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Dietary Transition, Food Choice Process, and Food Practices in Sub-Saharan African Pregnant Women Living in Massachusetts

The purpose of this study was to explore dietary transition, food choice process, and food practices among Sub-Saharan African (SSA), immigrant, pregnant women in Massachusetts. A narrative design with a photovoice approach was used to examine how pregnant SSA immigrants navigated dietary transition and food choice in their host country versus home countries. Data were collected through semi-structured interviews, digital food diaries, and photovoice interviews. Participants were recruited through community gatekeepers at African churches and an African community center. Data were analyzed using a constructivist grounded theory approach with constant comparative methods. Validating research trustworthiness included ensuring methodology and sample appropriateness for the research question, triangulating data sources, and member checks, memos, and journaling to clarify researcher bias. This study’s findings indicate a strong preference by participants to maintain an “African diet” as much as possible. Specifically, the findings reveal that (1) participants traversed a multi-staged food transition process that was impacted by their self-perceptions, the accessibility and availability of food, and the need to adapt; (2) participants’ choice to maintain an “African diet” in their new context involved five domains: conception, intuition, reality, practicability, adjustment; (3) in the adjustment phase, participants worked with what was available to them to maintain a diet close to what they were accustomed; (4) participants’ perceptions of what made a healthy diet was an important factor in food choice, particularly due to being pregnant; and (5) participants recommended new tools to navigate nutritional information that could inform their dietary decisions. Findings from this study highlight critical times during the dietary transition and food choice process that could be useful in preventing dietary acculturation and unhealthy eating habits. The SSA immigrant dietary practices and processes illustrated in this study provide a foundation for designing – in collaboration with the community – informed, focused, and culturally tailored nutrition programs.