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Understanding Fruit and Vegetable Consumption: a Qualitative Investigation in the Mitchells Plain Sub-District of Cape Town

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Understanding Fruit and Vegetable Consumption: a Qualitative Investigation in the Mitchells Plain Sub-District of Cape Town Understanding fruit and vegetable consumption: A qualitative investigation in the Mitchells Plain sub-district of Cape Town. by Catherine Jane Pereira Thesis presented in partial fulfilment of the requirements for the degree Master of Nutrition at the University of Stellenbosch Supervisor: Prof. Milla McLachlan1 Co-supervisor: Dr. Jane Battersby2 (1 – Stellenbosch University; 2 – University of Cape Town) Faculty of Medicine and Health Sciences Department of Interdisciplinary Health Sciences Division of Human Nutrition March 2014 Stellenbosch University http://scholar.sun.ac.za DECLARATION By submitting this thesis electronically, I declare that the entirety of the work contained therein is my work, original work, that I am the sole author thereof (save to the extent explicitly otherwise stated), that reproduction and publication thereof, by Stellenbosch University will not infringe any third party rights and that I have not previously in its entirety or in part submitted it for obtaining any qualification. Signature: Date: Copyright © 2014 Stellenbosch University All rights reserved ii Stellenbosch University http://scholar.sun.ac.za ABSTRACT Introduction Adequate fruit and vegetable consumption can provide many health and nutrition benefits, and can contribute to nutritional adequacy and quality of the diet. Despite existing strategies, most people in South Africa do not consume the recommended intake of five fruits and vegetables per day, and micronutrient intakes remain low. Aim The aim of this study was to describe underlying factors that influence individual and household fruit and vegetable consumption, in an area of the Mitchells Plain sub-district, by engaging with community members in a participatory manner in accordance with a human rights-based approach. Methodology This study was cross-sectional and descriptive. Data collection was conducted from November 2012 until January 2013, in an area of Mitchells Plain. Focus group discussions were conducted to gain a broad understanding of factors that influence fruit and vegetable consumption in the community and to identify individuals for individual interviews. In-depth interviews were conducted with strategically selected community members considered to be influential in food preparation, distribution or consumption, in order to gain in-depth understanding of specific factors associated with fruit and vegetable consumption. Results Four focus group discussions were conducted with 40 participants in total, allocated to three different groups (18 to 29 year old females, 30 to 70 year old females, 18 to 60 year old males). Fifteen in-depth interviews were conducted with community leaders, individuals involved in food production (kitchen managers) or sale thereof (an informal vendor and a tuck shop owner), individuals involved in health education (a professional nurse) and basic education (a grade one educator), and others. Dominant themes discussed included fruit and vegetable consumption patterns (religious, cultural and traditional dishes, seasonal variation), fruit and vegetable preparation techniques and commonly prepared dishes, fruit and vegetable access (purchasing, vegetable gardens and direct provision) and changes in fruit and vegetable consumption patterns. Barriers to fruit and vegetable consumption included that although most participants considered them to be important, fruit and vegetables were not considered a priority food item (inadequate time and effort is allocated to food purchasing and preparation), negative side-effects of consumption, fruit and vegetables are perishable and benefits of fruit and vegetable consumption iii Stellenbosch University http://scholar.sun.ac.za are not immediately apparent. Facilitators of fruit and vegetable consumption were personal preference, traditional dishes prepared that include fruit or vegetable ingredients, individuals who sell or grow fruit and vegetables having increased availability, use of convenience fruit and vegetable items, and modelling and discipline in children. Suggestions to improve consumption included education using practical advice such as fruit recipes to improve the appeal of fruit and vegetable dishes, and methods to decrease preparation time and cost. Conclusions Limited fruit and vegetable consumption is not simply determined by limited nutrition knowledge or poor decision-making by households, but rather by a much wider set of social, economic and spatial processes. Creative and innovative behaviour-changing strategies are required that target individuals but also take cognisance of wider structural barriers, and work to create an enabling environment that is supportive of healthy eating and an adequate consumption of fruit and vegetables. iv Stellenbosch University http://scholar.sun.ac.za OPSOMMING Inleiding Voldoende inname van vrugte en groente hou baie gesondheids- en voedingsvoordele in, en kan bydra tot voedingstoereikenheid en kwaliteit van die dieet. Ongeag bestaande strategieë, neem die meeste mense in Suid-Afrika nie die aanbevole vyf vrugte en groente in nie, en mikronutriënt inname bly laag. Doelwit Die doel van hierdie studie was om die onderliggende faktore wat indiwiduele en huishoudelike vrugte- en groenteverbruik in 'n area van die Mitchells Plein subdistrik beïnvloed, te beskryf, deur met lede van die gemeenskap in 'n deelnemende manier betrokke te raak in ooreenstemming met 'n menseregte-gebaseerde benadering. Metodes Hierdie deursnee studie was beskrywend. Data-insameling het vanaf November 2012 tot Januarie 2013 in 'n gedeelte van Mitchells Plein plaasgevind. Fokusgroepbesprekings is gehou om 'n breër begrip van die faktore wat vrugte- en groenteverbruik in die gemeenskap beïnvloed, te bekom en om indiwidue te identifiseer vir indiwiduele onderhoude. In-diepte onderhoude is gevoer met strategies verkose gemeenskapslede wat beskou word as invloedryk in voedselvoorbereiding, verspreiding en verbruik, om 'n dieper begrip van spesifieke faktore wat met vrugte- en groenteverbruik verband hou, te bekom. Resultate Vier fokusgroep-besprekings is gehou met 'n totaal van 40 deelnemers, versprei oor drie verskillende groepe (18 - 29 jarige vroue, 30 - 70 jarige vroue, 18 - 60 jarige mans). Vyftien in- diepte onderhoude is gevoer met gemeenskapsleiers (polities en godsdienstig), indiwidue betrokke by voedselverwerking (kombuisbestuurders) of verkope (informele verkoper en snoepwinkeleienaar), indiwidue betrokke by gesondheidsopvoeding (professionele verpleegster) en basiese onderrig (graad een opvoeder) en andere. Oorheersende temas sluit in vrugte- en groenteverbruikspatrone (godsdienstige, kulturele en tradisionele disse, seisonale wisseling in gebruik), vrugte en groente voorbereidingstegnieke en alledaagse disse, toegang tot vrugte en groente (aankoop, groentetuine en direkte voorsiening) en verandering in vrugte- en groenteverbruikspatrone. Hindernisse tot vrugte- en groenteverbruik sluit in dat hoewel die meeste deelnemers vrugte- en groenteverbruik belangrik ag, word vrugte en groente nie as 'n prioriteitsvoedsel gesien nie. Voldoende tyd en aandag word nie aan voedsel-aankope en - voorbereiding afgestaan nie, daar is negatiewe newe-effekte aan verbruik, vrugte en groente is bederfbaar en die voordele van vrugte en groenteverbruik is nie duidelik waarneembaar nie. v Stellenbosch University http://scholar.sun.ac.za Persoonlike voorkeur is bevorderlik vir vrugte- en groenteverbruik, sommige tradisionele disse word met vrugte of groente bestanddele voorberei, asook die groter beskikbaarheid van indiwidue wat vrugte en groente verkoop of kweek, die gebruik van vrugte en groente gemaksitems, en die gedragsmodellering en dissiplinering van kinders. Voorstelle om verbruik te verbeter het ingesluit opvoeding met praktiese raad soos vrugte en groente resepte om die aantreklikheid van vrugte en groente disse te verhoog en metodes om voorbereidingstyd en onkoste te verminder. Gevolgtrekking Beperkte vrugte en groente verbruik word nie net bepaal deur beperkte voeding kennis of swak besluitneming deur huishoudings nie, maar deur 'n veel wyer reeks van maatskaplike, ekonomiese en ruimtelike prosesse. Skeppende en innoverende gedragsveranderende-strategieë wat gemik is op indiwidue is nodig, asook aandag aan wyer strukturele hindernisser. Sodoende kan ‘n bemagtigende omgewing geskep word om gesonde eetgewoontes en die verbruik van voldoende vrugte en groente te ondersteun. vi Stellenbosch University http://scholar.sun.ac.za ACKNOWLEDGEMENTS To my study leaders, Prof. Milla McLachlan and Dr Jane Battersby, thank you for your guidance throughout the duration of my thesis preparation, for your constructive comments and especially for your innovative ideas. I have been inspired and have learned from you both. To Maritha Marais, Prof. Wenche Bard Eide, Prof. Per Ole Iversen, Prof. Joyce Kikafuna and the full NOMA team: thank you for allowing me the opportunity to do this special Master’s programme (in Nutrition, Human Rights and Governance), and thank you to NOMA for the scholarship received to do this Master’s (enabling me to study in Norway and Uganda). To the Stellenbosch University Division of Human Nutrition staff: thank you to Janicke Visser for consistent guidance throughout the Master’s course, thank you to all of the support staff, and all lecturers in the Division (particularly Maritha Marais, Lisanne du Plessis, Liesbet Koornhof and Lynette Daniels) for continued and valuable mentorship, guidance and support. Thank you to NICUS for the use of the voice recorders. To Dr Donald
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