Abstract:
Background: Poor communities in low and middle income countries are reported to experience a higher burden
of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay
perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and
unhealthy food practices, factors that influence food choices and the implications for developing population health
interventions in three urban poor communities in Accra, Ghana.
Methods: Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews
were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model
which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation.
Results: Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural,
healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g.
early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas
aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients,
use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the
right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included
finances, physical and psychological state, significant others and community resources.
Conclusions: The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level
factors, including individual experience, family dynamics and community factors. The factors influencing food choices are
also multilevel. The implications of the findings for the design and content of dietary and health interventions are
discussed.
