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AbstractResume
Traditional Indian diets are high in grains, vegetables and fruits, and in this respect are substantially in accord with Canada's Food Guide to Healthy Eating. Adopting North American eating patterns carries potential health risks. In this study we explored migration-associated changes in eating patterns, lifestyle practices, and health-related issues of Indian immigrants and their families in Newfoundland. A cross-sectional survey employing a self-administered mailed questionnaire was conducted. A random sample of 132 subjects aged ten to 65+ took part. Participants were well established in Newfoundland and almost all were fluent in English. They were somewhat acculturated to foods commonly eaten in Canada. The majority reported that they were very or somewhat likely to engage in healthy lifestyle practices, and most (73%) wanted more relevant nutrition information. Consumption of grains, vegetables, and fruits was not in accordance with Canada's Food Guide to Healthy Eating. Sixty-five percent of participants reported that traditional Indian foods were not readily available, and 72% indicated a change in food-preparation methods. Studies of diverse ethnic groups are needed to guide effective nutrition education programs. University curricula and dietetic training programs should include cross-cultural courses to increase awareness of immigrants' unique needs.
(Can J Diet Prac Res 2002; 63:72-79)
This paper was presented in two parts, at the Dietitians of Canada national conference in Wolfville, NS, on June 12, 1998, and at Beyond Borders II in Vancouver, BC, on June 14, 1999.
INTRODUCTION
Immigrants constitute 18% of the Canadian population (1). While the ratio of foreign-born to Canadian-born residents has remained constant at about 1:6 for the past 136 years, the source of recent immigrants has changed. Most immigrants now originate from Asia, Latin America, Africa, and the Caribbean (2-4).
Studies on immigrants' dietary practices have shown changing dietary patterns and acculturation to the dominant culture's food patterns (5-8). Potential health risks arising from dietary acculturation have also been reported (9,10). Sociodemographic characteristics such as length of residence in the new country, ability to speak and read English, education level, generation, age, and gender have an impact on the type and extent of changes in immigrants' eating patterns (9,11-15).
A pilot study among a group of ethnic seniors revealed that nutrition services available in St. John's, Newfoundland, were not culturally appropriate (16). Unavailability of culturally appropriate services may be due to nutrition educators' inadequate knowledge of immigrants' diet-related issues. Auger (17) has said that, compared with other provinces, Newfoundland has fewer immigrants; they are marginalized from the so called mainstream culture and invisible to service providers.
The purpose of this study was to explore Indian immigrants' sociodemographics, migration-associated changes in eating patterns, lifestyle practices, and health-- and diet-related issues.
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Table 1
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METHODS
A cross-section of Indian immigrants residing in Newfoundland were surveyed through use of a self-- administered, mailed questionnaire.
Instrument development and questions
Personal interviews, key informant interviews, focus group discussion, and an in-depth literature review were used to explore dietary consequences of migration. A questionnaire was developed to assess 27 independent variables, including demographic characteristics, dietary practices, attitudes, knowledge, and needs (18).
A group of experts reviewed the draft instrument. This group included a sociologist, a doctoral candidate in psychology, and dietitians from different parts of Canada who had worked among immigrants andor had previous research experience. The questionnaire was pilot tested among a representative sample of immigrants for readability, clarity of instructions, ease of administration, and time needed for completion.
Questions on sociodemographic characteristics: A series of multiple-- choice andended questions was developed to collect information on demographic characteristics that could influence dietary and lifestyle practices (Table 1).
Questions on eating patterns: A yes or no question with ranking-- type options was used to examine the prevalence of vegetarianism, a common practice among Hindus in India. A food-frequency scale ranging from often to never (Table 2) was used to estimate how frequently participants ate traditional Indian foods and foods common in Canada. Examples were provided of foods commonly consumed in India and Canada for breakfast, lunch, supper, and snacks. A similar food-- frequency scale assessed the acquisition of food habits that have been identified as risk factors for chronic disease (Table 3). Anended question was used to explore the changes made in cooking methods.
To permit evaluation of the quality of their diet in comparison with Canada's Food Guide to Healthy Eating (CFGHE) recommendations, respondents were asked to indicate their number of daily servings from the four food groups. Examples were provided of approximate volume per serving for various Indian foods. Canada's Food Guide to Healthy Eating is widely promoted as the basis for Canadians' healthy eating, and dietitians use it to evaluate nutritional adequacy.
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Table 2
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Questions on lifestyle practices: Respondents were asked to indicate their likelihood of following Canada's Guidelines to Healthy Eating (CGHE) -recommended healthy lifestyle practices, which may reduce the risk of chronic diseases. A Likert-type rating scale was used, and ranged from very likely to not at all likely (Table 4).
Questions on diet and health-related issues: Yes or no questions explored food-selection issues such as availability of authentic Indian foods and accessibility to relevant nutrition information. Ranking-type questions assessed commonly used sources of nutrition information, suggestions for better sources, and nutrition-related topics of interest (Tables 5 and 6). A food-frequency scale ranging from often to never (Table 7) was used to assess the use of locally available alternative ingredients in cooking.- ended questions identified health-related issues.
Study population
The study population comprised all Indian immigrants over age ten who were living in Newfoundland and who were born in India or whose parents were born in India. It was calculated that a sample size of 135 would provide valid information with a 5% level of significance. To allow for an estimated 30% refusal rate, an additional 40 subjects were included. The total sample size was 175.
Sample selection
Names were collected from the membership list of the Friends of India Association (FIA), an organization representing the Indian community in Newfoundland; the Chinmaya Mission Association (CMA) directory, which the Hindu Temple in St. John's makes available; the Seniors Bridging Cultures Club (SBC), an association of ethnic elderly people in St. John's, and the International Students' Association (ISA) of Memorial University of Newfoundland. All people with Indian surnames on the FIA, CMA, SBC, and ISA membership lists were contacted to determine their place of birth: 377 people (143 men, of whom six were seniors, 132 women, of whom nine were seniors, 30 students and 72 children) were born in India andor had parents who were born in India.
To achieve the calculated sample size of 175 and to allow a study sample distribution comparable to that of the population, a proportionate sample
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Table 3
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Table 4
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of approximately 50% was selected (60 men, 60 women, 30 children, and 15 students). Because there were relatively few aged 65+, all 15 seniors were selected. Participants were selected so that in each household, one child and either a husband or a wife would receive the questionnaire. This sample selection method decreased the chances of more than two questionnaires in one family unit. We believed this approach could prevent duplicated information from the same family households, which also could have discouraged study participation. Despite these efforts, the households of the 11 seniors who attended SBC and lived with their adult children received three questionnaires.
Ethical considerations
The Human Investigation Committee of the Faculty of Medicine of Memorial University of Newfoundland approved the study.
Data collection
Questionnaires were mailed to selected participants. Completed questionnaires were returned in stamped, self-addressed envelopes. There was one follow-up telephone call at two weeks; a second questionnaire was sent with a reminder after four weeks. Interpreter services were arranged for those who were not fluent in English. Overall, 132 responses were returned.
