1. guidelines will therefore help in the prevention

1.    
Introduction

 

A
healthy diet improves quality of life and wellbeing, and protects against
chronic diseases.

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Unfortunately,
diet-related chronic diseases are currently a major cause of death and
disability among Australians.

To
ensure that Australians can make healthy food choices, we need dietary advice
that is based on the best scientific evidence on food and health. The Australian
Dietary Guidelines and
the Australian Guide to Healthy Eating have been developed using the latest evidence and expert
opinion. These guidelines will therefore help in the prevention of diet-related
chronic diseases, and will improve the health and wellbeing of the Australian
community.

There
are many things that affect food choices, for example, personal preferences,
cultural backgrounds or philosophical choices such as vegetarian dietary
patterns. NHMRC has taken this into consideration in developing practical and
realistic advice.

Many of
the health problems due to poor diet in Australia stem from excessive intake of
foods that are high in energy, saturated fat, added sugars and/or added salt but
relatively low in nutrients. If these foods are consumed regularly they can
increase the risk of obesity and other diet-related conditions and diseases (1).

 

 Among adults, overweight and obesity has
adverse health and economic impacts, including a higher risk of developing many
chronic conditions, and of death (due to any cause).

Overweight and obesity was
responsible for 7% of the total health burden in Australia in 2011, 63% of
which was fatal burden. In 2011–12, obesity was estimated to have cost the
Australian economy $8.6 billion. (2)

Compared with non-Indigenous
Australians, Indigenous adults are more likely to be overweight or obese, and
Indigenous children and adolescents are more likely to be obese. Those who live
outside of Major cities, or who are in the lower socioeconomic groups are more
likely to be overweight or obese than others (3).
Body
Mass Index (BMI) is a commonly used measure for defining whether a person is
underweight, normal weight, overweight or obese
(4).

In 2014-15, 63.4% of
Australians aged 18 years and over were overweight or obese (11.2 million
people), comprised of 35.5% overweight (6.3 million people) and 27.9% obese
(4.9 million people). A further 35.0% were of normal weight and 1.6% were
underweight.
Overall, 70.8% of men were overweight or obese
in 2014-15, compared with 56.3% of women (4).

Being overweight or obese
increases a person’s risk of developing cardiovascular disease, high blood
pressure and/or Type 2 diabetes. These have significant implications for the
health sector in terms of cost and burden on services, and may affect a person’s
quality of life through the inability to work or participate in family and
community activities. The 2003 Australian Burden of Disease Study estimated
that high body mass accounts for 11% of the total burden of disease and injury
for indigenous people (3). 

In 2012–13, two-thirds (66%) indigenous
people aged 15 years and over were overweight or obese (29% and 37%
respectively), according to their BMI. Combined
overweight/obesity rates were higher for indigenous females than males (67%
compared with 64%), mainly due to higher obesity rates for females (3). 

In 2012–13, less than half
(43%) of indigenous people aged 15 years and over reported eating an adequate
amount of fruit each day, and only one in
twenty (5%) reported eating an adequate amount of vegetables each day (3). 

Poor nutrition is a
significant risk factor for selected cancers, cardiovascular disease and
diabetes. Poor nutrition (usually excess fats and sugar without comparable
energy use) can also contribute to high body mass, which in turn is an
independent risk factor for these same health conditions. Malnutrition may also
be an outcome where poor nutrition or where the low volume of foods is
problematic. The 2003 Australian Burden of Disease Study estimated that low
fruit and vegetable intake accounts for around 4% of the total burden of
disease and injury for indigenous people (3).

 

 

2.    
Aim
and research questions

The
aim of this study is to investigate what are the perceived motives and barriers
that could lead to healthy eating behaviour among young indigenous Australian
men (Aged 18-35 years).

Ø 
Research questions:

o  
What
are the factors that affect their preferences in food choices?

o  
How do
they perceive healthy diet?

o  
What
are the motivators which make indigenous men eat healthy food?

o  
What
are the perceived barriers behind restricting young indigenous people from adopting
healthy diet?

3.    
Rationale

Why indigenous Australian men?

There
is a huge gap in research
as well as lack of knowledge about motivators
and barriers to healthy diet among indigenous people.

Physical health of Indigenous
men is among the worst in Australia, and very poor in comparison to other non-indigenous
Australian (5,6). Recent reports from the Australian
Bureau of Statistics have indicated that the life expectancy for Indigenous
Australian men is 11.5 years lower than that of non-Indigenous men (7).

Furthermore, their mortality
rates are at least two times higher than that of non-Indigenous Australians,
and at least four to five times higher in young adult and middle-aged groups (7).
The most significant conditions contributing to the burden of disease amongst
Indigenous Australian men are cardiovascular disease, diabetes, and obesity (3).

 

4.    
Methods

A qualitative design, adopting
triangulation as a method of data collection by using a combination of focus
groups discussion and semi-structured interviews.

These two approaches are chosen
because they can be conducted in naturalistic settings which may stimulate and
encourage more openness and frankness that could help to answer the primary research
questions.

Questions will
be used during interviews and focus group discussion related to healthy diet will
be developed based on the definition of healthy diet according to Australian
Dietary Guidelines. The Australian Dietary Guidelines give advice on eating for
health and wellbeing based on the latest scientific evidence, they describe the
best approach to eating for a long and healthy life. (1)

 

Data collection:

Triangulation
methodology; using combination of focus groups discussion and semi-structured
interviews is not to cross validate the data,
but it’s to capture different dimensions related to research questions.

Six
focus group discussions, video recorded will be conducted; each group will be composed
of 6-9 men.

Focus
groups will be divided into three categories based on BMI of participants; overweight,
obese and normal weight people.

Each
participant will be assigned to one focus group category based on BMI and age;
in order to create homogeneity which could motivate them to talk and share their
thoughts and opinions.

In
addition to that 15 unstructured, audio-recorded in-depth interviews will be conducted.
The interviews will be as the following order: introduction, questions and
answers and conclusion.

Participants and setting:

Men
aged (18-35 years), Indigenous Australian, English speaker who has been living
in Australia since birth.

Participants
will be recruited through social media, work places.
Firstly, they will be required to fill questionnaire containing questions about
their date of birth, height and weight.

Height
and weight will be used to calculate their BMI.

All
interviews and focus groups will be conducted in a convenient and favourable
setting.

Sampling:

Purposeful
sampling method will be applied, Samples will be selected purposefully based on ethnicity,
age and BMI (8).

Material/data analysis:

Content analysis will be applied as
all data will be analysed using
NVivo software version 11.4.2 (9).

Audio material recorded from semi-structured
interviews as well as visual data collected from focus groups discussion will
be transcribed and coded by using NVivo software.

Thematic analysis will be
implemented for identifying themes until reaching saturation point is achieved.

 

5.    
Ethical
consideration

All participants
will be provided with statement in English language and will provide written
informed consent to their participation. The study will get approvals from University
of Gothenburg Research Ethics Committee as well as Australian Human Research
Ethics Committee (HRECs) and any other relevant organisations and community
elders in each location.

 

6.    
Previous
research

There is only one pervious
study conducted about motivators and barriers to healthy diet but it was
limited to non-indigenous Australian. There is lack of knowledge regrading this
topic among indigenous people.

Pervious study title
is “Young adult males’ motivators and
perceived barriers towards eating healthily and being active” (10).