While culturally traditional foods are a big part of the African-American heritage, they also are a significant factor in the type 2 diabetes epidemic among African-American women. And while the prevalance of type 2 diabetes is associated with higher rates of obesity, diabetes nutrition education programs have been relatively unsuccessful in attracting and retaining African-American women.
However a new study shows that there is a way to reach members of this population and make a positive impact on their dietary behavior.
“Successful diabetes prevention nutrition programs need to be culturally sensitive — at the very least, they need to consider the traditional foods and recipes of the participants,” says James Herbert Williams, Ph.D., the E. Desmond Lee Professor of Racial and Ethnic Diversity at Washington University in St. Louis. “Programs for African-American women that are developed with Afrocentric values and culture in mind lead to greater program satisfaction for the participants and significant changes in eating habits.”
Williams examines the Eat Well Live Well Nutrition Program (EWLW) in his study “Cultural Relevancy of a Diabetes Prevention Program for African American Women,” to be published in the upcoming issue of the journal Health Promotion Practice. EWLW is a community-based, culturally specific diabetes prevention nutrition program for African-American women.
“Study results indicate that 90 percent of the EWLW participants found the programs to be culturally relevant while 82 percent were very satisfied with the program,” Williams says. “One important finding from this study was the significant positive relationship between cultural relevancy and adopting the dietary change behavior of avoiding fried foods.
“Previous dietary studies have found that African Americans eat higher levels of fried and high-fat foods than other races and ethnic groups,” he continues. “After EWLW, participants also showed improvement in dietary behaviors such as decreasing fat intake and avoiding fat as a seasoning.”
According to Williams, EWLW addressed dimensions of Afrocentric culture that are critical to developing a successful program for African-American communities.
“This program was developed with substantive input from the community,” he says. “Participants helped shape teaching approaches and defined relevant course material. A group of women from the community also trained to become peer educators for the EWLW program in their community.”
EWLW adapted food preparation courses and recipes to reflect cultural and community tastes and conducted focus groups during and after the program for continuous feedback from the community.
“The peer educators encouraged participants to cook greens without added salt pork or ham hocks and substitute lean cuts of meat in place of traditional high-fat meats such as pigs feet and sausage,” Williams says.
“Overall course emphasis focused on personal development as a means of assisting the family or community. The peer educators delivered the program content with a high level of comprehensiveness and accuracy.”
‘It was more meaningful to me’
The study followed 152 African-American women through the EWLW program. Demographics of the participants were similar to the general population of African-American women. EWLW participants were interviewed before, upon graduation and six months after the program. Below is a sample of comments from participants:
• “Because the programs were delivered by women from my community, it was more meaningful to me.”
• “When I talked about what was going on in my life, I felt that my peer educator understood what I was saying.”
• “The program made me aware of health risks associated with the people in my community because of the way we eat.”
• “My peer educator was familiar with the type of food that people in my community eat.”
• “There were women participating in the program who had similar values and beliefs as me.”
• “The program helped me to feel good about how I am as a Black woman.”
“Programs for African Americans need to assure a culturally relevant focus targeting both individuals and groups if they are to have any impact in the community,” Williams says.
“African-American disease prevalence and mortality from dietary related diseases are disproportionately high. Although many factors may contribute to this, such as socioeconomic status, a lack of appropriate services contributes to this epidemic. It is important to include culturally relevant strategies based on Afrocentric principles to achieve the most effective program results.”
This study was supported through funding from the National Institute of Diabetes & Digestive & Kidney Diseases and the Office of Minority Health Research Coordination.
Study co-authors are: Wendy Auslander, Ph.D., professor of social work at Washington University; Mary de Groot, Ph.D., assistant professor of psychology at Ohio University; Adjoa Dionne Robinson, Ph.D., research assistant at Portland State University; Cheryl Houston, Ph.D., R.D., associate professor in the Department of Human Environmental Sciences at Fontbonne University; and Debra Haire-Joshu, Ph.D., M.P.H., professor of community health at Saint Louis University.