John Jeyanthi H, Ziebland Sue
Division of Public Health and Primary Health Care, University of Oxford, Oxford, UK.
Health Educ Res. 2004 Apr;19(2):165-74. doi: 10.1093/her/cyg016.
This qualitative study compares the barriers to eating more fruit and vegetables reported before and after participation in a 6-month randomized controlled trial in primary care. At the initial intervention appointment of a primary care intervention to promote eating five or more portions of fruit and vegetables a day, participants were asked to identify the barriers that they thought they might encounter. Barriers were discussed again at the final appointment 6 months later. At the end of the study, a purposive sample of 40 of the trial participants was interviewed to explore their experiences in greater detail. Transcripts of tape recordings of the intervention appointments and the semi-structured interview were analysed using qualitative methods. This paper presents the results of a qualitative analysis of these appointment and interview transcripts (results of the trial are published elsewhere). Women reported that children and male partners were obstructive to their attempts to eat more fruit and vegetables, whilst men reported that their partners were supportive of the change. The perception that fruit and vegetables were expensive was a relatively intractable barrier for those with inflexible food budgets. Some barriers, including the problem of getting fruit and vegetables when travelling or when the daily routine is disrupted such as at weekends, were not anticipated and only encountered when participants tried to make changes. However, while all but three of the interview respondents described experiencing at least one barrier to eating more fruit and vegetables, three quarters (29 of 40) reported an increase in intake of between one and five daily portions. This study adds to the existing literature in that it investigates those barriers that were reported at the end of, as well as before, a 6-month trial of a dietary intervention. The findings show that trial participants were not always able to anticipate what might be a barrier to change at the initial intervention appointment. The flexible action plan meant that if participants found their initial plan hard to maintain, they were able to adapt it rather than give up. This suggests that health behaviour interventions that are negotiated and non-prescriptive may be more successful than those that are relatively inflexible.
这项定性研究比较了在初级保健机构参与为期6个月的随机对照试验前后，报告的食用更多水果和蔬菜的障碍。在初级保健干预的初始预约中，该干预旨在促进每天食用五份或更多份水果和蔬菜，参与者被要求识别他们认为可能遇到的障碍。6个月后的最终预约时再次讨论了这些障碍。在研究结束时，对40名试验参与者进行了有目的抽样访谈，以更详细地探讨他们的经历。使用定性方法分析了干预预约和半结构化访谈的录音转录本。本文呈现了对这些预约和访谈转录本的定性分析结果（试验结果已在其他地方发表）。女性报告称，孩子和男性伴侣阻碍她们食用更多水果和蔬菜的尝试，而男性则报告称他们的伴侣支持这种改变。对于那些食品预算不灵活的人来说，认为水果和蔬菜昂贵是一个相对难以解决的障碍。一些障碍，包括在旅行时或日常安排被打乱（如周末）时获取水果和蔬菜的问题，在参与者试图做出改变之前并未被预料到，只是在尝试改变时才遇到。然而，虽然除了三名访谈受访者外，所有人都描述了在食用更多水果和蔬菜方面至少遇到一个障碍，但四分之三（40人中的29人）报告摄入量增加了一到五份。这项研究补充了现有文献，因为它调查了在为期6个月的饮食干预试验结束时以及之前报告的那些障碍。研究结果表明，试验参与者在初始干预预约时并不总是能够预料到哪些可能是改变的障碍。灵活的行动计划意味着，如果参与者发现他们的初始计划难以维持，他们能够调整计划而不是放弃。这表明，经过协商且非规定性的健康行为干预可能比那些相对不灵活的干预更成功。
