Abstract

The Barriers and Facilitators for Healthy Eating in Socio-Economically Disadvantaged Areas in Cork City and Identifying Potential Policy Actions using Group Model Building

Background: There is a large gap in life expectancy and in the prevalence of diet-related diseases, including obesity, between the most and least disadvantaged areas. A mediating factor in this relationship is food-related inequalities whereby residents of disadvantaged areas are more likely to be exposed to unhealthy food environments and have limited access to healthy foods.

Aim: To identify the barriers and facilitators of healthy dietary behaviours amongst those living in socio-economically disadvantaged areas in Cork City from a community member and professionals’ perspective, and to determine the leverage points for change and policy actions that can facilitate healthier dietary behaviours.

Methodology: Qualitative research combining systems thinking with a community-based participatory research approach. Three group model-building sessions with community members of disadvantaged areas (n=13), professionals (n=12) and a combination (n=16) were conducted. Factors that influence dietary behaviours for those on a low-income were identified and mapped into causal loop diagrams. Participants worked together using the diagrams to identify leverage points and suggest policy actions.

Results: Barriers included wide availability and advertising of foods high in fats, sugars, and salt, the proximity of discount stores and takeaways, the cost of public transportation, the cost of healthy food, aversions to wasting food, competing priorities, mental health and trauma, poor health messaging, misleading nutrition claims, and marketing strategies. Facilitators included community gardens, increased gym culture among young adults, mindfulness of chemicals in food, and school meals. Recommendations for policies included banning advertising of unhealthy foods and retail outlets around schools, implementing calorie labelling, increasing food literacy, addressing misinformation, implementing community cooking facilities, increasing social prescribing and income support, and improving the food quality in food banks and school meals.

Conclusions: To promote health and improve dietary patterns interventions need to be aimed at improving food environments rather than focusing on policy changes.

Funding acknowledgements: This work was supported by the European Research Area for Health Research (ERA4Health) (grant no. E4H/1/FOODPATH/90/2024).