Developing a culturally tailored brain healthy diet intervention for older midwestern African Americans: A Qualitative and Quantitative Study

BackgroundAlzheimers disease and related dementia (ADRD) in the United States (U.S.) disproportionately affects African Americans (AA). Previous research has indicated that healthy eating habits help slow cognitive decline among adults 65 years and older. However, dietary intervention studies that demonstrated preliminary ability to protect against cognitive decline demonstrated low adherence and acceptability among African Americans. ObjectiveThe objective of this study is to identify and understand knowledge and attitudes that influence dietary practices among older African Americans using a community-engaged approach. DesignA non-interventional mixed methods study designed to inform the development of an adapted brain-healthy soul food diet intervention. A purposive sampling approach was used to conduct 5 semi-structured focus group discussions and an online quantitative survey. The Health Belief Model guided the focus group using the following constructs: susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cue to action. Participants/settingInclusion criteria included self-identifying as African American or Black, aged 55 years and older, English proficient, and cognitively normal with an AD8 < 2. Participant were asked to participate in a single 60-minute virtual focus group discussion. In total, 39 individuals (25.6% men, 74.4% women) took part in one of the seven virtual focus group discussion (5-7 per focus group). Main outcome measureKnowledge and attitudes that influence dietary practices among older African Americans. Statistical analysis performedFocus groups were analyzed using a 6-step thematic analysis process, and quantitative survey data was analyzed using descriptive statistics. ResultsFive themes emerged: Knowledge of dementia; practices shaping food choices and consumption; barriers impacting healthy dietary consumption; experiential instrumental support; and elements of a culturally tailored brain healthy dietary intervention. ConclusionOlder Midwesterners perceived an adapted MIND dietary model as most feasible with the incorporation of salient cultural characteristics and strategies within both the design and delivery phases. Research SnapshotO_ST_ABSResearch QuestionC_ST_ABSWhat are the perceptions related to healthy diets and the facilitators and barriers that influence dietary practices among older Midwestern African Americans? Key FindingFive themes emerged from the focus group discussions: Knowledge of dementia; Practices shaping food choices and consumption; Barriers impacting healthy dietary consumption; External instrumental support; and Elements of culturally tailored brain healthy dietary intervention. Facilitators identified to support following a healthy diet included cooking education, food preparation demonstrations, and accessibility guidance. Barriers identified that impact healthy dietary consumption included access, cost, taste, and food spoilage.