1 Federal University of Sao Paulo, Health and Society Institute, Brazil; 2 Johns Hopkins Bloomberg School of Public Health Department of International Health, Global Obesity Prevention Center at Johns Hopkins, United States; 3 Federal University of Sao Paulo, Department of Human Movement Science, Nutritional Epidemiology Laboratory. Brazil.
Understanding perceptions and values about healthy eating is important in the design of community-based programs in order to make them culturally appropriate to the target population. We used in-depth interviews (n=7) and free-listings (n=16) to identify what healthy food means to residents in a low-income community in Santos City (Southeast Brazil) to inform a planned food store intervention focusing on obesity prevention. We also conducted 32 community workshops over a one-year period to social engagement and to create an agenda to intervene in stores. Interviews were transcribed for coding and analysis. Free-listing data were analyzed to elicit salient items in cognitive and cultural domains. The respondents ranged in age from early 20s to elderly. A total of 96 healthy foods were listed. The top four most listed foods were (frequency; salience): beans (66.7%; 0.39), vegetables (60.0%; 0.51), fruits (53.3%; 0.45) and rice (46.7%; 0.36). We found the cooking behavior as the core in healthy eating. Most common food preparations mentioned were vegetable- and meat-based, particularly the typical dishes from Northeast Brazilian cuisine. Meats in general were considered healthier due to its nutritional value. Rice and beans – staple foods of Brazil – were emphasized as the healthiest food pattern. As hypothesized, unhealthy foods mentioned in in-depth interviews were basically ultra- processed foods, such as snacks, soda and processed fruit juices. These findings allow the design of interactive nutrition education and the selection of food categories to be promoted in small food stores, which is crucial to the success of food environment interventions. Our further intervention aims to increase access to, demand for, and consumption of healthier foods through incentives to local store owners and point of purchase promotions to influence consumers’ food-related behaviors.