Developing a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe - a DEDIPAC study

Abstract

Background: Some ethnic minority populations have a higher risk of non-communicable diseases than the majority European population. Diet and physical activity behaviours contribute to this risk, shaped by a system of inter-related factors. This study mapped a systems-based framework of the factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe, to inform research prioritisation and intervention development.

Methods: A concept mapping approach guided by systems thinking was used: i. Preparation (protocol and terminology); ii. Generating a list of factors influencing dietary and physical activity behaviours in ethnic minority populations living in Europe from evidence (systematic mapping reviews) and 'eminence' (89 participants from 24 academic disciplines via brainstorming, an international symposium and expert review) and; iii. Seeking consensus on structuring, rating and clustering factors, based on how they relate to each other; and iv. Interpreting/utilising the framework for research and interventions. Similar steps were undertaken for frameworks developed for the majority European population.

Results: Seven distinct clusters emerged for dietary behaviour (containing 85 factors) and 8 for physical activity behaviours (containing 183 factors). Four clusters were similar across behaviours: Social and cultural environment; Social and material resources; Psychosocial; and Migration context. Similar clusters of factors emerged in the frameworks for diet and physical activity behaviours of the majority European population, except for 'migration context'. The importance of factors across all clusters was acknowledged, but their relative importance differed for ethnic minority populations compared with the majority population.

Conclusions: This systems-based framework integrates evidence from both expert opinion and published literature, to map the factors influencing dietary and physical activity behaviours in ethnic minority groups. Our findings illustrate that innovative research and complex interventions need to be developed that are sensitive to the needs of ethnic minority populations. A systems approach that encompasses the complexity of the inter-related factors that drive behaviours may inform a more holistic public health paradigm to more effectively reach ethnic minorities living in Europe, as well as the majority host population.

Keywords: Diet; Europe; Framework; Immigrants; Migrants; Minority populations; Physical activity; Sedentary behaviour; Systems.

Fig. 1

¹Areas of expertise that were represented in the process are summarised in Table 1. ²Holdsworth M, Nicolaou M, Araba Saeed H, Jørun Langøien L, Powell K, Terragni L et al. (2015) Developing a framework map of the major determinants of dietary behaviour and physical activity/sedentary behaviour in minority ethnic groups living in Europe. International Society for Behavioral Nutrition and Physical Activity, June, Edinburgh (UK), abstract book p107, S6.73. https://eventmobi.com/api/events/7231/documents/download/596c6adb-ef0f-4695-be2c-8a1927877d2c.pdf/as/ISBNPA%202015%20bstract%20Book.pdf. Concept mapping process for developing the systems-based framework for dietary and physical activity behaviours in ethnic minority populations

Fig. 2

A systems-based framework of the priority factors and clusters influencing dietary behaviours in ethnic minority populations living in Europe. The numbers represent the order of ranking of the clusters. The factors listed under each cluster are the top 5 factors ranked by a range of experts from a wide array of disciplines for their importance based on 3 criteria of ‘research priority’, ‘expected modifiability’ and ‘potential effect size on behaviour’. Dotted lines indicate that factors in the cluster are associated with behaviours, but they do not indicate evidence for causation

Fig. 3

A systems-based framework of the priority factors and clusters influencing physical activity behaviours in ethnic minority populations living in Europe. The numbers represent the order of ranking of the clusters. The factors listed under each cluster are the top 5 factors ranked by a range of experts from a wide array of disciplines for their importance based on 3 criteria of ‘research priority’, ‘expected modifiability’ and ‘potential effect size on behaviour’. Dotted lines indicate that factors in the cluster are associated with behaviours, but they do not indicate evidence for causation

Fig. 4

A systems-based integrated framework of the clusters influencing dietary and physical activity behaviours in ethnic minority populations living in Europe. Dotted lines indicate that factors in the cluster are associated with behaviours, but they do not indicate evidence for causation