An Exploration of Healthy Food and Physical Activity Behaviors and Perceptions among Two Generations of Black Women in Soweto, South Africa Open Access

Phillips, Emily (2015)

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The prevalence of overweight and obesity is on the rise in South Africa, particularly among females living in urban environments. While obesity is a complex issue, research shows that lifestyle, cultural, and environmental factors most likely explain the high prevalence of obesity in South Africa. Risk factors and predictors of obesity among South African females are well documented in the literature; however, there is little research that explores how those at highest risk for obesity are able to maintain a healthy body weight and make healthy lifestyle choices. The purpose of this qualitative study is to understand how young adult females make healthy lifestyle choices regarding eating and physical activity within the urban, obesogenic environment of Soweto, South Africa. Specifically, it aims to discern how young adult females maintain a normal BMI by exploring the socio-cultural attitudes, beliefs, perceptions, and environmental characteristics of food and physical activity behaviors of young adult females and their mothers who are currently obese. The present qualitative study is nested within Birth to Twenty (Bt20), the biggest and longest running longitudinal study in Africa. This study utilizes a mother-daughter pair approach, and thirty-two individual interviews were conducted from June-July, 2014 in Soweto-Johannesburg, South Africa. Interviews ranged from 40 to 80 minutes and explored a variety of topics related to food, physical activity, and body size. A multi-tiered case-based and thematic analysis approach was used to gain a rich understanding of potential protective factors against overweight and obesity in the Soweto context. Results indicate a variety of implications for health promotion, the use of behavioral theory in health education, and future research.

Table of Contents

Acknowledgements. ii

Chapter 1: Introduction. 1

Chapter 2: Literature Review.. 6

Chapter 3: Methods. 13

Chapter 4: Results. 22

Demographic Characteristics of Participants. 22

Eating and Physical Activity among Young Adults. 24

Decision Making Processes and Facilitators to Healthy Behaviors. 32

Health Perceptions among Young Adults within Soweto, South Africa. 37

Body Size and Weight among Young Adults in Soweto, South Africa. 40

Mother and Daughter Comparison. 44

Mother and Daughter Relationship. 47

Recommendations and Suggestions for Change by Participants. 51

Chapter 5: Discussion. 52

Implications for Conceptual Frameworks. 54

Implications for Health Promotion in Soweto, South Africa. 54

Limitations. 57

Future Directions. 59

References. 62

Appendices. 69

Appendix 1: Young Adult Interview Guide. 69

Appendix 2: Mother Interview Guide. 74

Appendix 3: Demographic Questionnaire. 78

Appendix 4: Codebook. 80

Appendix 5: Advice and Recommendations Table. 84

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