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JNFS 2024, 9(2): 189-199 |
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Ogbuabor D O, Ogbuabor A O, Ghasi N. Women’s Perception and Readiness regarding Adoption of A Healthy and Sustainable Diet: A Cross-Sectional Study in Enugu City, Nigeria. JNFS 2024; 9 (2) :189-199
URL: http://jnfs.ssu.ac.ir/article-1-703-en.html
URL: http://jnfs.ssu.ac.ir/article-1-703-en.html
Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu State, Nigeria
Keywords: Access to healthy foods, Diet, Food and nutrition, Consumer behaviour, Food preferences, Transtheoretical model.
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Discussion
The study examined women’s perception and readiness with respect to adopting HSD and the factors affecting the diet. Overall, the perceived benefit of HSD was moderately high. Low perceived HSD benefit, low health concern, low taste consideration, being under 35, low level of education, and being poor significantly influenced women’s readiness to adopt HSDs.
The proportion of women with high perceived benefit of HSD was moderately high in this study. The finding was consistent with previous studies (Culliford and Bradbury, 2020, Rankin et al., 2018, Reipurth et al., 2019, Tobler et al., 2011, Vanhonacker et al., 2013), and might reflect an increasing awareness of diet-related NCDs, health consciousness, high nutritional value of HSDs, and renewed interest in traditional foods among Nigerians (Maziya-Dixon et al., 2021). Nevertheless, women’s perceived benefit of individual dietary behaviors in this study varied from the findings of prior studies (Culliford and Bradbury, 2020, Tobler et al., 2011). These diversities in individual dietary behaviors could be due to contextual differences in women’s understanding of dietary behaviors and sustainability perspectives in various settings (Sánchez-Bravo et al., 2020). Hence, strategies intended to improve readiness regarding HSDs among women in this study
should be tailored to variations in individual dietary behaviors.
Full-Text: (76 Views)
Women’s Perception and Readiness regarding Adoption of A Healthy and Sustainable Diet: A Cross-Sectional Study in Enugu City, Nigeria
Daniel Ogbuabor; PhD*1, Alphonsus Ogbuabor; PhD2 & Nwanneka Ghasi; PhD3
Daniel Ogbuabor; PhD*1, Alphonsus Ogbuabor; PhD2 & Nwanneka Ghasi; PhD3
1 Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu State, Nigeria; 2 Department of Medical Laboratory Sciences, College of Medicine, Enugu State University Science and Technology, Enugu, Enugu State, Nigeria; 3 Department of Management, Faculty of Business Administration, University of Nigeria, Enugu Campus, Enugu State, Nigeria
| ARTICLE INFO | ABSTRACT | |
| ORIGINAL ARTICLE | Background: There is little knowledge about healthy and sustainable diets (HSDs) in Africa. This study assesses women’s readiness to adopt HSDs and its associated factors in Enugu, Nigeria. Methods: This was a cross-sectional household survey in 2021, which assessed women’s (n =450) food choice motives, perceived benefit, and readiness to adopt HSDs. The diets were categorised as pre-contemplation and contemplation (PC/C), preparation and relapse (P/R), and action and maintenance (A/M) stages. Odds ratios (OR) were generated using multinomial logistic regression. Results: Almost 57% of the women perceived HSD to be of high benefit. About 19%, 21%, and 60% of the women were in the PC/C, P/R and A/M, respectively. Low perceived benefit (OR=4.30, 95%CI: 2.30-8.05, P<0.001), low health concern (OR=6.35, 95%CI: 2.53-15.93, P<0.001), low education (OR=2.75, 95%CI: 1.39-5.44, P=0.004), and age <35 years (OR=2.48, 95%CI: 1.02-6.07, P=0.046) predicted being in the PC/C stage. Low perceived benefit (OR=2.75, 95%CI: 1.63-4.63, P<0.001), low health concern (OR=5.35, 95% CI: 2.40-11.92, P<0.001), low level of education (OR=1.90, 95%CI: 1.05-3.42, P=0.033), and being poor (OR=2.90, 95%CI: 1.05-7.97, P=0.039) predicted being in the P/R stage. Being <35 (OR=0.50, 95%CI: 0.28-0.87, P=0.014) and having low taste consideration (OR=0.29, 95%CI: 0.12-0.72, P=0.008) predicted being in the A/M stage. Conclusions: Readiness to adopt HSDs needs to be improved in Enugu, Nigeria. For this purpose, respective nutrition education interventions might be implemented regarding progress in HSDs. Keywords: Access to healthy foods; Diet; Food and nutrition; Consumer behaviour; Food preferences; Transtheoretical model. |
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| Article history: Received: 29 Aug 2022 Revised: 19 Nov 2022 Accepted: 19 Oct 2022 |
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| *Corresponding author daniel.ogbuabor@unn.edu.ng Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu State, Nigeria Enugu, Enugu State, Nigeria. Postal code: 400241 Tel: +234 803 877 4436 |
Healthy and sustainable diets (HSDs), defined as dietary patterns that promote all the dimensions of individuals' health, have low environmental pressure and impact. The diets are accessible, affordable, safe, equitable, and culturally acceptable (World Health Organization and Food and Agliculture Organization, 2019), which is important for achieving nutrition and health-related targets of Sustainable Development Goals (SDGs) (Martini et al., 2021, Willett et al., 2019). HSDs prevent malnutrition, reduce the risk of non-communicable diseases (NCDs), and improve planetary health (McClements, 2020, Qian et al., 2019, Steenson and Buttriss, 2021, Willett et al., 2019, World Health Organization and Food and Agliculture Organization, 2019). In Nigeria, adherence to food-based guidelines is poor (Obayelu and Osho, 2020), which results in a double burden of malnutrition where undernutrition co-exists with rising cases of overnutrition (Ministry of Budget and National Planning, 2016). Diet-related NCDs are the top risk factors for deaths and disability-adjusted life-years (DALYs) lost (Afshin et al., 2019). HSDs prevent 10.8-11.6 million deaths per year, resulting in 19–24% reduction in deaths among adults (Willett et al., 2019). The mortality rate from non-communicable diseases (NCDs), such as diabetes mellitus, hypertension and dyslipidaemia, increased from 24% in 2014 to 29% in 2018 (World Health Organisation, 2018). Regarding the environmental impact, adopting HSDs reduces land use, greenhouse gas emission, and water use (Lonnie and Johnstone, 2020, Veeramani et al., 2017).
Studies investigating consumer’s perceived benefits and readiness to adopt HSDs are growing. Most consumers have high perception of the benefits of HSDs (Culliford and Bradbury, 2020, Rankin et al., 2018, Reipurth et al., 2019, Tobler et al., 2011, Vanhonacker et al., 2013). Readiness to adopt HSDs increases with its perceived benefit (Culliford and Bradbury, 2020, de Boer et al., 2016, Pacho, 2020, Rankin et al., 2018). Moreover, food choice motives including availability (Fink et al., 2021), taste (Allès et al., 2017, Boesveldt et al., 2018, Liem and Russell, 2019, Rankin et al., 2018, Tan and Tucker, 2019, Wekeza and Sibanda, 2019), price (Fink et al., 2021, Rankin et al., 2018, Wekeza and Sibanda, 2019), health (Allès et al., 2017, Culliford and Bradbury, 2020, Hu et al., 2019, Lê et al., 2013, Rankin et al., 2018, Shrestha and Baral, 2019), weight control (Rankin et al., 2018) and environmental consideration (Allès et al., 2017, Culliford and Bradbury, 2020, Wekeza and Sibanda, 2019) affect readiness. Findings regarding the influence of socio-demographic factors are mixed; in some studies, willingness to adopt HSDs is not associated with socio-demographic characteristics (Tobler et al., 2011). Conversely, females (Culliford and Bradbury, 2020, de Boer et al., 2016, Tobler et al., 2011), young people (Culliford and Bradbury, 2020, Sánchez-Bravo et al., 2020), and high level of education (Azizi Fard et al., 2021, Fink et al., 2021, Lê et al., 2013, Sánchez-Bravo et al., 2020) increase readiness to adopt HSDs. Higher socio-economic status of households decrease the likelihood of adopting a healthy and sustainable diet (Eini-Zinab et al., 2021).While low level of knowledge and self-efficacy influence high-income people, high prices and lack of inspiration and skills influence low-income people’s sustainable food choices (Vos et al., 2022).
There are three key gaps in literature regarding HSDs. First, little is known about the factors that influence perception and the actual practices of consumers (Vermeir et al., 2020). Second, environmental impact and socio-cultural aspects of diet are not much considered in national dietary guidelines of developing countries (Martini et al., 2021). Third, most studies on benefits and readiness to adopt HSDs are conducted outside sub-Saharan Africa. In Nigeria, while urbanization has led to a dietary shift from traditional to highly processed diets, there are no empirical evidence to show what factors should be considered to shift Nigerian diet towards a healthier and more sustainable one (Maziya-Dixon et al., 2021). Therefore, there is a need for studies which assess the factors influencing sustainable dietary behaviours in Nigeria. Given that women make the decisions regarding food and meals in Nigerian families (Mapis, 2020), the objective of this study is to assess readiness to adopt HSDs and its association with food choice motives, perceived benefits, and socio-demographic factors among childbearing women in Enugu State, Nigeria.
Materials and Methods
Study setting: The study as cross-sectional survey was conducted in Enugu metropolis, Enugu State, Nigeria. Enugu metropolis is the capital city of Enugu State and comprises three local government areas (LGAs): Enugu East, Enugu North, and Enugu South LGAs. Whereas Enugu North is composed of an entirely urban population, Enugu East and Enugu North have a mix of urban and rural areas. Enugu East, Enugu North, and Enugu South LGAs consist of 808, 565, and 451 enumeration areas (EAs) (National Bureau of Statistics, 2006). In 2020, the estimated population of Enugu metropolis was 1.2m people from the 2006 population census (National Bureau of Statistics, 2007). Publicly owned health facilities in metropolis include one teaching hospital, three general hospitals, and a network of primary healthcare facilities.
Study population and sampling strategy: The study population consisted of childbearing women aged 18 to 49 living in Enugu metropolis. The women in childbearing age were chosen because mothers make good decisions in families (Mapis, 2020). The sample size was calculated with the absolute error of 5% and at type 1 error of 5% using the following formula:
Sample size = Z1-α/22 P(1-P)/d2
Where, Z1-α/2 is the standard normal variate considered at 5% type 1 error which is 1.96, and P is the expected proportion in population based on previous or pilot studies. As there was no previously published study regarding the actual proportion of HSD in Nigeria, the authors chose 50%. In addition, a 10% non-response rate was included. Therefore, 422 women were calculated as sample size. However, the study sampled 450 eligible women using a multi-stage sampling strategy with proportionate size weights. The first stage was to select 20, 14, and 11 enumeration areas from Enugu East, Enugu North, and Enugu South LGAs respectively using systematic random sampling. In the second stage, 10 households were selected from each enumeration area by systematic sampling. Regarding the 450 respondents, 1 eligible woman was interviewed per household.
Data collection: Data were collected in January and February 2021 using an interviewer-administered questionnaire. The questionnaire had four sections. Section A included 9 items which assessed consumers’ perception of HSDs published in a previous study (Culliford and Bradbury, 2020). Women’s perceived benefits of HSDs were measured using a 5-point Likert scale ranging from ‘a little amount of benefit’ to ‘a large amount of benefit’. Section B of the questionnaire measured readiness to adopt HSDs using 1 question with 6 response options based on the stages of change construct regarding transtheoretical model of behaviour change (Prochaska and Velicer, 1997). The response options included: ‘I am not interested in doing this at the moment’ (pre-contemplation), ‘I am thinking about this;, but I need more information’ (contemplation), ‘I would like to do this; but, some things are stopping me’ (planning), ‘I have started to do this some of the time’ (action), ‘I am doing this confidently most of the time’ (maintenance), and ‘I am not currently doing this; but, I have done it in the past’ (relapse). Section C focused on food choice motives. Childbearing age women selected their 3 most significant food-choice motivations from a provided list (health, cost, taste, environmental concern, and availability) based on a previous study (Culliford and Bradbury, 2020).
The authors estimated scale content validity index (S-CVI) of the nine-item questionnaire and content validity index of the single-item measure for readiness to adopt HSD and food choice motive. Five experts (in the fields of nutrition, public health, and health systems) evaluated the content of the questionnaire for its relevance to Nigerian context and its socio-cultural appropriateness of the statements. A moderate sample size (5-9 experts) was deemed appropriate for assessing the content validity of data collection tools (Mokkink et al., 2016). The evaluation was done using a 4-point scale (1=not relevant, 2=somewhat relevant, 3=quite relevant, 4=highly relevant). In this study, the S-CVI of the perceived benefit scale was 0.95, while its reliability in the sample was 0.755. The content validity indices of the single-item measures for readiness to adopt HSD and the food choice motives were also calculated as 0.95 and 0.95, respectively.
Section D covered socio-economic and demographic information. The socio-economic status was measured using Nigeria's equity tool (Metrics for Management, 2015). Information about age, education level, marital status, and the number of children living at home were also collected. Data were collected using an open data kit (ODK) version 1.29.2. The questionnaire was interviewer-administered, and by the 5 research assistants who were trained to use ODK. The assistants were trained regarding the questionnaire, data collection procedure, and ethical consideration for two days prior to data collection, including one day of field testing for the questionnaire. The interviewers explained each question to the women, evaluated how the women answered the questions, and scored the response.
Ethical consideration: The Ethics Committee of Health Research from Enugu State Ministry of Health, Enugu, Nigeria, approved this study (MH/MSD/REC21/163). Moreover, written and informed consent was obtained from all the respondents.
Data analysis: Data were analysed using SPSS (version 20, IBM, New York, USA). Descriptive statistics were used to summarise the characteristics of respondents, perceived benefit, and food choice motives. The perceived benefit of HSD was dichotomised into 2 categories 'low benefit' (scores 1 to 3) and 'high benefit' (scores 4 and 5). Furthermore, the 6 stages of change were reclassified into 3 categories: pre-contemplation and contemplation (PC/C), preparation and relapse (P/R), action and maintenance (A/M). These stages reflected the groups of individuals who were not interested or needed further information (PC/C), those who experience other barriers (P/R), and the subjects who were already taking action (A/M). Chi-square test of independence was used to test the differences between the proportion of women at different stages of adoption disaggregated by women's perceived benefit, food choice motives, and sociodemographic characteristics. Multinomial regression analysis was used to predict women's stage of change for HSD based on perceived benefit, demographic characteristics, and reported food-choice motives. Odds ratio (OR) represented the likelihood of women being in the PC/C or P/R stages of change, compared to the reference A/M stage of change. Statistical significance was also set at P-value ≤0.05.
Results
Basic characteristics of the respondents: All the responses were complete and were included in the analysis. Over 50% of the respondents were within the 25-34 age group (Table 1). Almost 68% of respondents were married, about 60% had university education, and 64% were living with their children. Nearly 83% of respondents were in rich quintiles.
Women’s food choice motives: Health, cost, availability, and taste were the most reported motives regarding food choice among the women (Figure 1).
Perceived benefits of HSDs: Overall, about 57.3% of the women perceived regarded HSD to be highly beneficial (Table 2). The perceived benefit of individuals’ dietary behaviors ranged from 54% to 84%.
Factors associated with readiness to adopt HSDs: About 19%, 21%, and 60% of the women were in the PC/C, P/R, and A/M stages, respectively. Other than environmental concern, marital status, and living with a child at home, readiness to adopt HSDs significantly differed based on perceived benefit, other food choice motives, age, education, and socio-economic status (Table 3).
Predictors of readiness to adopt HSDs: As shown in Table 4, low perceived benefit of HSD was predicted to be in the PC/C (OR=4.30, 95%CI: 2.30-8.05) and P/R (OR=2.75, 95%CI: 1.63-4.63) stages of change (Table 5). Stating low health concern as a food choice motive predicted women’s likelihood of being in the PC/C (OR=6.35, 95%CI: 2.53-15.93) and P/R (OR=5.35, 95%CI: 2.40-11.92) stages of change.
Low taste consideration, as a food choice motive (OR=0.29, 95%CI: 0.12-0.72) was significantly associated with being in the PC/C stage of change. Low education level predicted being in the (OR=2.75, 95%CI: 1.39-5.44) and PR (OR=1.90, 95%CI: 1.05-3.42) stages. Being over 35 suggested the likelihood of women being in the PC/C (OR=2.48, 95%CI: 1.02-6.07) and A/M stage compared to P/R (OR=0.50, 95%CI: 0.28-0.87) stage of change.
Studies investigating consumer’s perceived benefits and readiness to adopt HSDs are growing. Most consumers have high perception of the benefits of HSDs (Culliford and Bradbury, 2020, Rankin et al., 2018, Reipurth et al., 2019, Tobler et al., 2011, Vanhonacker et al., 2013). Readiness to adopt HSDs increases with its perceived benefit (Culliford and Bradbury, 2020, de Boer et al., 2016, Pacho, 2020, Rankin et al., 2018). Moreover, food choice motives including availability (Fink et al., 2021), taste (Allès et al., 2017, Boesveldt et al., 2018, Liem and Russell, 2019, Rankin et al., 2018, Tan and Tucker, 2019, Wekeza and Sibanda, 2019), price (Fink et al., 2021, Rankin et al., 2018, Wekeza and Sibanda, 2019), health (Allès et al., 2017, Culliford and Bradbury, 2020, Hu et al., 2019, Lê et al., 2013, Rankin et al., 2018, Shrestha and Baral, 2019), weight control (Rankin et al., 2018) and environmental consideration (Allès et al., 2017, Culliford and Bradbury, 2020, Wekeza and Sibanda, 2019) affect readiness. Findings regarding the influence of socio-demographic factors are mixed; in some studies, willingness to adopt HSDs is not associated with socio-demographic characteristics (Tobler et al., 2011). Conversely, females (Culliford and Bradbury, 2020, de Boer et al., 2016, Tobler et al., 2011), young people (Culliford and Bradbury, 2020, Sánchez-Bravo et al., 2020), and high level of education (Azizi Fard et al., 2021, Fink et al., 2021, Lê et al., 2013, Sánchez-Bravo et al., 2020) increase readiness to adopt HSDs. Higher socio-economic status of households decrease the likelihood of adopting a healthy and sustainable diet (Eini-Zinab et al., 2021).While low level of knowledge and self-efficacy influence high-income people, high prices and lack of inspiration and skills influence low-income people’s sustainable food choices (Vos et al., 2022).
There are three key gaps in literature regarding HSDs. First, little is known about the factors that influence perception and the actual practices of consumers (Vermeir et al., 2020). Second, environmental impact and socio-cultural aspects of diet are not much considered in national dietary guidelines of developing countries (Martini et al., 2021). Third, most studies on benefits and readiness to adopt HSDs are conducted outside sub-Saharan Africa. In Nigeria, while urbanization has led to a dietary shift from traditional to highly processed diets, there are no empirical evidence to show what factors should be considered to shift Nigerian diet towards a healthier and more sustainable one (Maziya-Dixon et al., 2021). Therefore, there is a need for studies which assess the factors influencing sustainable dietary behaviours in Nigeria. Given that women make the decisions regarding food and meals in Nigerian families (Mapis, 2020), the objective of this study is to assess readiness to adopt HSDs and its association with food choice motives, perceived benefits, and socio-demographic factors among childbearing women in Enugu State, Nigeria.
Materials and Methods
Study setting: The study as cross-sectional survey was conducted in Enugu metropolis, Enugu State, Nigeria. Enugu metropolis is the capital city of Enugu State and comprises three local government areas (LGAs): Enugu East, Enugu North, and Enugu South LGAs. Whereas Enugu North is composed of an entirely urban population, Enugu East and Enugu North have a mix of urban and rural areas. Enugu East, Enugu North, and Enugu South LGAs consist of 808, 565, and 451 enumeration areas (EAs) (National Bureau of Statistics, 2006). In 2020, the estimated population of Enugu metropolis was 1.2m people from the 2006 population census (National Bureau of Statistics, 2007). Publicly owned health facilities in metropolis include one teaching hospital, three general hospitals, and a network of primary healthcare facilities.
Study population and sampling strategy: The study population consisted of childbearing women aged 18 to 49 living in Enugu metropolis. The women in childbearing age were chosen because mothers make good decisions in families (Mapis, 2020). The sample size was calculated with the absolute error of 5% and at type 1 error of 5% using the following formula:
Sample size = Z1-α/22 P(1-P)/d2
Where, Z1-α/2 is the standard normal variate considered at 5% type 1 error which is 1.96, and P is the expected proportion in population based on previous or pilot studies. As there was no previously published study regarding the actual proportion of HSD in Nigeria, the authors chose 50%. In addition, a 10% non-response rate was included. Therefore, 422 women were calculated as sample size. However, the study sampled 450 eligible women using a multi-stage sampling strategy with proportionate size weights. The first stage was to select 20, 14, and 11 enumeration areas from Enugu East, Enugu North, and Enugu South LGAs respectively using systematic random sampling. In the second stage, 10 households were selected from each enumeration area by systematic sampling. Regarding the 450 respondents, 1 eligible woman was interviewed per household.
Data collection: Data were collected in January and February 2021 using an interviewer-administered questionnaire. The questionnaire had four sections. Section A included 9 items which assessed consumers’ perception of HSDs published in a previous study (Culliford and Bradbury, 2020). Women’s perceived benefits of HSDs were measured using a 5-point Likert scale ranging from ‘a little amount of benefit’ to ‘a large amount of benefit’. Section B of the questionnaire measured readiness to adopt HSDs using 1 question with 6 response options based on the stages of change construct regarding transtheoretical model of behaviour change (Prochaska and Velicer, 1997). The response options included: ‘I am not interested in doing this at the moment’ (pre-contemplation), ‘I am thinking about this;, but I need more information’ (contemplation), ‘I would like to do this; but, some things are stopping me’ (planning), ‘I have started to do this some of the time’ (action), ‘I am doing this confidently most of the time’ (maintenance), and ‘I am not currently doing this; but, I have done it in the past’ (relapse). Section C focused on food choice motives. Childbearing age women selected their 3 most significant food-choice motivations from a provided list (health, cost, taste, environmental concern, and availability) based on a previous study (Culliford and Bradbury, 2020).
The authors estimated scale content validity index (S-CVI) of the nine-item questionnaire and content validity index of the single-item measure for readiness to adopt HSD and food choice motive. Five experts (in the fields of nutrition, public health, and health systems) evaluated the content of the questionnaire for its relevance to Nigerian context and its socio-cultural appropriateness of the statements. A moderate sample size (5-9 experts) was deemed appropriate for assessing the content validity of data collection tools (Mokkink et al., 2016). The evaluation was done using a 4-point scale (1=not relevant, 2=somewhat relevant, 3=quite relevant, 4=highly relevant). In this study, the S-CVI of the perceived benefit scale was 0.95, while its reliability in the sample was 0.755. The content validity indices of the single-item measures for readiness to adopt HSD and the food choice motives were also calculated as 0.95 and 0.95, respectively.
Section D covered socio-economic and demographic information. The socio-economic status was measured using Nigeria's equity tool (Metrics for Management, 2015). Information about age, education level, marital status, and the number of children living at home were also collected. Data were collected using an open data kit (ODK) version 1.29.2. The questionnaire was interviewer-administered, and by the 5 research assistants who were trained to use ODK. The assistants were trained regarding the questionnaire, data collection procedure, and ethical consideration for two days prior to data collection, including one day of field testing for the questionnaire. The interviewers explained each question to the women, evaluated how the women answered the questions, and scored the response.
Ethical consideration: The Ethics Committee of Health Research from Enugu State Ministry of Health, Enugu, Nigeria, approved this study (MH/MSD/REC21/163). Moreover, written and informed consent was obtained from all the respondents.
Data analysis: Data were analysed using SPSS (version 20, IBM, New York, USA). Descriptive statistics were used to summarise the characteristics of respondents, perceived benefit, and food choice motives. The perceived benefit of HSD was dichotomised into 2 categories 'low benefit' (scores 1 to 3) and 'high benefit' (scores 4 and 5). Furthermore, the 6 stages of change were reclassified into 3 categories: pre-contemplation and contemplation (PC/C), preparation and relapse (P/R), action and maintenance (A/M). These stages reflected the groups of individuals who were not interested or needed further information (PC/C), those who experience other barriers (P/R), and the subjects who were already taking action (A/M). Chi-square test of independence was used to test the differences between the proportion of women at different stages of adoption disaggregated by women's perceived benefit, food choice motives, and sociodemographic characteristics. Multinomial regression analysis was used to predict women's stage of change for HSD based on perceived benefit, demographic characteristics, and reported food-choice motives. Odds ratio (OR) represented the likelihood of women being in the PC/C or P/R stages of change, compared to the reference A/M stage of change. Statistical significance was also set at P-value ≤0.05.
Results
Basic characteristics of the respondents: All the responses were complete and were included in the analysis. Over 50% of the respondents were within the 25-34 age group (Table 1). Almost 68% of respondents were married, about 60% had university education, and 64% were living with their children. Nearly 83% of respondents were in rich quintiles.
Women’s food choice motives: Health, cost, availability, and taste were the most reported motives regarding food choice among the women (Figure 1).
Perceived benefits of HSDs: Overall, about 57.3% of the women perceived regarded HSD to be highly beneficial (Table 2). The perceived benefit of individuals’ dietary behaviors ranged from 54% to 84%.
Factors associated with readiness to adopt HSDs: About 19%, 21%, and 60% of the women were in the PC/C, P/R, and A/M stages, respectively. Other than environmental concern, marital status, and living with a child at home, readiness to adopt HSDs significantly differed based on perceived benefit, other food choice motives, age, education, and socio-economic status (Table 3).
Predictors of readiness to adopt HSDs: As shown in Table 4, low perceived benefit of HSD was predicted to be in the PC/C (OR=4.30, 95%CI: 2.30-8.05) and P/R (OR=2.75, 95%CI: 1.63-4.63) stages of change (Table 5). Stating low health concern as a food choice motive predicted women’s likelihood of being in the PC/C (OR=6.35, 95%CI: 2.53-15.93) and P/R (OR=5.35, 95%CI: 2.40-11.92) stages of change.
Low taste consideration, as a food choice motive (OR=0.29, 95%CI: 0.12-0.72) was significantly associated with being in the PC/C stage of change. Low education level predicted being in the (OR=2.75, 95%CI: 1.39-5.44) and PR (OR=1.90, 95%CI: 1.05-3.42) stages. Being over 35 suggested the likelihood of women being in the PC/C (OR=2.48, 95%CI: 1.02-6.07) and A/M stage compared to P/R (OR=0.50, 95%CI: 0.28-0.87) stage of change.
| Table 1. Socio-demographic characteristics of women. | |
| Variables | n(%) |
| Age(y) 18-24 |
99(22.0) |
| 25-34 | 244(54.2) |
| 35-44 | 95(21.1) |
| 45-49 | 12(2.7) |
| Marital Status Never married |
125(27.8) |
| Married | 304(67.6) |
| Divorced or widowed Formerly married |
21(4.7) |
| Education Primary |
25(5.6) |
| Secondary/vocational | 157(34.9) |
| University degree | 268(59.6) |
| Children Yes |
287(63.8) |
| No | 163(36.2) |
| Socio-economic status Poorest/poorer |
37(8.2) |
| Middle-income | 41(9.1) |
| Riche | 372(82.7) |
| Figure 1. Motives for food choices among women. |
| Table 2. Women's perceived benefit of healthy and sustainable diets (HSDs). | ||
| Variables | Perceived benefit | |
| Low | High | |
| n(%) | n(%) | |
| Avoiding overpackaged food | 164(36.4) | 286(64.6) |
| Buying locally grown products | 73(16.2) | 377(83.8) |
| Consuming fruits and vegetables | 58(12.9) | 392(87.1) |
| Limiting red and processed meat | 195(43.3) | 255(56.7) |
| Prioritising plant-based diets | 158(35.1) | 292(64.9) |
| Reducing consumption of air freighted foods | 199(44.2) | 251(55.8) |
| Choosing sustainable fish | 100(22.2 | 300(77.8) |
| Reducing food waste | 81(18.0) | 369(82.0) |
| Choosing organic produce | 114(25.3) | 336(74.7) |
| Overall HSD | 192(42.7) | 258(57.3) |
Discussion
The study examined women’s perception and readiness with respect to adopting HSD and the factors affecting the diet. Overall, the perceived benefit of HSD was moderately high. Low perceived HSD benefit, low health concern, low taste consideration, being under 35, low level of education, and being poor significantly influenced women’s readiness to adopt HSDs.
The proportion of women with high perceived benefit of HSD was moderately high in this study. The finding was consistent with previous studies (Culliford and Bradbury, 2020, Rankin et al., 2018, Reipurth et al., 2019, Tobler et al., 2011, Vanhonacker et al., 2013), and might reflect an increasing awareness of diet-related NCDs, health consciousness, high nutritional value of HSDs, and renewed interest in traditional foods among Nigerians (Maziya-Dixon et al., 2021). Nevertheless, women’s perceived benefit of individual dietary behaviors in this study varied from the findings of prior studies (Culliford and Bradbury, 2020, Tobler et al., 2011). These diversities in individual dietary behaviors could be due to contextual differences in women’s understanding of dietary behaviors and sustainability perspectives in various settings (Sánchez-Bravo et al., 2020). Hence, strategies intended to improve readiness regarding HSDs among women in this study
should be tailored to variations in individual dietary behaviors.
| Table 3. Factors associated with readiness to adopt healthy and sustainable diet among women. | ||||||||
| Variables | Readiness to adopt HSD | ᵡ2 | P-value | |||||
| PC/C | P/R | A/M | ||||||
| n | % | n | % | n | % | |||
| Perceived HSD benefit Low |
60 |
31.3 |
54 |
28.1 |
78 |
40.6 |
53.21 | <0.001 |
| High | 26 | 10.1 | 42 | 16.3 | 190 | 73.6 | ||
| Health consciousness No |
53 |
46.1 |
35 |
30.4 |
27 |
23.5 |
98.58 | <0.001 |
| Yes | 33 | 9.9 | 61 | 18.2 | 241 | 71.9 | ||
| Cost consideration No |
15 |
11.0 |
22 |
16.2 |
99 |
72.8 |
14.83 | 0.001 |
| Yes | 71 | 22.6 | 74 | 23.6 | 169 | 53.8 | ||
| Taste consideration No |
16 |
8.4 |
42 |
22.1 |
132 |
69.5 |
25.19 | <0.001 |
| Yes | 70 | 26.9 | 54 | 20.8 | 136 | 52.3 | ||
| Environmental concern No |
82 |
20.4 |
86 |
21.4 |
234 |
58.2 |
4.42 | 0.110 |
| Yes | 4 | 8.3 | 10 | 20.8 | 34 | 70.8 | ||
| Availability consideration No |
20 |
10.9 |
36 |
19.6 |
128 |
69.6 |
16.76 | <0.001 |
| Yes | 66 | 24.8 | 60 | 22.6 | 140 | 52.6 | ||
| Age (years) <35 |
78 |
22.7 |
61 |
17.8 |
204 |
59.5 |
18.46 | <0.001 |
| 35≤ | 8 | 7.5 | 35 | 32.7 | 64 | 59.8 | ||
| Education Low |
56 |
30.8 |
50 |
27.5 |
76 |
41.8 |
43.39 | <0.001 |
| High | 30 | 11.2 | 46 | 17.2 | 192 | 71.6 | ||
| Socio-economic status Poor |
14 |
37.8 |
13 |
35.1 |
10 |
27.0 |
20.58 | <0.001 |
| Moderate | 9 | 22.0 | 11 | 26.8 | 21 | 51.2 | ||
| Rich | 63 | 16.9 | 72 | 19.4 | 237 | 63.7 | ||
| Marital status Never married |
26 |
20.8 |
23 |
18.4 |
76 |
60.8 |
1.61 | 0.806 |
| Formerly married | 3 | 14.3 | 6 | 28.6 | 12 | 57.1 | ||
| Married | 57 | 18.8 | 67 | 22.0 | 180 | 59.2 | ||
| Living with a child Yes |
54 |
18.8 |
66 |
23.0 |
167 |
58.2 |
1.31 | 0.519 |
| No | 32 | 19.6 | 30 | 18.4 | 101 | 62.0 | ||
| HSD: Healthy and sustainable diet; PC/C: Pre-contemplation and contemplation; P/R: Preparation and relapse; A/M: Action and maintenance. | ||||||||
| Table 4. Predictors of readiness to adopt a healthy and sustainable diet among women. | |||||||
| Variables | PC/C | P/R | |||||
| OR (95%CI) | P-value | OR (95%CI) | P-value | ||||
| HSD benefit intercept | |||||||
| Low | 4.30(2.30-8.05) | <0.001 | 2.75(1.63-4.63) | <0.001 | |||
| High | 1.00 | ||||||
| Health consciousness Low |
6.35(2.53-15.93) |
<0.001 |
5.35(2.40-11.92) |
<0.001 |
|||
| High | 1.00 | ||||||
| Cost consciousness Low |
0.63(0.27-1.49) |
0.293 |
0.91(0.46-1.83) |
0.799 |
|||
| High | 1.00 | ||||||
| Taste consideration Low |
0.29(0.12-0.72) |
0.008 |
1.03(0.52-2.04) |
0.938 |
|||
| High | 1.00 | ||||||
| Environmental concern Low |
1.40(0.36-5.40) |
0.624 |
1.05(0.41-2.73) |
0.917 |
|||
| High | 1.00 | ||||||
| Availability consideration Low |
0.51(0.21-1.23) |
0.135 |
1.26(0.63-2.51) |
0.514 |
|||
| High | 1.00 | ||||||
| Age (years) <35 |
2.48(1.02-6.07) |
0.046 |
0.50(0.28-0.87) |
0.014 |
|||
| 35≤ | 1.00 | ||||||
| Education Low |
2.75(1.39-5.44) |
0.004 |
1.90(1.05-3.42) |
0.033 |
|||
| High | 1.00 | ||||||
| Socio-economic status Poor |
2.54(0.83-7.76) |
0.103 |
2.90(1.05-7.97) |
0.039 |
|||
| Middle-income | 0.66(0.23-1.86) | 0.431 | 0.95(0.38-2.38) | 0.917 | |||
| Rich | 1.00 | ||||||
| HSD: Healthy and sustainable diet; PC/C: Pre-contemplation and contemplation; P/R: Preparation and relapse; A/M: Action and maintenance; The reference category is A/M. | |||||||
Consistent with the transtheoretical model of behavior change (Prochaska and Velicer, 1997), the authors found that readiness to adopt HSDs increased with its perceived benefit. This finding aligned with the results of previous studies (Culliford and Bradbury, 2020, de Boer et al., 2016, Pacho, 2020, Rankin et al., 2018). In the current study, women with low perceived benefits were 4 and 3 times more likely to be in the PC/C and P/R stage of change. This finding implied that women with perceived low benefits were either not intending to adopt HSD in the foreseeable future or were preparing for the diet, while those who had started were more likely to relapse. Hence, women’s awareness of the benefits of HSDs must be prioritized in interventions to enhance readiness to adopt HSDs.
That low health consciousness increased the likelihood of being in the PC/C and P/R stages of change was supported by several studies which found that high health concerns increased consumer’s readiness to adopt healthy and sustainable diets (Allès et al., 2017, Culliford and Bradbury, 2020, Lê et al., 2013, Rankin et al., 2018, Shrestha and Baral, 2019, Wang et al., 2019). In this sample, health was the foremost food choice motive, implying that health and nutrition benefits of food take precedence over all the other motivations for choosing food. In the current study, health consciousness among women could also be the result of increasing awareness regarding the relationship between NCD and unhealthy diets (Maziya-Dixon et al., 2021, Pacho, 2020). Given that transition towards HSD results in substantial health benefits (Fadnes et al., 2022), there is a need for policies and to encourage people to adopt HSD.
According to this research, the participants with a low level of concern for taste were more inclined to adopt HSD compared with those who prioritized taste as a motive. This finding was consistent with the results of the previous studies, where high concern for taste was associated with less healthy dietary habits (Allès et al., 2017, Boesveldt et al., 2018, Liem and Russell, 2019, Rankin et al., 2018, Tan and Tucker, 2019). Two reasons might explain this finding. First, the taste profile of unhealthy foods makes them attractive to consumers especially the refined and total sugars (Liem and Russell, 2019, Tan and Tucker, 2019). Second, the innate liking for sweet and salty food does not prevent consumers from having unhealthy foods (Boesveldt et al., 2018, Liem and Russell, 2019, Tan and Tucker, 2019). Consequently, interventions regarding nutrition education with a focus on HSD should encourage women to try healthy foods (Liem and Russell, 2019).
In this research, younger women were more likely to be in the PC/C stage, which was consistent with the results of the studies by Culliford and Bradbury in 2020 and Sánchez-Bravo et al.in 2020 (Culliford and Bradbury, 2020, Sánchez-Bravo et al., 2020). Young Nigerian women tended to eat few traditional foods and preferred imported and western goods, as they were considered appealing and healthy (Mapis, 2020). The young women also tended to be greatly influenced by mass media which promote air-freighted foods (Mapis, 2020). Moreover, the consumption of sugary foods decreased with aging among Nigerian women (National Population Commission and ICF International, 2019). Younger women were more likely to be in A/M compared to older women in PR stage. This study found that older women faced more barriers for remaining in the action and maintenance stage. It might be food choosiness as is the case in high-income countries where food choosiness is a barrier to the acceptance of healthy and sustainable diets among older adults (Grasso et al., 2019). A double-barrel intervention addressing the needs of women in different age groups is recommended to motivate them to adopt HSD.
The association of high level of education with readiness to adopt HSDs was in line with the other studies (Fink et al., 2021, Lê et al., 2013, Sánchez-Bravo et al., 2020). On the other hand, low education was associated with higher consumption of carbohydrates, sweets, red meats, and low dietary diversity (Azizi Fard et al., 2021). Higher education and the resulting innovations might provide consumers the tools to access and comprehend dietary information and its impact on health (Azizi Fard et al., 2021). Moreover, education increased the opportunities for employment, improving financial status to access diverse healthy and sustainable diets (Mapis, 2020, Obayelu and Osho, 2020). Targeting information campaigns regarding food sustainability of women with a lower level of education might improve their readiness to adopt HSDs.
Furthermore, poor women were more likely to be in the PR stage of change, which was supported by the fact that higher socio-economic status improved dietary quality. In contrast, an Iranian study revealed that higher socio-economic status of households decreased the likelihood of HSD (Eini-Zinab et al., 2021). This study suggested that poor women might face barriers which limited their choices regarding sustainable dietary behaviours. For instance, financial problem is a barrier to daily consumption of fruit and vegetable among the women in Nigeria (De Filippo et al., 2021).High prices and lack of inspiration and skills were also reported as barriers to HSD among the low-income households (Vos et al., 2022).
This was the first study regarding the factors influencing the adoption of HSD by Nigerian women. This study contributes to the growing volume of research on appropriate policies and strategies to facilitate a shift towards alternative sustainable dietary guidelines. Nevertheless, women in this study may have projected a socially desirable perception of food choice motives and dietary behaviors, which could limit the scope of findings. Furthermore, as a cross-sectional study, a cause-and-effect relationship could not be established. Third, the perceived benefit of HSD may not have adequately captured environmental benefits given that the impact of food on the environment is poorly understood, and consumers have not yet internalised environmental sustainability (Sánchez-Bravo et al., 2020). Therefore, the interpretation of the environmental effects of food in Nigeria can be addressed in future studies.
Conclusions
Adopting HSD needs to be improved in Enugu Metropolis, Nigeria. Nutritional education interventions to improve transition towards action and maintenance stage of change must focus on raising awareness regarding the benefits of the diet. Moreover, such policies and programs must prioritize health benefits, the taste of healthy foods, younger women inclinations, women with low level of education, and.
Acknowledgements
The authors would like to thank the officials in National Population Commission Enugu State Office for their cooperation in selecting enumeration areas for the study; they would also like to thank Uche Ezema for developing the ODK questionnaires used in this study.
Authors’ contributions
Ogbuabor D, Ogbuabor A, and Ghasi N designed the research; Ogbuabor D, and Ghasi N conducted the study; Ogbuabor D, and Ogbuabor A analyzed the data; Ogbuabor D, Ogbuabor A, and Ghasi N wrote the paper; Ogbuabor D had the primary responsibility for final content. All the authors approved the final manuscript.
Conflict of interests
The authors report no conflict of interest.
Funding
The authors received no external funding for this study.
References
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Allès B, et al. 2017. Food choice motives including sustainability during purchasing are associated with a healthy dietary pattern in french adults. Nutrition journal. 16 (1): 58.
Azizi Fard N, De Francisci Morales G, Mejova Y & Schifanella R 2021. On the interplay between educational attainment and nutrition: a spatially-aware perspective. EPJ data science. 10 (1): 18.
Boesveldt S, et al. 2018. The changing role of the senses in food choice and food intake across the lifespan. Food quality and preference 68: 80-89.
Culliford A & Bradbury J 2020. A cross-sectional survey of the readiness of consumers to adopt an environmentally sustainable diet. Nutrition journal. 19: 138.
de Boer J, de Witt A & Aiking H 2016. Help the climate, change your diet: A cross-sectional study on how to involve consumers in a transition to a low-carbon society. Appetite. 98: 19-27.
De Filippo A, et al. 2021. Barrier analysis for adequate daily fruit and vegetable consumption among low-income residents of Hanoi, Vietnam and Ibadan, Nigeria. Global food security. 31: 100586.
Eini-Zinab H, Shoaibinobarian N, Ranjbar G, Norouzian Ostad A & Sobhani SR 2021. Association between the socio-economic status of households and a more sustainable diet. Public health nutrition. 24 (18): 6566-6574.
Fadnes LT, kland J-M, Haaland yA & Johansson KA 2022. Estimating impact of food choices on life expectancy: A modeling study. PLOS Med. 19 (2): e1003889.
Fink L, Strassner C & Ploeger A 2021. Exploring External Factors Affecting the Intention-Behavior Gap When Trying to Adopt a Sustainable Diet: A Think Aloud Study. Frontiers in nutrition. 8: 511412.
Grasso AC, Hung Y, Olthof MR, Verbeke W & Brouwer IA 2019. Older Consumers' Readiness to Accept Alternative, More Sustainable Protein Sources in the European :union:. Nutrients. 11 (8): 1904.
Hu Y, Chen Y, Liang H & Wang Y 2019. Reliability and validity of a survey to identify vaccine hesitancy among parents in Changxing county, Zhejiang province. Human vaccines & immunotherapeutics. 15 (5): 1092-1099.
Lê J, et al. 2013. Attitudes toward healthy eating: a mediator of the educational level-diet relationship. European journal of clinical nutrition. 67 (8): 808-814.
Liem DG & Russell CG 2019. The Influence of Taste Liking on the Consumption of Nutrient Rich and Nutrient Poor Foods. Frontiers in nutrition. 6: 174.
Lonnie M & Johnstone AM 2020. The public health rationale for promoting plant protein as an important part of a sustainable and healthy diet. Nutrition bulletin. 45 (3): 281-293.
Mapis GJ 2020. The Dietary Decision-Making Process of Women in Nigeria. In College of Health Sciences. Walden University Walden Dissertations and Doctoral Studies Collection.
Martini D, et al. 2021. Principles of Sustainable Healthy Diets in Worldwide Dietary Guidelines: Efforts So Far and Future Perspectives. Nutrients. 13 (6): 1827.
Maziya-Dixon B, et al. 2021. Food systems for healthier diets in Nigeria: A research agenda International Food Policy Research Institute (IFPRI): Washington, DC.
McClements DJ 2020. Future foods: Is it possible to design a healthier and more sustainable food supply? Nutrition bulletin. 45 (3): 341-354.
Metrics for Management 2015. Nigeria equity tool. Metric for Measurement.
Ministry of Budget and National Planning 2016. National policy on food and nutrition in Nigeria. 2016. Federal Ministry ofBudget and National Planning: Abuja, Nigeria.
Mokkink LB, Prinsen CA, Bouter LM, Vet HC & Terwee CB 2016. COnsenus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Brazilian journal of physical therapy. 20 (2): 105-113.
National Bureau of Statistics 2006. Local Government Area (LGA) Master Frame. Abuja, Nigeria.
National Bureau of Statistics 2007. 2006 Population Census. National Bureau of Statistics, Federal Government of Nigeria: Abuja, Nigeria.
National Population Commission and ICF International 2019. Nigeria Demographic and Health Survey 2018. Abuja, Nigeria, and Rockville, Maryland, USA.
Obayelu OA & Osho FR 2020. How diverse are the diets of low-income urban households in Nigeria? Journal of agriculture andfFood research. 2: 100018.
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That low health consciousness increased the likelihood of being in the PC/C and P/R stages of change was supported by several studies which found that high health concerns increased consumer’s readiness to adopt healthy and sustainable diets (Allès et al., 2017, Culliford and Bradbury, 2020, Lê et al., 2013, Rankin et al., 2018, Shrestha and Baral, 2019, Wang et al., 2019). In this sample, health was the foremost food choice motive, implying that health and nutrition benefits of food take precedence over all the other motivations for choosing food. In the current study, health consciousness among women could also be the result of increasing awareness regarding the relationship between NCD and unhealthy diets (Maziya-Dixon et al., 2021, Pacho, 2020). Given that transition towards HSD results in substantial health benefits (Fadnes et al., 2022), there is a need for policies and to encourage people to adopt HSD.
According to this research, the participants with a low level of concern for taste were more inclined to adopt HSD compared with those who prioritized taste as a motive. This finding was consistent with the results of the previous studies, where high concern for taste was associated with less healthy dietary habits (Allès et al., 2017, Boesveldt et al., 2018, Liem and Russell, 2019, Rankin et al., 2018, Tan and Tucker, 2019). Two reasons might explain this finding. First, the taste profile of unhealthy foods makes them attractive to consumers especially the refined and total sugars (Liem and Russell, 2019, Tan and Tucker, 2019). Second, the innate liking for sweet and salty food does not prevent consumers from having unhealthy foods (Boesveldt et al., 2018, Liem and Russell, 2019, Tan and Tucker, 2019). Consequently, interventions regarding nutrition education with a focus on HSD should encourage women to try healthy foods (Liem and Russell, 2019).
In this research, younger women were more likely to be in the PC/C stage, which was consistent with the results of the studies by Culliford and Bradbury in 2020 and Sánchez-Bravo et al.in 2020 (Culliford and Bradbury, 2020, Sánchez-Bravo et al., 2020). Young Nigerian women tended to eat few traditional foods and preferred imported and western goods, as they were considered appealing and healthy (Mapis, 2020). The young women also tended to be greatly influenced by mass media which promote air-freighted foods (Mapis, 2020). Moreover, the consumption of sugary foods decreased with aging among Nigerian women (National Population Commission and ICF International, 2019). Younger women were more likely to be in A/M compared to older women in PR stage. This study found that older women faced more barriers for remaining in the action and maintenance stage. It might be food choosiness as is the case in high-income countries where food choosiness is a barrier to the acceptance of healthy and sustainable diets among older adults (Grasso et al., 2019). A double-barrel intervention addressing the needs of women in different age groups is recommended to motivate them to adopt HSD.
The association of high level of education with readiness to adopt HSDs was in line with the other studies (Fink et al., 2021, Lê et al., 2013, Sánchez-Bravo et al., 2020). On the other hand, low education was associated with higher consumption of carbohydrates, sweets, red meats, and low dietary diversity (Azizi Fard et al., 2021). Higher education and the resulting innovations might provide consumers the tools to access and comprehend dietary information and its impact on health (Azizi Fard et al., 2021). Moreover, education increased the opportunities for employment, improving financial status to access diverse healthy and sustainable diets (Mapis, 2020, Obayelu and Osho, 2020). Targeting information campaigns regarding food sustainability of women with a lower level of education might improve their readiness to adopt HSDs.
Furthermore, poor women were more likely to be in the PR stage of change, which was supported by the fact that higher socio-economic status improved dietary quality. In contrast, an Iranian study revealed that higher socio-economic status of households decreased the likelihood of HSD (Eini-Zinab et al., 2021). This study suggested that poor women might face barriers which limited their choices regarding sustainable dietary behaviours. For instance, financial problem is a barrier to daily consumption of fruit and vegetable among the women in Nigeria (De Filippo et al., 2021).High prices and lack of inspiration and skills were also reported as barriers to HSD among the low-income households (Vos et al., 2022).
This was the first study regarding the factors influencing the adoption of HSD by Nigerian women. This study contributes to the growing volume of research on appropriate policies and strategies to facilitate a shift towards alternative sustainable dietary guidelines. Nevertheless, women in this study may have projected a socially desirable perception of food choice motives and dietary behaviors, which could limit the scope of findings. Furthermore, as a cross-sectional study, a cause-and-effect relationship could not be established. Third, the perceived benefit of HSD may not have adequately captured environmental benefits given that the impact of food on the environment is poorly understood, and consumers have not yet internalised environmental sustainability (Sánchez-Bravo et al., 2020). Therefore, the interpretation of the environmental effects of food in Nigeria can be addressed in future studies.
Conclusions
Adopting HSD needs to be improved in Enugu Metropolis, Nigeria. Nutritional education interventions to improve transition towards action and maintenance stage of change must focus on raising awareness regarding the benefits of the diet. Moreover, such policies and programs must prioritize health benefits, the taste of healthy foods, younger women inclinations, women with low level of education, and.
Acknowledgements
The authors would like to thank the officials in National Population Commission Enugu State Office for their cooperation in selecting enumeration areas for the study; they would also like to thank Uche Ezema for developing the ODK questionnaires used in this study.
Authors’ contributions
Ogbuabor D, Ogbuabor A, and Ghasi N designed the research; Ogbuabor D, and Ghasi N conducted the study; Ogbuabor D, and Ogbuabor A analyzed the data; Ogbuabor D, Ogbuabor A, and Ghasi N wrote the paper; Ogbuabor D had the primary responsibility for final content. All the authors approved the final manuscript.
Conflict of interests
The authors report no conflict of interest.
Funding
The authors received no external funding for this study.
References
Afshin A, et al. 2019. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 393 (10184): 1958-1972.
Allès B, et al. 2017. Food choice motives including sustainability during purchasing are associated with a healthy dietary pattern in french adults. Nutrition journal. 16 (1): 58.
Azizi Fard N, De Francisci Morales G, Mejova Y & Schifanella R 2021. On the interplay between educational attainment and nutrition: a spatially-aware perspective. EPJ data science. 10 (1): 18.
Boesveldt S, et al. 2018. The changing role of the senses in food choice and food intake across the lifespan. Food quality and preference 68: 80-89.
Culliford A & Bradbury J 2020. A cross-sectional survey of the readiness of consumers to adopt an environmentally sustainable diet. Nutrition journal. 19: 138.
de Boer J, de Witt A & Aiking H 2016. Help the climate, change your diet: A cross-sectional study on how to involve consumers in a transition to a low-carbon society. Appetite. 98: 19-27.
De Filippo A, et al. 2021. Barrier analysis for adequate daily fruit and vegetable consumption among low-income residents of Hanoi, Vietnam and Ibadan, Nigeria. Global food security. 31: 100586.
Eini-Zinab H, Shoaibinobarian N, Ranjbar G, Norouzian Ostad A & Sobhani SR 2021. Association between the socio-economic status of households and a more sustainable diet. Public health nutrition. 24 (18): 6566-6574.
Fadnes LT, kland J-M, Haaland yA & Johansson KA 2022. Estimating impact of food choices on life expectancy: A modeling study. PLOS Med. 19 (2): e1003889.
Fink L, Strassner C & Ploeger A 2021. Exploring External Factors Affecting the Intention-Behavior Gap When Trying to Adopt a Sustainable Diet: A Think Aloud Study. Frontiers in nutrition. 8: 511412.
Grasso AC, Hung Y, Olthof MR, Verbeke W & Brouwer IA 2019. Older Consumers' Readiness to Accept Alternative, More Sustainable Protein Sources in the European :union:. Nutrients. 11 (8): 1904.
Hu Y, Chen Y, Liang H & Wang Y 2019. Reliability and validity of a survey to identify vaccine hesitancy among parents in Changxing county, Zhejiang province. Human vaccines & immunotherapeutics. 15 (5): 1092-1099.
Lê J, et al. 2013. Attitudes toward healthy eating: a mediator of the educational level-diet relationship. European journal of clinical nutrition. 67 (8): 808-814.
Liem DG & Russell CG 2019. The Influence of Taste Liking on the Consumption of Nutrient Rich and Nutrient Poor Foods. Frontiers in nutrition. 6: 174.
Lonnie M & Johnstone AM 2020. The public health rationale for promoting plant protein as an important part of a sustainable and healthy diet. Nutrition bulletin. 45 (3): 281-293.
Mapis GJ 2020. The Dietary Decision-Making Process of Women in Nigeria. In College of Health Sciences. Walden University Walden Dissertations and Doctoral Studies Collection.
Martini D, et al. 2021. Principles of Sustainable Healthy Diets in Worldwide Dietary Guidelines: Efforts So Far and Future Perspectives. Nutrients. 13 (6): 1827.
Maziya-Dixon B, et al. 2021. Food systems for healthier diets in Nigeria: A research agenda International Food Policy Research Institute (IFPRI): Washington, DC.
McClements DJ 2020. Future foods: Is it possible to design a healthier and more sustainable food supply? Nutrition bulletin. 45 (3): 341-354.
Metrics for Management 2015. Nigeria equity tool. Metric for Measurement.
Ministry of Budget and National Planning 2016. National policy on food and nutrition in Nigeria. 2016. Federal Ministry ofBudget and National Planning: Abuja, Nigeria.
Mokkink LB, Prinsen CA, Bouter LM, Vet HC & Terwee CB 2016. COnsenus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Brazilian journal of physical therapy. 20 (2): 105-113.
National Bureau of Statistics 2006. Local Government Area (LGA) Master Frame. Abuja, Nigeria.
National Bureau of Statistics 2007. 2006 Population Census. National Bureau of Statistics, Federal Government of Nigeria: Abuja, Nigeria.
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Received: 2022/08/29 | Published: 2024/05/21 | ePublished: 2024/05/21
Received: 2022/08/29 | Published: 2024/05/21 | ePublished: 2024/05/21
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