The dietary acculturation process in newly immigrated Chinese mothers with dependent children

Thesis (Ph.D.)--University of Washington, 2022Upon arrival in a new host country, generally a more developed or modern one, immigrants have a better health profile than the counterpart native population, i.e., the “healthy immigrant effect.” After arrival, the overall mortality rate and the prevalence of disease risk factors among immigrants increase with their duration of residence in a host country, such as the United States and Canada. Many aspects of adaptation occur with immigration, i.e., acculturation, including the aspect of dietary practice. Dietary acculturation is the process that occurs when members of a minority group adopt the eating patterns/food choices of the host country. Knowledge of such a process is crucial yet not well understood. The purpose of this dissertation study is to understand the dietary acculturation process among newly immigrated Chinese American mothers with dependent children. The aims are to (1) generate a new framework to conceptualize phases involved in the dietary acculturation process, and (2) identify key mechanisms and factors associated with change in dietary intake and dietary behaviors.The study was guided by the precede-proceed model and Satia-Abouta’s model of dietary acculturation (2002). Naturalism served as the study’s philosophical underpinning, and a generic qualitative approach was taken. Six focus group discussion sessions were conducted with newly immigrated Chinese mothers. Purposeful sampling was done through three different types of social organizations to include immigrants from both urban and suburban areas as well as from an ethnic enclave. The study sample consisted of 42 participants, with five to eight participants in each of the six focus groups. A semi-structured discussion guide for focus groups was used to facilitate the discussions. To make the research design suitable to the study purpose and aims, tools from multiple established qualitative methods, such as the grounded theory approach, thematic analysis, and content analysis, were used. The analytic procedures included decontextualizing, synthesizing, and re-contextualizing. An iterative, 5-stage multi-step analytic process was conducted. Measures were taken to ensure trustworthiness and rigor. Thick descriptions of the dietary acculturation process were reported in the results chapter. The findings reveal four phases in the dietary acculturation process: (1) Phase 0 immigration and change, (2) Phase 1 dietary encounters and dietary involvement, (3) Phase 2 appraisal, and (4) Phase 3 reaction and adaptation. The mechanisms and factors during the process include (a) structural change, personal change, and change related to other family members in Phase 0; (b) personal encounters and encounters through connections with others in Phase 1; (c) depreciation of the U.S. diet, depreciation of the Chinese diet, appraisal of options, and appreciation of the U.S. diet in Phase 2; and (d) resisting acculturation, primary acculturation, and secondary acculturation in Phase 3. A framework was presented that shows phases in the dietary acculturation process derived from the analysis of focus group discussions. The emerged themes of adjusting, adapting, and habituating under primary acculturation in Phase 3 highlight the act of adaptation in the dietary acculturation process. The development of flavor acceptance, a concept that emerged under habituating, evidently is important to the pace of the dietary acculturation process. The study findings are discussed within their theoretical contexts, i.e., Satia-Abouta’s model of dietary acculturation (2002) and Berry’s model of acculturation (1997). Within the former, a conceptual framework of the dietary acculturation process is presented with sequenced phases showing mechanisms and detailed factor categories. Within the latter, three figures are presented related to two dimensions (i.e., heritage and host) and four strategies (i.e., integration/biculturalism, assimilation, separation, and marginalization). The dissertation concludes with study strengths and limitations as well as implications. The implications for future research are to (a) integrate identified factors and mechanisms to design testable interventions, (b) use similar research design or methodology with other immigrant populations, and (c) continue focusing on disadvantaged immigrants to prevent further health inequities. The implications for future nursing practice are to (a) assess contexts in which the identified factors and mechanisms occur, (b) provide culturally competent care with an understanding of ethnic dietary practices, and (c) knowledgeably initiate discussions of dietary practices with immigrant clients and provide needed education