four communities: Ways of Knowing about Healthy Eating (‘Meanings;’ ‘Motivations;’ ‘Knowledge Sources’), Eating Practices (‘Family Practices;’ ‘Americanized Eating Practices’ ‘Eating What’s Easy’), Barriers (‘Taste and Cravings;’ ‘Easy Access to Junk Food;’ ‘Role of Family;’ Cultural Foods and Traditions;’ ‘Time;’ ‘Finances’), and Preferences for Intervention (‘Family Counseling;’ Community Education;’ and ‘Healthier Traditional Meals.’). Some generational (adult vs. adolescents) and gender differences were observed.


Our study demonstrates how personal, structural, and societal/cultural factors influence meanings of food and dietary practices across immigrant and refugee populations. We conclude that cultural factors are not fixed variables that occur independently from the contexts in which they are embedded.