Multilevel Influences on Fat, Sugar, Salt, Fruit, and Vegetable Consumption Behaviors Among Urban Indians: Application of the Social Ecological Model

Abstract

Designing effective interventions for achieving desired dietary behavior changes requires an in-depth study of people’s behaviors situated in sociocultural and interpersonal contexts. Guided by the Social Ecological Model, we explored the individual, family, and social-structural-level influences on dietary behaviors related to consumption of fat, sugar, salt, fruits, and vegetables among urban adults in India. We conducted 10 focus groups with a sample of men and women in diverse socioeconomic groups. Data were explored using framework analysis. Social Ecological Model helped in identifying multilevel influences that facilitated or hindered healthy dietary behaviors: Individual-level influences —awareness of dietary recommendations, self-efficacy, risk perception, and perceived benefits and costs; Family-level influences —family members’ preferences, family norms, family support, and the home environment; and Social-structural influences— societal norms, culture, media, cost, availability and accessibility of fruits and vegetables, and government policies. Overall, the findings indicated the need for a range of multilevel interventions that are more likely to promote and sustain healthy dietary behaviors—for example, improving awareness about dietary recommendations (individual level), promoting positive family norms through involvement of family members (family level), and restricting the use of fat, sugar, and salt in packaged food, and supportive policies for promoting consumption of fruits and vegetables (structural level).