Exploring a combined quantitative and qualitative research approach in developing a culturally competent dietary behavior assessment instrument

One particular challenge concerning racial/ethnic disparities within health and healthcare relates to overweight/obesity prevalence among American adults, as studies have shown that ethnic minority adults have disproportionately high overweight/obesity prevalence.;The primary objective of this research study was to develop, test, and evaluate a culturally-competent dietary behavior assessment instrument by effectively synthesizing qualitative methods from Cognitive Anthropology with appropriate survey research and quantitative statistical methods. The study was conducted in the Murray/Whitfield county region—an ethno-culturally-diverse Georgia community with a considerably large Hispanic subpopulation.;There is limited evidence demonstrating the utility of meal-based dietary recalls among certain populations; thus, a dietary behavior assessment protocol in the form of a meal-based free listing dietary recall was developed that elicits typical foods eaten by individuals primarily according to meals and snacks. The protocol was constructed in a manner to elicit typical foods eaten by adults according to three culturally-based consumption models: workday versus non-workday eating habits, Saturday eating habits, and Sunday eating habits.;Binary logistic regression and Poisson regression enabled the relationship between selected food categories and certain demographic/cultural indicators to be modeled, while hierarchical cluster analyses enabled modeling of the distinct patterns of food category groupings that comprise the collective diet of the target population. Additionally, initial qualitative analyses of the raw data promoted an understanding of the influence of the local fast food and dine-in restaurant environment on the dietary behaviors of the target population.;The performance of the free listing dietary recall protocol was compared with that of the Southwestern Food Frequency Questionnaire (SWFFQ), an established dietary assessment tool that has been used in multicultural communities within the United States with a substantial percentage of Hispanic residents. Because of time and resource constraints, each participant’s food item entry was projected onto the Southwestern Food Frequency Questionnaire as if he or she completed the SWFFQ themselves. Then, based on the “pseudo-data” generated by this process, hierarchical cluster analyses and binary logistic regression analyses were conducted in the same manner as for the free listing-generated data. (Poisson regression analyses were not performed on the SWFFQ “pseudo-data” because of the incomparability between some free listing-generated food categories and SWFFQ food categories.).;Although a primary aim of this research study was to construct a comprehensive eating model that explains local food use and consumption in the community, a small sample size of 32 participants that was necessitated by limited time and financial resources precluded this objective from being fully achieved. Although the participant demographics were very similar to those of the region as a whole, there were simply not enough participants to justify the generalization of the results to the community at large. Additionally, the small sample size rendered some of the results generated by the binary logistic and Poisson regression analyses unstable. Furthermore, because the “pseudo” data generated for the instrument comparison analyses was projected by the researcher and not directly elicited from the participants themselves, there may be unintentional researcher bias incorporated into the results.;Despite these limitations, there were several illuminating results from the study. Although the sample size was small, several results from the binary logistic regression and Poisson regression analyses seemed to meet expectations based on conjecture. Additionally, there was utility gained by conducting the comparative analyses, as they provided understanding of the relative performance of the selected quantitative methodologies with respect to each of the dietary behavior assessment instruments—despite concerns about the introduction of unintentional researcher bias.;The results of this study suggest that a quantitative methods triangle of hierarchical cluster analysis, binary logistic regression analysis, and Poisson regression analysis founded upon qualitative research principles has potential for use as a combined methodological approach for researchers and public health professionals wishing to develop a comprehensive understanding of dietary behaviors at the local community level. By employing these techniques, researchers can analyze individual dietary behaviors and eating patterns from a multifaceted perspective. In turn, public health professionals can develop community-based, cross-culturally relevant programs and interventions that are equally effective across all ethno-cultural groups in their target population. (Abstract shortened by UMI.).