Dietary health perceptions and sources of nutritional knowledge in an urban food environment: a qualitative study from Indonesia.

OBJECTIVE To investigate dietary health understandings; healthy foods access perceptions; and the main sources of nutritional knowledge of residents in three urban communities of varying socio-economic make-up. DESIGN An ethnographic approach to primary qualitative data collection, involving frequent visits to study areas over four months and in-depth interviews. Interviews were recorded, transcribed verbatim, and analysed through an iterative approach. SETTING Yogyakarta, Indonesia. PARTICIPANTS A purposive sample of 45 participants divided equally among the three communities. Participants were mostly female (93%), aged between 27-75 years (mean 47.7), and largely identified as the person responsible for household food-related decisions (93%). RESULTS Three overarching themes emerged: i) dietary health understandings, ii) healthy foods access perceptions, and iii) sources of nutritional knowledge. Participants employed multi-faceted conceptualisation of dietary health. Most identified healthy foods with traditional plant-based foods, inexpensive and locally-available from multiple sources. Thus, all participants perceived healthy foods as highly available in the local environment and most (80%) as affordable. Reported affordability issues referred to specific foods (particularly animal-source products) and were independent of income levels. Participants acquired nutritional knowledge from multiple sources, including many community-based initiatives. These were overall perceived as useful, but also as presenting some limitations. CONCLUSIONS The variety in dietary health understandings reported by study participants, and their high perceptions of healthy foods availability in the local environment reinforce the idea that individual- and food environment-level determinants of nutritional behaviours are highly contextual.