Discussions with CHARPs
Overeating was the most common theme that surfaced during discussions on the causes of obesity among low-income African Americans in the Mississippi Delta. For example, one discussion participant observed, "People in the Mississippi Delta are used to three pieces of pork chop instead of one piece of pork chop, or four biscuits instead of one biscuit." When asked about reasons for overeating, the discussion participants identified the following: 1) low self-esteem, 2) a way of coping with depression or loneliness, 3) compensation for what they did not have during childhood, 4) social and family gatherings as a tradition, 5) easy accessibility to buffets, and 6) food stamps. Participants stated that food stamps provide a lot of food, but they do not teach recipients how to cook, shop, or prepare food. provides sample comments on each reason for overeating suggested during the discussions.
Summary of Results, Discussion Among Lay Health Workers (n = 18) on Overeating and Barriers to Healthy Eating Among Low-Income African Americans in the Mississippi Delta, 2005
Another common theme on the causes of obesity was that obesity and overweight are not perceived as a health concern. Participants had the following comments: "You know, people got this saying about what their doctor says, which is that if you are fat and you get sick, you got some meat stored." "A lot of people feel that as long as they can get around and get up and do what they gotta do, it does not matter how big they are. If they can get around and do what they gotta do, they think they are not overweight."
The CHARPs expressed the belief that lack of healthy eating among African Americans in the Mississippi Delta is not due to lack of knowledge. For example, one participant remarked, "Well, I am just saying that we all know what a proper helping should be." They identified the following barriers to healthy eating: 1) food price, 2) family structure or lack of behavioral rules on eating within the household, 3) lack of parenting skills, and 4) lack of assistance from health care providers. Sample comments on these barriers are provided in .
The CHARPs participating in the discussions agreed that African Americans in the Mississippi Delta are sedentary. The main reason given for not engaging in physical activity was lack of motivation. The following comments were made: "Well, in my neighborhood we got that [walk trail], and when I am passing through I might see one person out there. I might come back through and not see nobody out there." "I done worked on the job all day and that is walking. I am not fixing to do it."
After the group discussions, the CHARPs were asked to assist in developing a topic guide designed to probe the following issues within the focus groups:
- Overeating and barriers to healthy eating
- Obesity and overweight and related diseases
- Physical inactivity
- Benefits and barriers of using the CDC Community Guide's suggested strategies for increasing physical activity levels
- Knowledge levels on healthy eating and physical activity
The CHARPs recommended that focus groups should be segmented according to age and sex, predicting that the responses for the age and sex groups would differ from each other.
Focus group demographics
Phase 1 focus groups consisted of 36 participants (18 women and 18 men). Most of the Phase 1 participants also took part in Phase 2. Phase 2 focus groups consisted of 53 participants (28 men and 25 women). Characteristics of Phase 2 participants were as follows: women were significantly older than men (mean [SD] age of women, 49.8 [13.7] years; men, 38.9 [17.6] years), but men and women did not differ significantly in number of years of education (mean [SD] for men, 11.2 [2.3] years; women, 12.8 [4.0] years), monthly income (mean [SD] for men, $1302 [$751]; women, $1361 [$1187]), marital status, or employment status. Approximately 50% of Phase 2 participants were single (57.7% of men and 45.8% of women), and 30% were married or living with a significant other (34.6% of men and 33.3% of women). Approximately 40% of participants were currently employed (39.3% of men and 40% of women).
Focus group discussions: Phase 1
provides a summary of the topics discussed during the Phase 1 focus group meetings as well as a sample of responses. When asked the meaning of good health and healthy living, the focus group participants provided varied responses, but the most common themes were 1) good diet 2) stress-free living, 3) independent living, and 4) having a positive self-image. Definitions of exercise included walking, walking after eating, and sit-ups before going to bed. Questions about patterns of eating evoked a common theme of favoring high-volume meals. The most common themes on barriers to healthy cooking were 1) the influence of the family on what was cooked and how it was prepared, 2) the cost of food, and 3) lack of knowledge. The most common definition of physical activity was being in motion. Participants seemed to have a general understanding of the relationship between physical activity and disease prevention.
Summary of Results, Discussion Among Phase 1 Focus Group Participants (n = 36) on Perceptions of Health and Factors Associated With Eating Habits and Physical Activity Among Low-Income African Americans in the Mississippi Delta, 2005
Focus group discussions: Phase 2
The themes identified in Phase 2 differed by sex. provides a summary of themes and sample participant comments. Themes identified by female participants on potential strategies to promote physical activity included 1) comprehensive approaches rather than isolated strategies, 2) strategies that are implemented with community involvement, 3) personalized programs that meet individual needs but are implemented in groups, including families, and 4) programs implemented in church settings. Themes discussed by men included 1) group activities involving family members, 2) no need for personalized programs, and 3) income as a major barrier to physical activity.
Summary of Results, Discussion Among Phase 2 Focus Group Participants (n = 53) on Potential Strategies to Promote Physical Activity Among Low-Income African Americans in the Mississippi Delta, 2005