Association between Selected Food Purchase Practices, Physical Activity and Sociodemographic Factors among People Living in a Low Socioeconomic Peri-Urban and Rural Area of South Africa

1. INTRODUCTION

Noncommunicable Diseases (NCDs), including heart disease, stroke, cancer, diabetes, and chronic lung disease, are a major cause of deaths globally [1]. The majority of deaths due to NCD occurs prematurely, that is before the age of 70 years, and those who reside in low- and middle-income countries are most affected [1].

South Africa is currently undergoing a nutrition transition characterized by a shift from traditional diets consisting mainly of vegetables and high in fibre to highly refined diets high in fat, salt and sugar and low in fibre [2]. The dietary shifts are attributed to urbanization and industrialization and accompanied by demographic and epidemiologic shifts, with the consequence of the increased prevalence of diet-related NCD [3]. The environment where people are born, live and work has a significant role in determining the food choices and health outcomes of the populations. Recent research shows that unhealthy food environments contribute to unhealthy food choices leading to an increased diet-related chronic disease [4].

The Socio-Ecological Model suggests that there is an overlap in factors that influence food choices and or, food practices of the populations. These include settings, social and cultural norms, and values, and individual factors [5]. Exploring some of these factors among people residing in under-resourced communities may help us understand the range of factors that put people at risk or protect them from the risk factors for non-communicable diseases.

Food practices are a cycle that is understood to be any doings that involve food preparations [6]. Food preparations could be cooking food, donating food, distribution of meals, or tidying up [6], but not limited to food purchasing practices which include where grocery is purchased, reasons for grocery purchase in this particular type of shop, and mode of transportation used when travelling to purchase the grocery. Food purchasing practices have also been seen as a prior activity of food consumption [7]. Further, the probable impact of regional factors on food buying and consumption has received increasing consideration [8]. On the other hand, public health advocates are increasingly interested in what motivates food purchasing from a particular location and how people get to retail food outlets.

The food retail environment in South Africa has thrived [9]. This has, in turn, contributed to people’s food choices and purchase in the communities. The increased number of supermarkets and interconnected alterations in diets has been acknowledged as a factor adding to ill health in emerging nations [10]. Consequently, the supermarkets and their food trades tactics could have a straight effect on population’s well-being and quality of life [10].

In South Africa, food is purchased either in the supermarket such as ShopRite, Pick ‘n’ Pay, Spar, U-Save among others, or small, informal convenience food shops popularly known as spaza shops. Perks [11] described the spaza shop as a small, informal convenience store business in a hut or small store where buyers stand outside to buy the basic grocery over a kiosk. Many of these spaza shops are located in strategic points close to the consumer homes for convenience. Although, sometimes regarded as less healthy shops compared to more sophisticated grocery outlets. Kerr et al. [12] opined that increased access to food closer to where one lives could lead to the reduced purchase of groceries when going or returning from the workplace. Observationally, grocery purchase and consumption seem strongly dependent on socio-economic characteristics which may include factors such as gender, age, household income, education level, employment status among other factors [13].

Wong et al. [14] reported that the price of the food estimate, access and being able to afford the price could be viewed also as a vital step in order to understand community food selections, especially among people from low socio-economic areas. Although, very few studies have been undertaken on where people purchase their groceries and the reason behind it, especially on the mode of transportation used in traveling to grocery stores [15]. Significant relationships have been found between socio-demographic profiles and certain FPP. For example, gender, age and income [15-17], employment status [15, 18], and car availability and or transport fare [15, 19] have been found to be associated with FPP. On the other hand, distance, time, and street network connections, and proximity influence peoples’ grocery purchase trips.

Physical activity engagement has been understood to result in a better food choice [20]. Consequently, involvement in PA has also been known to be associated with some of the characteristics of the built and food environment [21]. Those who have access to leisure amenities could physically be more active and this helps to prevent the risk factors for NCDs, especially obesity [21]. On the other hand, access to nutritious foods could promote healthy diets consumption [21]. Access gained through PA involvement could be more effective in promoting health than nutritious food alone. Furthermore, regular engagement in PA could assist in the choice of where, why, and mode of travelling to purchase groceries. Meanwhile, the FPP especially where people buy their groceries, reasons for grocery purchase in a particular retail location, and mode of travelling to purchase the grocery in relation to sociodemographic and PA among people living in a low socio-economic area remained understudied.

In 2014, the University of the Western Cape was awarded a Center of Excellence in Food Security (COEFS) by the Department of Science and Technology/National Research Foundation (DST/NRF). The purpose of the CoEFS study was to explore food security, lifestyle, and health status in the poor communities and to use the information to support the development of interventions on lifestyle modification in similar populations. As part of this research initiative, this study aimed at understanding the context in which food choices are made by those living in poor settings to help us begin to explain some of the connections between individual food intake and the environment. Despite the existing information regarding food practices, no study has examined the association between sociodemographic, PA, and selected FPP among people living in low socio-economic peri-urban and rural settings. This study examined the association between sociodemographic, PA, and selected FPP among people living in a low socio-economic peri-urban and rural area in the Western Cape and Eastern Cape Provinces in South Africa, respectively. We hypothesised that there will be an association between sociodemographic, PA, and selected FPP among people living in a low socio-economic peri-urban area.

2. MATERIALS AND METHODS

3. RESULTS

4. DISCUSSION

This study examined the association between sociodemographic factors, physical activity, and selected food practices among people living in Langa (peri-urban area) and Mount Frere (rural area) in the Western and Eastern Cape Provinces in South Africa. Understanding where people purchase their groceries and the reasons behind it has been established to be important in health improvement [25]. Our findings indicate that the majority of participants from both urban and rural spend a thousand rand or less per month on the purchase of groceries and purchase their groceries at the supermarket. This result corroborates those of Hillier et al. [25] who reported that the majority of participants purchased groceries at the supermarket. On the other hand, the distance travelled for food purchasing either by walking or with the use of motorised transport could also be related to health. For instance, traveling more than a mile for food shopping has been linked with elevated Body Mass Index (BMI) and as a better predictor when controlled for some sociodemographic factors [25]. Pechey et al. [26] also advocated that having a choice of purchasing groceries at the supermarket could be related to well-being.

Our analyses also showed that people purchased groceries based on whether the groceries are cheap and affordable, or most probably when the food products are on special discount. One Australian study on monitoring the price and affordability of foods and diets globally has shown that being able to afford food prices are an important factor in food choices [27], as it influences where individuals purchased their food. It is also important to understand that the targeted price discounts or promotions could influence individuals to consistently purchase groceries at a particular location, especially people of low socioeconomic status. In this study, the majority of the participants in the urban area walked to purchase groceries. This is understandable as there are various easy accessible large, medium, or small groceries store in urban areas compared to the rural area where participants mostly use taxis as their mode of transportation to purchase groceries. Hamrick & Hopkins [28] stated that many people who reside in rural areas do not have access to supermarkets. Subsequently, they travel by taxis to a large grocery store in the nearest populace center as one trip at the month-end.

This study also revealed that younger participants were likely to travel by motorised transport compared to walking to buy groceries at the supermarket. As this age group (25- to 54)-years age are currently the workforce they may be able to afford a car or travel with public transport. Similar to our findings Zenk et al. [29] and Jiao et al. [15] also found that younger individuals in their studies purchased groceries in a faraway grocery store. Jiao and colleagues in their study also found that 88% of their participants drive to grocery stores to purchase their groceries. Furthermore, transiting remained one of the ways to access food, especially for people of low socioeconomic status [15]. These findings show us that it is not only the immediate environment that matters in influencing food choices as people could shop primarily outside their built-up environment and accessibility [15, 30].

Our study also revealed that unmarried people purchased groceries at supermarket based on the price compared to proximity. These findings are contrary to the findings of Steinhofer [31] who described unmarried individuals as people who seek comfort, not bothered by the price of goods, and ready to pay more for convenience.

It has been reported that people with a low educational accomplishment may be vulnerable in purchasing less healthy food compared to those with advanced knowledge [32]. Education status has been known to play a vital role in food purchase practices. Zenk et al. [29] reported that an individual with advanced education status was more likely to purchase their groceries in the environs when compared to an individual with lesser education.

In the current study, people with none-to-low education achievement mostly purchased groceries at supermarkets compared to spaza outlets. Similarly, people with a monthly income of R2000 or less significantly mostly purchased groceries at the supermarket based on affordability and cheapness, and mostly used public transport. Since these individuals seem to travel once a month to purchase groceries in bulk from a supermarket where they could also have access to grants vouchers, this helps in saving frequent traveling expenses. Some studies have shown that inadequate food resources in people's districts could force many to purchase their groceries outside their locality [25, 29]. This again is an indication that when planning interventions we should look at a broader environment rather than the immediate one. Similarly, unemployed participants purchased groceries at the supermarket and used motorised transport. An individual with no incomes could have lesser movement, little prospects with reverence to the quality of food and choices.

The relationship between physical activity and healthy eating had previously been confirmed especially when it comes to reducing the risk factors for chronic diseases [20]. In the current study, those who engaged in PA were less likely to purchase groceries due to affordability but highly likely to travel to grocery stores with motorised transport. Some individuals seem conscious of their health which then gives them an opportunity to search for quality foods whenever they want to purchase their groceries. There is an assumption that those who regularly engaged in PA could have good knowledge about the benefits of physical activity and healthy eating.

This study has some limitations of only including the participants from a rural and a peri-urban black community from two Provinces of Eastern and Western Cape, respectively. The findings of this study should be interpreted with caution and should not be generalised to the entire population of adults in South Africa. Further, studies with a larger sample size are desirable. In addition, data concerning food practices were collected using self-report questionnaires from which response bias might be present.

Furthermore, the findings of this study have vital indications. Firstly, in advising that where most of the groceries purchasing is performed [33]; secondly, reasons for the grocery shopping in a particular location; and thirdly, modes of transportation to groceries location might be a focus for public health interventions which could be directed at supporting adequate food practices [33] among people, especially in low socio-economic areas.

5. CONCLUSION

Our study begins to shed light on factors that are related to where, why and transportation mode to where people shop for their groceries. This study revealed that it is not only the immediate environment that shapes food choices and food practices as people could travel far to purchase food items that they need. Supermarkets seem to be the preferred place to purchase food probably due to specials/promotions which makes some food more affordable than buying in small, informal convenience stores popularly regarded as Spaza shops.

REFERENCES