Exploring the Dietary Experiences of Tongan Americans: Barriers and Facilitators to Healthy Dietary Behaviors

Abstract

Background and Significance: Over the past two decades, the quality of the Tongan-American diet has become of increasing concern to researchers, health professionals, and within the Tongan American communities. Schmidt (2007) found the dietary behaviors among Tongan-Americans consist of unhealthy foods including a high intake of sugar, salt, and fat. Yu et al. (2016) argued that the adoption of healthy dietary behaviors can help to reduce the disproportionate rate of diseases. Obesity rates have increased among this population in the last 20 years (Flegal et al., 2010; Panapasa et al., 2012) and obesity is now considered to be an epidemic among Tongan-Americans (Panapasa et al., 2012). According to the World Health Organization (2003), Tongans have the fifth-highest percentage of obese people in the world. In addition, the prevalence of diabetes among Tongan-American adults is also twice as high (21%) as compared to the U.S. population (10%) (Panapasa et al., 2012). These health disparities could be addressed by exploring the experiences with dietary behaviors among this population given the link between dietary behaviors and obesity and other chronic diseases such as diabetes. Purpose of Study: The purpose of this study is to better understand the dietary experiences and attitudes of Tongan Americans that contribute to the disproportionate rates of obesity and other chronic diseases in an effort to inform culturally tailored health strategies to address the high incidences. Methods: The study utilizes the principles of a grounded theoretical approach to understanding the lived experiences of Tongan American adults. The inductive nature of this exploratory qualitative study gives voice to participants' stories of how their behaviors around food and food preparation have evolved. The shift in dietary practices is among the underlying causes of the high rates of the chronic disease currently experienced by Tongan American adults. The methodology includes semi-structured interviews with 12 Tongan Americans (six men, six women). Findings: The findings indicate that there are complex behaviors involved with dietary behaviors. Thus, there were various nuances between the Tongan American dietary behaviors and the facilitators and barriers to adopting healthy dietary behaviors among Tongan American adults, including variables at the individual, environmental, sectoral, and socio-cultural levels, as the framework. In this study, the findings show that the barriers to healthy dietary behaviors include (1) home and physical environment, (2) convenience, (3) time management, (4) stress, (5) health literacy, and (6) the media; and the facilitators include (1) social support, (2) family meals, (3) meal planning and preparation, (4) individual health benefits, and (5) resiliency. Further findings suggest the importance of considering social, structural, and cultural contexts when engaging Tongan American populations and formulating preventive strategies. Therefore, research efforts and intervention initiatives aimed at preventing health disparities among Tongan Americans should be adaptable, innovative, multi-component, and multi-faceted, and should be culturally tailored to meet the needs of Tongan Americans.