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Journal of Nutrition Education and Behavior
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Special Article| Volume 44, ISSUE 4, P282-301, July 2012

How People Interpret Healthy Eating: Contributions of Qualitative Research

DOI:https://doi.org/10.1016/j.jneb.2011.11.009
How People Interpret Healthy Eating: Contributions of Qualitative Research
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      Abstract

      Objective

      To identify how qualitative research has contributed to understanding the ways people in developed countries interpret healthy eating.

      Design

      Bibliographic database searches identified reports of qualitative, empirical studies published in English, peer-reviewed journals since 1995.

      Data Analysis

      Authors coded, discussed, recoded, and analyzed papers reporting qualitative research studies related to participants’ interpretations of healthy eating.

      Results

      Studies emphasized a social constructionist approach, and most used focus groups and/or individual, in-depth interviews to collect data. Study participants explained healthy eating in terms of food, food components, food production methods, physical outcomes, psychosocial outcomes, standards, personal goals, and as requiring restriction. Researchers described meanings as specific to life stages and different life experiences, such as parenting and disease onset. Identity (self-concept), social settings, resources, food availability, and conflicting considerations were themes in participants’ explanations for not eating according to their ideals for healthy eating.

      Implications

      People interpret healthy eating in complex and diverse ways that reflect their personal, social, and cultural experiences, as well as their environments. Their meanings include but are broader than the food composition and health outcomes considered by scientists. The rich descriptions and concepts generated by qualitative research can help practitioners and researchers think beyond their own experiences and be open to audience members’ perspectives as they seek to promote healthy ways of eating.

      Key Words

      Introduction

      Because of its potential to advance understanding of social and behavioral aspects of food and eating, qualitative research continues to gain importance in the fields of food, nutrition, and health. Researchers acknowledge that compared to experts, the public may view food, nutrition, and health very differently. Understanding audiences’ perspectives and experiences related to healthy eating is important if nutrition and health educators wish to gain people’s attention and assist them in meaningful ways. Previous reviews have described the general roles of qualitative research in nutrition and health promotion.
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      The term “qualitative research” typically refers to studies that are characterized by both their underlying philosophies and their methods.
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      • Lincoln Y.S.
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      in: Denzin N.K. Lincoln Y.S. The Sage Handbook of Qualitative Research. Sage Publications, Inc, Thousand Oaks, CA2005: 1-32
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      Qualitative Inquiry and Research Design. Choosing Among Five Approaches.
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      Qualitative researchers typically view the world as having multiple realities, because people’s understanding and interpretations of the world depend on their unique personal experiences and the historical, social, and cultural contexts in which they have lived. Qualitative researchers strive to understand other people’s perspec-tives and experiences, and they usually study people in their natural settings. Denzin and Lincoln’s Handbook of Qualitative Research describes this field’s complex history and diverse traditions, including disciplinary origins, applications, and issues.
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      • Lincoln Y.S.
      Introduction.
      in: Denzin N.K. Lincoln Y.S. The Sage Handbook of Qualitative Research. Sage Publications, Inc, Thousand Oaks, CA2005: 1-32
      Creswell
      • Creswell J.W.
      Qualitative Inquiry and Research Design. Choosing Among Five Approaches.
      2nd ed. Sage Publications, Inc, Thousand Oaks, CA2007
      characterizes qualitative research as having 5 approaches: narrative research (listening to people’s life stories), phenomenology (identifying and understanding people’s lived experiences), grounded theory (developing new concepts, frameworks, or models based on participants’ perspectives), ethnography (immersion in a setting and collection of multiple types of data about people and their community), and case studies (detailed historical and contextual information about a single person, group, organization, or community). All of these approaches involve the collection of detailed, descriptive data that may take a variety of forms, such as transcripts of interviews with individuals or groups, photos, field notes, journals, documents, blogs, or audiovisual recordings. As a study uncovers new insights, opportunities, or problems, researchers may adjust their data sources, methods, and research tools. Analysis uses non-numerical systems of coding, categorizing, comparing, and contrasting as researchers examine data for themes and emerging patterns.
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      Researchers may report findings as descriptive cases, themes, or conceptual frameworks. They may propose theories or hypotheses for future study.
      Qualitative researchers typically use purposive samples with specific criteria for inclusion and exclusion that may be dynamic as investigation uncovers new insights. Small samples enable researchers to collect in-depth data. The sample size is determined by the amount of data or data extensiveness needed to achieve theoretical saturation, the point when continued sampling yields no new insights.
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      Qualitative researchers use a number of strategies to enhance the quality or soundness of their studies, often described as trustworthiness.
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      Key concerns are how well findings represent participants’ actual perspectives (credibility), how any modifications in the methods may have affected researchers’ interpre-tations (dependability), the extent to which others reviewing the data and procedures would come to the same interpretations (confirmability), and the extent to which findings may be applied to other people, places, and times (transferability).
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      Credibility has been likened to internal validity; transferability to external validity; dependability to reliability; and confirmability to objectivity.
      • Shenton A.K.
      Strategies for ensuring trustworthiness in qualitative research projects.
      Educ Inf. 2004; 22: 63-75
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      Sage, Beverly Hills, CA1985
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      Qualitative research is often contrasted with quantitative research, a term that usually refers to studies that test hypotheses, examine predefined concepts and variables, use predetermined sample sizes that are often representative of populations, employ numerical methods for measurement and analysis, and strive for objectivity. Table 1 summarizes some key characteristics of qualitative and quantitative research projects. In mixed-methods studies, researchers combine qualitative and quantitative procedures in various ways to achieve their goals.
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      Table 1Characteristics of Qualitative and Quantitative Research Projects
      CharacteristicsQualitative ProjectsQuantitative Projects
      PurposeGain new perspectives and insights on topicsDetermine frequencies or test hypotheses about factors predefined by researchers
      SampleSmaller, purposeful samples with continued sampling until no new findings, characteristics may change as analysis proceedsLarger, preset sample sizes with predefined characteristics
      DataOpen-ended, non-numerical forms in text, photo, audio, documentsMeasurements or answers to predefined, specific questions that can be coded for counting
      MethodsSubjectivity and flexibility in methods to gain in-depth and holistic understanding of topicObjectivity, standardization, and use of controls in methods
      AnalysisThematic to identify concepts, commonalities, contrasts, relationshipsStatistical to test hypotheses and relationships
      Reporting styleDetailed (thick) descriptions, themes, contrasts, case studies, conceptualizationsNumerical forms with statistics
      The authors reviewed the literature to learn how researchers have used the philosophy and methods of qualitative research to gain insight into the ways that people consider health related to food and eating. This review asked, “How has qualitative research advanced understanding of the ways that people interpret healthy eating?”

      Methods

      The authors searched PubMed, Soc Abstracts, PsychInfo, and ERIC bibliographic databases for empirical studies published in English since 1995 using terms related to healthy eating (ie, food habits, food preferences, food behavior, eating behavior, behavior change, healthy eating, food psychology, dietary change, food decision making, food choice, nutrition education) in combination with terms relating to qualitative methods (ie, ethnography, focus groups, interviews, grounded theory, and qualitative research). Each database was searched using 55 different combinations of terms. These key terms could appear anyplace in the article’s title, abstract, or descriptive terms. To find articles that the search may have missed, the authors followed up on citations in many papers and hand searched through Appetite and the Journal of Nutrition Education and Behavior. They also examined the publication records of qualitative researchers who were extensively engaged in research related to the topic of the review.
      The initial search of the published literature since 1995 revealed thousands of papers on an array of topics and types of studies related to the question. To keep the review manageable, the review focused on a subset of this literature and examined empirical papers reporting qualitative studies that were published in English, and in peer-reviewed journals. The authors also limited the search to those studies done in developed countries (ie, United States, European countries, Australia, New Zealand, Canada, and Japan) where food variety and availability are great for most people and where health issues related to food and eating are likely to encompass a wide variety of considerations. The authors excluded the many papers focused on the topics of food insecurity, eating disorders, obesity, and community-based interventions. These topics frame healthy eating in important ways that could not be fully explored in this limited review. The review focused on the ways that people perceived and experienced health related to food and eating and not on the factors, processes, or practices of health promotion or environmental change.
      Articles meeting the selection criteria were added to a RefWorks bibliographic database that was accessible to all authors on the team. As the pool of articles increased, the authors developed a list of codes to characterize each paper’s methods and findings. Each author carefully read through a subset of the papers and assigned codes according to the details of the paper. As authors read and discussed papers, new codes emerged, and they revised the code list and recoded papers as appropriate. Initially, the authors found about 500 papers that seemed to be within the scope of the review. After all team members closely looked at methods employed and topics investigated, they selected only papers that reported qualitative findings in a substantive way. Papers reporting mixed-methods studies in which the qualitative findings were not reported in detail were excluded. Also eliminated were papers that reported on face-to-face interviews (much like surveys) that were not in depth, papers that described only brief discussions with study participants, or included only 1 open-ended question. This process yielded 195 papers that were coded in further detail and used for the review. Papers were not evaluated for trustworthiness or limitations.
      Analysis of the papers concentrated on identifying the particular ways that qualitative methods contributed to the understanding of how people interpret healthy eating. Though health aspects of eating were not necessarily the focus of many of these studies, how people interpreted health related to food and eating was a substantive topic in the findings. The authors discussed the methods and findings reported in the papers and the themes emerging across the papers. Using an iterative process, the authors identified the following 3 main themes: meanings people associate with healthy eating, ways meanings develop and change in relation to life stage and life experiences, and explanations people provide for the gaps between healthy eating ideals and their actual behaviors. Next, the authors reexamined the 195 papers to be sure that they understood their contributions related to how people interpret healthy eating. Authors identified meaningful participant quotes that illustrated the depth and the detail of the insights provided.

      Results

      The results of this review are organized in 5 sections:
      • •
        The first section describes the underlying philosophies used by these qualitative researchers.
      • •
        The second section gives an overview of the methods the researchers reported.
      • •
        The third section describes the insights these studies provide about the meanings that people expressed about healthy eating.
      • •
        The fourth section presents what these studies reveal about the evolving and dynamic nature of meanings across life stages and life experiences.
      • •
        The fifth section reviews key insights that these studies provide about people’s explanations for the gaps between healthy eating ideals and actual behaviors.
      The topics discussed in the third, fourth, and fifth sections overlap, and many papers made contributions across the sections. To avoid redundancies, however, the authors develop a topic in 1 section only, where it seemed most appropriate for the overall paper. Table 2, Table 3, Table 4 provide citations for various topics in the third, fourth, and fifth sections and also use selected participant quotes to illustrate the topics.
      Table 2Types of Meanings People Associate with Healthy Eating
      Types of MeaningsExamples of Participants' Interpretations
      Fruits and vegetables
      • Bouwman L.I.
      • te Molder H.
      • Koelen M.M.
      • van Woerkum C.M.J.
      ‘I eat healthfully but I am not a freak.’ Consumers’ everyday life perspective on healthful eating.
      Appetite. 2009; 53: 390-398
      , 
      • Chapman G.E.
      • Beagan B.
      Women’s perspectives on nutrition, health, and breast cancer.
      J Nutr Educ Behav. 2003; 35: 135-141
      , 
      • Cullen K.W.
      • Baranowski T.
      • Rittenberry L.
      • Olvera N.
      Social-environmental influences on children’s diets: results from focus groups with African, Euro- and Mexican-American children and their parents.
      Health Educ Res. 2000; 15: 581-590
      , 
      • Bove C.F.
      • Sobal J.
      • Rauschenbach B.S.
      Food choices among newly married couples: convergence, conflict, individualism and projects.
      Appetite. 2003; 40: 25-41
      , 
      • Beagan B.L.
      • Chapman G.E.
      Eating after breast cancer: influences on women’s actions.
      J Nutr Educ Bahav. 2004; 36: 181-188
      , 
      • Brug J.
      • Sigird D.
      • van Assema P.
      • Weijts W.
      Psychosocial determinants of fruit and vegetable consumption among adults: results of focus group interviews.
      Food Qual Prefer. 1995; 6: 99-107
      , 
      • Akamatsu R.
      • Maeda Y.
      • Hagihara A.
      • Shirakawa T.
      Interpretations and attitudes toward healthy eating among Japanese workers.
      Appetite. 2005; 44: 123-129
      , 
      • Gellar L.A.
      • Schrader K.
      • Nansel T.R.
      Healthy eating practices: perceptions, facilitators, and barriers among youth with diabetes.
      Diabetes Educ. 2007; 33: 671-679
      , 
      • Hildebrand D.A.
      • Shriver L.H.
      A quantitative and qualitative approach to understanding fruit and vegetable availability in low-income African-American families with children enrolled in an urban Head Start program.
      J Am Diet Assoc. 2010; 110: 710-718
      , 
      • McKinley M.C.
      • Lowis C.
      • Robson P.J.
      • et al.
      It’s good to talk: children’s views on food and nutrition.
      Eur J Clin Nutr. 2005; 59: 542-551
      , 
      • Povey R.
      • Conner M.
      • Sparks P.
      • James R.
      • Shepherd R.
      Interpretations of healthy and unhealthy eating, and implications for dietary change.
      Health Educ Res. 1998; 13: 171-183
      , 
      • Sandelowski M.
      • DeVellis B.
      • Campbell M.
      Variations in meanings of the personal core value ‘Health’.
      Patient Educ Couns. 2008; 73: 347-353
      , 
      • Shriver L.H.
      • Hildebrand D.
      • Austin H.
      Determinants of fruit and vegetable availability in Hispanic Head Start families with preschool-aged children living in an urban Midwestern area.
      J Nutr Educ Behav. 2010; 42: 299-306
      		Fruits and vegetables are key ingredients to being healthy.
      • Sandelowski M.
      • DeVellis B.
      • Campbell M.
      Variations in meanings of the personal core value ‘Health’.
      Patient Educ Couns. 2008; 73: 347-353


      Fruits and vegetables are healthier than a bag of chips.
      • Shriver L.H.
      • Hildebrand D.
      • Austin H.
      Determinants of fruit and vegetable availability in Hispanic Head Start families with preschool-aged children living in an urban Midwestern area.
      J Nutr Educ Behav. 2010; 42: 299-306


      I serve FV [fruits and vegetables] to my kids because I want to give them healthy food. FV are the most important food of the day.
      • Shriver L.H.
      • Hildebrand D.
      • Austin H.
      Determinants of fruit and vegetable availability in Hispanic Head Start families with preschool-aged children living in an urban Midwestern area.
      J Nutr Educ Behav. 2010; 42: 299-306


      A person who eats fruits and vegetables [is] taking care of his body mentally and spiritually. When you take care of your body, you're mentally and physically alert.
      • Sandelowski M.
      • DeVellis B.
      • Campbell M.
      Variations in meanings of the personal core value ‘Health’.
      Patient Educ Couns. 2008; 73: 347-353
      Animal food
      • Chapman G.E.
      • Beagan B.
      Women’s perspectives on nutrition, health, and breast cancer.
      J Nutr Educ Behav. 2003; 35: 135-141
      , 
      • Jabs J.A.
      • Devine C.M.
      • Sobal J.
      A model of the process of adopting vegetarian diets: health vegetarians and ethical vegetarians.
      J Nutr Educ. 1998; 30: 196-202
      , 
      • Fox N.
      • Ward K.J.
      You are what you eat? Vegetarianism, health and identity.
      Soc Sci Med. 2008; 66: 2585-2595
      , 
      • Roos G.
      • Prättälä R.
      • Koski K.
      Men, masculinity and food: interviews with Finnish carpenters and engineers.
      Appetite. 2001; 37: 47-56
      		…some kind of meat; for some reason, you still imagine that meat is the crown, without it, it's not proper food.
      • Roos G.
      • Prättälä R.
      • Koski K.
      Men, masculinity and food: interviews with Finnish carpenters and engineers.
      Appetite. 2001; 37: 47-56


      …not too heavy on the meat…32

      Physiologically I, for some reason… my body seemed to not want to eat meat any more. I was getting ill actually from it.
      • Jabs J.A.
      • Devine C.M.
      • Sobal J.
      A model of the process of adopting vegetarian diets: health vegetarians and ethical vegetarians.
      J Nutr Educ. 1998; 30: 196-202
      Safe food
      • Shaw A.
      Discourses of risk in lay accounts of microbiological safety and BSE: a qualitative interview study.
      Health Risk Soc. 2004; 6: 151-171
      , 
      • Lupton D.A.
      Lay discourses and beliefs related to food risks: an Australian perspective.
      Sociol Health Illn. 2005; 27: 448-467
      , 
      • Green J.M.
      • Draper A.K.
      • Dowler E.A.
      Short cuts to safety: risk and ‘rules of thumb’ in accounts of food choice.
      Health, Risk Soc. 2003; 5: 33-52
      , 
      • Holmes T.S.
      • Gates G.E.
      Influences on fruit, vegetable, and grain intake of older men.
      J Nutr Elder. 2003; 22: 43-61
      		I've got children and I've got grandchildren… and it bothers me that the food they're eating could be changing them. But we don't know until 20 or 30 years down the track.
      • Lupton D.A.
      Lay discourses and beliefs related to food risks: an Australian perspective.
      Sociol Health Illn. 2005; 27: 448-467


      We're careful about the chickens that we buy.
      • Lupton D.A.
      Lay discourses and beliefs related to food risks: an Australian perspective.
      Sociol Health Illn. 2005; 27: 448-467
      Functional food
      • Crawford P.
      • Brown B.
      • Nerlich B.
      • Koteyko N.
      Nutritional altruism and functional food: lay discourses on probiotics.
      Sociol Health Illn. 2010; 32: 745-760
      , 
      • Urala N.
      • Lähteenmäki L.
      Reasons behind consumers’ functional food choices.
      Nutr Food Sci. 2003; 33: 148-158
      , 
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      , 
      • Krutulyte R.
      • Grunert K.G.
      • Scholderer J.
      • et al.
      Motivational factors for consuming omega-3 PUFAs: an exploratory study with Danish consumers.
      Appetite. 2008; 51: 137-147
      , 
      • Korzen-Bohr S.
      • Jensen K.O.
      Heart disease among post-menopausal women: acceptability of functional foods as a preventive measure.
      Appetite. 2006; 46: 152-163
      , 
      • Patch C.S.
      • Tapsell L.C.
      • Williams P.G.
      Overweight consumers’ salient beliefs on omega-3-enriched functional foods in Australia’s Illawarra region.
      J Nutr Educ Behav. 2005; 37: 83-89
      		But I do think you need a little help in the diet and if I can see that lovely tasting Vitality stuff and it's telling me it's got all these millions of good bacteria in it, so I'll drink it.
      • Crawford P.
      • Brown B.
      • Nerlich B.
      • Koteyko N.
      Nutritional altruism and functional food: lay discourses on probiotics.
      Sociol Health Illn. 2010; 32: 745-760


      Of course, you wonder what additives you get from it [functional food], so maybe you'll get rid of cholesterol but what if you'll get cancer or something in return?73
      General nutrients
      • Coveney J.
      A qualitative study exploring socio-economic differences in parental lay knowledge of food and health: implications for public health nutrition.
      Public Health Nutr. 2005; 8: 290-297
      , 
      • Ristovski-Slijepcevic S.
      • Chapman G.E.
      • Beagan B.L.
      Engaging with healthy eating discourse(s): ways of knowing about food and health in three ethnocultural groups in Canada.
      Appetite. 2008; 50: 167-178
      , 
      • Falk L.W.
      • Sobal J.
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      Managing healthy eating: definitions, classifications, and strategies.
      Health Educ Behav. 2001; 28: 425-439
      		Different nutrients from different things but I think again when you look at things overall I think they probably have a very adequate diet.
      • Coveney J.
      A qualitative study exploring socio-economic differences in parental lay knowledge of food and health: implications for public health nutrition.
      Public Health Nutr. 2005; 8: 290-297
      Fiber
      • Gustafsson K.
      • Ekblad J.
      • Sidenvall B.
      Older women and dietary advice: occurrence, comprehension and compliance.
      J Hum Nutr Diet. 2005; 18: 453-460
      		I start the morning with porridge, which I make of fiber-rich oats and oat bran. …they say it's good because it pulls out the fat… it should counteract high cholesterol.
      • Gustafsson K.
      • Ekblad J.
      • Sidenvall B.
      Older women and dietary advice: occurrence, comprehension and compliance.
      J Hum Nutr Diet. 2005; 18: 453-460
      Vitamins and minerals
      • Maskarinec G.
      • Murphy S.
      • Shumay D.M.
      • Kakai H.
      Dietary changes among cancer survivors.
      Eur J Cancer Care. 2001; 10: 12-20
      , 
      • Beagan B.L.
      • Chapman G.E.
      Eating after breast cancer: influences on women’s actions.
      J Nutr Educ Bahav. 2004; 36: 181-188
      , 
      • Dye C.J.
      • Cason K.L.
      Perceptions of older, low-income women about increasing intake of fruits and vegetables.
      J Nutr Elder. 2005; 25: 21-41
      , 
      • Reedy J.
      • Haines P.S.
      • Steckler A.
      • Campbell M.K.
      Qualitative comparison of dietary choices and dietary supplement use among older adults with and without a history of colorectal cancer.
      J Nutr Educ Behav. 2005; 37: 252-258
      , 
      • Satia J.A.
      • Walsh J.F.
      • Pruthi R.S.
      Health behavior changes in white and African American prostate cancer survivors.
      Cancer Nurs. 2009; 32: 107-117
      		…taking the appropriate vitamins to help supplement what I don't eat.
      • Reedy J.
      • Haines P.S.
      • Steckler A.
      • Campbell M.K.
      Qualitative comparison of dietary choices and dietary supplement use among older adults with and without a history of colorectal cancer.
      J Nutr Educ Behav. 2005; 37: 252-258
      Fat
      • Chapman G.E.
      • Beagan B.
      Women’s perspectives on nutrition, health, and breast cancer.
      J Nutr Educ Behav. 2003; 35: 135-141
      , 
      • Falk L.W.
      • Sobal J.
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      Managing healthy eating: definitions, classifications, and strategies.
      Health Educ Behav. 2001; 28: 425-439
      , 
      • Cullen K.W.
      • Baranowski T.
      • Rittenberry L.
      • Olvera N.
      Social-environmental influences on children’s diets: results from focus groups with African, Euro- and Mexican-American children and their parents.
      Health Educ Res. 2000; 15: 581-590
      , 
      • Gans K.M.
      • Lovell H.J.
      • Fortunet R.
      • McMahon C.
      • Carton-Lopez S.
      • Lasater T.M.
      Implications of qualitative research for nutrition education geared to selected Hispanic audiences.
      J Nutr Educ. 1999; 31: 331-338
      , 
      • Gustafsson K.
      • Sidenvall B.
      Food-related health perceptions and food habits among older women.
      J Adv Nurs. 2002; 39: 164-173
      , 
      • Akamatsu R.
      • Maeda Y.
      • Hagihara A.
      • Shirakawa T.
      Interpretations and attitudes toward healthy eating among Japanese workers.
      Appetite. 2005; 44: 123-129
      , 
      • Holmes T.S.
      • Gates G.E.
      Influences on fruit, vegetable, and grain intake of older men.
      J Nutr Elder. 2003; 22: 43-61
      , 
      • Gustafsson K.
      • Ekblad J.
      • Sidenvall B.
      Older women and dietary advice: occurrence, comprehension and compliance.
      J Hum Nutr Diet. 2005; 18: 453-460
      		…because he [husband] has high cholesterol… so I keep it [fat] pretty low.
      • Holmes T.S.
      • Gates G.E.
      Influences on fruit, vegetable, and grain intake of older men.
      J Nutr Elder. 2003; 22: 43-61


      You should be careful with fat…
      • Gustafsson K.
      • Ekblad J.
      • Sidenvall B.
      Older women and dietary advice: occurrence, comprehension and compliance.
      J Hum Nutr Diet. 2005; 18: 453-460
      Carbohydrates
      • Gellar L.A.
      • Schrader K.
      • Nansel T.R.
      Healthy eating practices: perceptions, facilitators, and barriers among youth with diabetes.
      Diabetes Educ. 2007; 33: 671-679
      , 
      • Bhaskaran S.
      • Hardley F.
      Buyer beliefs, attitudes and behaviour: foods with therapeutic claims.
      Journal of Consumer Marketing. 2002; 19: 591-606
      , 
      • Rainey C.J.
      • Mayo R.M.
      • Haley-Zitlin V.
      • Kemper K.A.
      • Cason K.L.
      Nutritional beliefs, attitudes and practices of elderly, rural, Southern women.
      J Nutr Elder. 2000; 20: 3-27
      , 
      • Savoca M.
      • Miller C.
      Food selection and eating patterns: themes found among people with type 2 diabetes mellitus.
      J Nutr Educ. 2001; 33: 224-233
      		… a particular friend is on a protein diet so she's cut out all of her carbohydrates…
      • Bhaskaran S.
      • Hardley F.
      Buyer beliefs, attitudes and behaviour: foods with therapeutic claims.
      Journal of Consumer Marketing. 2002; 19: 591-606


      I cannot eat potatoes and rice because it turns to sugar because I am a diabetic.
      • Rainey C.J.
      • Mayo R.M.
      • Haley-Zitlin V.
      • Kemper K.A.
      • Cason K.L.
      Nutritional beliefs, attitudes and practices of elderly, rural, Southern women.
      J Nutr Elder. 2000; 20: 3-27
      Contaminants/toxins
      • Lupton D.A.
      Lay discourses and beliefs related to food risks: an Australian perspective.
      Sociol Health Illn. 2005; 27: 448-467
      , 
      • Paisley J.
      • Skrzypczyk S.
      Qualitative investigation of differences in benefits and challenges of eating fruits versus vegetables as perceived by Canadian women.
      J Nutr Educ Behav. 2005; 37: 77-82
      , 
      • Paisley J.
      • Beanlands H.
      • Goldman J.
      • Evers S.
      • Chappell J.
      Dietary change: what are the responses and roles of significant others?.
      J Nutr Educ Behav. 2008; 40: 80-88
      		…the different insecticides and everything that's being used. I get concerned about that.
      • Paisley J.
      • Skrzypczyk S.
      Qualitative investigation of differences in benefits and challenges of eating fruits versus vegetables as perceived by Canadian women.
      J Nutr Educ Behav. 2005; 37: 77-82
      Natural
      • Crawford P.
      • Brown B.
      • Nerlich B.
      • Koteyko N.
      Nutritional altruism and functional food: lay discourses on probiotics.
      Sociol Health Illn. 2010; 32: 745-760
      , 
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      , 
      • Maskarinec G.
      • Murphy S.
      • Shumay D.M.
      • Kakai H.
      Dietary changes among cancer survivors.
      Eur J Cancer Care. 2001; 10: 12-20
      , 
      • Falk L.W.
      • Sobal J.
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      Managing healthy eating: definitions, classifications, and strategies.
      Health Educ Behav. 2001; 28: 425-439
      , 
      • McKie L.
      Older people and food: independence, locality and diet.
      Br Food J. 1999; 101: 528-536
      , 
      • Fox N.
      • Ward K.J.
      You are what you eat? Vegetarianism, health and identity.
      Soc Sci Med. 2008; 66: 2585-2595
      , 
      • Povey R.
      • Conner M.
      • Sparks P.
      • James R.
      • Shepherd R.
      Interpretations of healthy and unhealthy eating, and implications for dietary change.
      Health Educ Res. 1998; 13: 171-183
      , 
      • Green J.M.
      • Draper A.K.
      • Dowler E.A.
      Short cuts to safety: risk and ‘rules of thumb’ in accounts of food choice.
      Health, Risk Soc. 2003; 5: 33-52
      		I think natural food for baby is much better.
      • Crawford P.
      • Brown B.
      • Nerlich B.
      • Koteyko N.
      Nutritional altruism and functional food: lay discourses on probiotics.
      Sociol Health Illn. 2010; 32: 745-760


      I try to eat all raw, living [food] most of the time…
      • Maskarinec G.
      • Murphy S.
      • Shumay D.M.
      • Kakai H.
      Dietary changes among cancer survivors.
      Eur J Cancer Care. 2001; 10: 12-20
      Organic
      • Fox N.
      • Ward K.
      Health, ethics and environment: a qualitative study of vegetarian motivations.
      Appetite. 2008; 50: 422-429
      		I try to eat primarily organic. Being where I live the cost of organic food isn't really an issue. I try to eat as few processed foods as possible and eliminate added sugars. For the most part all of the above are working.
      • Fox N.
      • Ward K.
      Health, ethics and environment: a qualitative study of vegetarian motivations.
      Appetite. 2008; 50: 422-429
      Homemade
      • Sellaeg K.
      • Chapman G.
      Masculinity and food ideals of men who live alone.
      Appetite. 2008; 51: 120-128
      , 
      • Ross S.
      ‘Do I really have to eat that?’: A qualitative study of schoolchildren’s food choices and preferences.
      Health Educ J. 1995; 54: 312-321
      , 
      • Watt R.G.
      • Sheiham A.
      Towards an understanding of young people’s conceptualization of food and eating.
      Health Educ J. 1997; 56: 340
      , 
      • McKie L.
      Older people and food: independence, locality and diet.
      Br Food J. 1999; 101: 528-536
      , 
      • Backett-Milburn K.C.
      • Wills W.J.
      • Gregory S.
      • Lawton J.
      Making sense of eating, weight and risk in the early teenage years: views and concerns of parents in poorer socio-economic circumstances.
      Soc Sci Med. 2006; 63: 624-635
      		Eating in was associated with “having control over what goes into the food,” both in terms of including the “right” foods and compounds (eg, vegetables, natural food), but more importantly, avoiding “bad” aspects (eg, high fat intake, processed food).
      • Sellaeg K.
      • Chapman G.
      Masculinity and food ideals of men who live alone.
      Appetite. 2008; 51: 120-128


      I don't know how they're manufactured or what they are putting into it. I'd rather just buy fresh food and cook it myself.
      • McKie L.
      Older people and food: independence, locality and diet.
      Br Food J. 1999; 101: 528-536
      Balance
      • Bouwman L.I.
      • te Molder H.
      • Koelen M.M.
      • van Woerkum C.M.J.
      ‘I eat healthfully but I am not a freak.’ Consumers’ everyday life perspective on healthful eating.
      Appetite. 2009; 53: 390-398
      , 
      • Crawford P.
      • Brown B.
      • Nerlich B.
      • Koteyko N.
      Nutritional altruism and functional food: lay discourses on probiotics.
      Sociol Health Illn. 2010; 32: 745-760
      , 
      • Lupton D.A.
      Lay discourses and beliefs related to food risks: an Australian perspective.
      Sociol Health Illn. 2005; 27: 448-467
      , 
      • Falk L.W.
      • Bisogni C.A.
      • Sobal J.
      Food choice processes of older adults.
      J Nutr Educ. 1996; 28: 257-265
      , 
      • Wandel M.
      • Roos G.
      Work, food and physical activity. A qualitative study of coping strategies among men in three occupations.
      Appetite. 2005; 44: 93-102
      , 
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      , 
      • Chapman K.
      • Ogden J.
      A qualitative study exploring how mothers manage their teenage children’s diets.
      Vulnerable Child Youth Stud. 2009; 4: 90-100
      , 
      • Gough B.
      • Conner M.T.
      Barriers in healthy eating amongst men: a qualitative analysis.
      Soc Sci Med. 2006; 62: 387-395
      , 
      • Anving T.
      • Sellerberg A.
      Family meals and parents’ challenges.
      Food Cult Soc. 2010; 13: 201-214
      , 
      • Falk L.W.
      • Sobal J.
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      Managing healthy eating: definitions, classifications, and strategies.
      Health Educ Behav. 2001; 28: 425-439
      , 
      • Croll J.K.
      • Nuemark-Sztainer D.
      • Story M.
      Healthy eating: what does it mean to adolescents?.
      J Nutr Educ. 2001; 33: 193-198
      , 
      • Farrimond H.
      • Saukko P.M.
      • Qureshi N.
      • Evans P.H.
      Making sense of being at ‘high risk’ of coronary heart disease within primary prevention.
      Psychol Health. 2010; 25: 289-304
      , 
      • Backett K.C.
      • Davison C.
      Lifecourse and lifestyle: the social and cultural location of health behaviours.
      Soc Sci Med. 1995; 40: 629-638
      , 
      • Roos G.
      • Prättälä R.
      • Koski K.
      Men, masculinity and food: interviews with Finnish carpenters and engineers.
      Appetite. 2001; 37: 47-56
      , 
      • Arcury T.A.
      • Quandt S.A.
      • Bell R.A.
      Staying healthy: the salience and meaning of health maintenance behaviors among rural older adults in North Carolina.
      Soc Sci Med. 2001; 53: 1541-1556
      , 
      • McVittie C.
      • Hepworth J.
      • Schilling B.
      The select committee report on obesity (2004): the significant omission of parental views of their children’s eating.
      Crit Public Health. 2008; 18: 33-40
      , 
      • Moore S.N.
      • Tapper K.
      • Murphy S.
      Feeding goals sought by mothers of 3-5-year-old children.
      Br J Health Psychol. 2010; 15: 185-196
      		And with a pizza I often eat, I buy a cucumber. Then I think it's all bread and salami, and fat etc. Then I want to have something fresh with it.
      • Bouwman L.I.
      • te Molder H.
      • Koelen M.M.
      • van Woerkum C.M.J.
      ‘I eat healthfully but I am not a freak.’ Consumers’ everyday life perspective on healthful eating.
      Appetite. 2009; 53: 390-398


      I think the emphasis on food should be about balance.
      • Gough B.
      • Conner M.T.
      Barriers in healthy eating amongst men: a qualitative analysis.
      Soc Sci Med. 2006; 62: 387-395


      You strive to find a balance between spoiling yourself, feeling good and being healthy. You may sometimes gorge yourself and bargain with your health to buy yourself mental well-being.
      • Roos G.
      • Prättälä R.
      • Koski K.
      Men, masculinity and food: interviews with Finnish carpenters and engineers.
      Appetite. 2001; 37: 47-56
      Variety
      • Wandel M.
      • Roos G.
      Work, food and physical activity. A qualitative study of coping strategies among men in three occupations.
      Appetite. 2005; 44: 93-102
      , 
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      , 
      • Roos G.
      • Prättälä R.
      • Koski K.
      Men, masculinity and food: interviews with Finnish carpenters and engineers.
      Appetite. 2001; 37: 47-56
      , 
      • Moore S.N.
      • Tapper K.
      • Murphy S.
      Feeding goals sought by mothers of 3-5-year-old children.
      Br J Health Psychol. 2010; 15: 185-196
      , 
      • Dixey R.
      • Sahota P.
      • Atwal S.
      • Turner A.
      Children talking about healthy eating: data from focus groups with 300 9-11-year-olds.
      Nutr Bull. 2001; 26: 71-79
      , 
      • McKie L.
      • MacInnes A.
      • Hendry J.
      • Donald S.
      • Peace H.
      The food consumption patterns and perceptions of dietary advice of older people.
      J Hum Nutr Diet. 2000; 13: 173-183
      		As long as you have a good variety of food and don't eat too much of anything, you can't go far wrong.
      • McKie L.
      • MacInnes A.
      • Hendry J.
      • Donald S.
      • Peace H.
      The food consumption patterns and perceptions of dietary advice of older people.
      J Hum Nutr Diet. 2000; 13: 173-183


      [A healthy diet] consists of lots of vegetables, but is above all varied—in a week's period there's quite a lot of various stuff included.
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      Moderation
      • Bouwman L.I.
      • te Molder H.
      • Koelen M.M.
      • van Woerkum C.M.J.
      ‘I eat healthfully but I am not a freak.’ Consumers’ everyday life perspective on healthful eating.
      Appetite. 2009; 53: 390-398
      , 
      • Pajari P.M.
      • Jallinoja P.
      • Absetz P.
      Negotiation over self-control and activity: an analysis of balancing in the repertoires of Finnish healthy lifestyles.
      Soc Sci Med. 2006; 62: 2601-2611
      , 
      • Gough B.
      • Conner M.T.
      Barriers in healthy eating amongst men: a qualitative analysis.
      Soc Sci Med. 2006; 62: 387-395
      , 
      • McKie L.
      Older people and food: independence, locality and diet.
      Br Food J. 1999; 101: 528-536
      , 
      • Byrne S.
      • Cooper Z.
      • Fairburn C.
      Weight maintenance and relapse in obesity: a qualitative study.
      Int J Obesity. 2003; 27: 955-962
      		It [healthful] makes me think of salad. You know, just vegetables, fruit. And some types of meat, but in moderation, not a whole lot.
      • Bouwman L.I.
      • te Molder H.
      • Koelen M.M.
      • van Woerkum C.M.J.
      ‘I eat healthfully but I am not a freak.’ Consumers’ everyday life perspective on healthful eating.
      Appetite. 2009; 53: 390-398


      This is my motto. Eat everything, just small amounts of it.
      • Byrne S.
      • Cooper Z.
      • Fairburn C.
      Weight maintenance and relapse in obesity: a qualitative study.
      Int J Obesity. 2003; 27: 955-962
      Regular meals
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      , 
      • McKie L.
      Older people and food: independence, locality and diet.
      Br Food J. 1999; 101: 528-536
      , 
      • Akamatsu R.
      • Maeda Y.
      • Hagihara A.
      • Shirakawa T.
      Interpretations and attitudes toward healthy eating among Japanese workers.
      Appetite. 2005; 44: 123-129
      , 
      • Savoca M.
      • Miller C.
      Food selection and eating patterns: themes found among people with type 2 diabetes mellitus.
      J Nutr Educ. 2001; 33: 224-233
      , 
      • Arcury T.A.
      • Quandt S.A.
      • Bell R.A.
      Staying healthy: the salience and meaning of health maintenance behaviors among rural older adults in North Carolina.
      Soc Sci Med. 2001; 53: 1541-1556
      		…keeping regular hours for meals everyday.
      • Akamatsu R.
      • Maeda Y.
      • Hagihara A.
      • Shirakawa T.
      Interpretations and attitudes toward healthy eating among Japanese workers.
      Appetite. 2005; 44: 123-129
      Proper meals
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      , 
      • Anving T.
      • Thorsted S.
      Feeding ideals and the work of feeding in Swedish families.
      Food Cult Soc. 2010; 13: 29-46
      , 
      • McKie L.
      Older people and food: independence, locality and diet.
      Br Food J. 1999; 101: 528-536
      , 
      • McKie L.
      • MacInnes A.
      • Hendry J.
      • Donald S.
      • Peace H.
      The food consumption patterns and perceptions of dietary advice of older people.
      J Hum Nutr Diet. 2000; 13: 173-183
      , 
      • Fagerli R.A.
      • Lien M.E.
      • Wandel M.
      Experience of dietary advice among Pakistani-born persons with type 2 diabetes in Oslo.
      Appetite. 2005; 45: 295-304
      , 
      • Owen J.
      • Metcalfe A.
      • Dryden C.
      • Shipton G.
      ‘If they don't eat it, it's not a proper meal’: images of risk and choice in fathers’ accounts of family food practices.
      Health Risk Soc. 2010; 12: 395-406
      		It's working out a compromise all the time…what is a good proper meal to what we can get down their [children's] necks.
      • Owen J.
      • Metcalfe A.
      • Dryden C.
      • Shipton G.
      ‘If they don't eat it, it's not a proper meal’: images of risk and choice in fathers’ accounts of family food practices.
      Health Risk Soc. 2010; 12: 395-406


      Ordinary proper food is as healthful [as functional food].
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      Weight
      • Blake C.
      • Bisogni C.A.
      Personal and family food choice schemas of rural women in upstate New York.
      J Nutr Educ Behav. 2003; 35: 282-293
      , 
      • Falk L.W.
      • Sobal J.
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      Managing healthy eating: definitions, classifications, and strategies.
      Health Educ Behav. 2001; 28: 425-439
      , 
      • Watt R.G.
      • Sheiham A.
      Towards an understanding of young people’s conceptualization of food and eating.
      Health Educ J. 1997; 56: 340
      , 
      • Gustafsson K.
      • Sidenvall B.
      Food-related health perceptions and food habits among older women.
      J Adv Nurs. 2002; 39: 164-173
      , 
      • Dye C.J.
      • Cason K.L.
      Perceptions of older, low-income women about increasing intake of fruits and vegetables.
      J Nutr Elder. 2005; 25: 21-41
      , 
      • Backett-Milburn K.C.
      • Wills W.J.
      • Gregory S.
      • Lawton J.
      Making sense of eating, weight and risk in the early teenage years: views and concerns of parents in poorer socio-economic circumstances.
      Soc Sci Med. 2006; 63: 624-635
      , 
      • Dixey R.
      • Sahota P.
      • Atwal S.
      • Turner A.
      Children talking about healthy eating: data from focus groups with 300 9-11-year-olds.
      Nutr Bull. 2001; 26: 71-79
      		Healthy means food that's good for you, not fattening. (association of being thin with healthy eating by 9- to 11-year-olds)
      • Dixey R.
      • Sahota P.
      • Atwal S.
      • Turner A.
      Children talking about healthy eating: data from focus groups with 300 9-11-year-olds.
      Nutr Bull. 2001; 26: 71-79
      Energy
      • Paquette M.
      • Devine C.M.
      Dietary trajectories in the menopause transition among Quebec women.
      J Nutr Educ. 2000; 32: 320-328
      , 
      • Roos G.
      • Prättälä R.
      • Koski K.
      Men, masculinity and food: interviews with Finnish carpenters and engineers.
      Appetite. 2001; 37: 47-56
      , 
      • Neumark-Sztainer D.
      • Story M.
      • Perry C.
      • Casey M.A.
      Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents.
      J Am Diet Assoc. 1999; 99: 929-937
      		I have made these gradual changes in my diet to feel better, to have more energy. My body needs it and I listen to my body.
      • Paquette M.
      • Devine C.M.
      Dietary trajectories in the menopause transition among Quebec women.
      J Nutr Educ. 2000; 32: 320-328
      Strength and physical performance
      • Smart L.R.
      • Bisogni C.A.
      Personal food systems of male college hockey players.
      Appetite. 2001; 37: 57-70
      , 
      • Moss S.Z.
      • Moss M.S.
      • Kilbride J.E.
      • Rubinstein R.L.
      Frail men’s perspectives on food and eating.
      J Aging Stud. 2007; 21: 314-324
      		It [food] helps you get around and gives you the strength.
      • Moss S.Z.
      • Moss M.S.
      • Kilbride J.E.
      • Rubinstein R.L.
      Frail men’s perspectives on food and eating.
      J Aging Stud. 2007; 21: 314-324


      I don't have a big piece of pie, because I'm worried about practice, I'm worried about my energy level. . . I do think pretty consciously about what I'm going to eat during the day before hockey practice.
      • Smart L.R.
      • Bisogni C.A.
      Personal food systems of male college hockey players.
      Appetite. 2001; 37: 57-70
      Disease avoidance
      • Coveney J.
      A qualitative study exploring socio-economic differences in parental lay knowledge of food and health: implications for public health nutrition.
      Public Health Nutr. 2005; 8: 290-297
      , 
      • Chapman G.E.
      • Beagan B.
      Women’s perspectives on nutrition, health, and breast cancer.
      J Nutr Educ Behav. 2003; 35: 135-141
      , 
      • Dibsdall L.A.
      • Lambert N.
      • Frewer L.J.
      Using interpretative phenomenology to understand the food-related experiences and beliefs of a select group of low-income UK women.
      J Nutr Educ Behav. 2002; 34: 298-309
      , 
      • Falk L.W.
      • Bisogni C.A.
      • Sobal J.
      Food choice processes of older adults.
      J Nutr Educ. 1996; 28: 257-265
      , 
      • Maskarinec G.
      • Murphy S.
      • Shumay D.M.
      • Kakai H.
      Dietary changes among cancer survivors.
      Eur J Cancer Care. 2001; 10: 12-20
      , 
      • Falk L.W.
      • Sobal J.
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      Managing healthy eating: definitions, classifications, and strategies.
      Health Educ Behav. 2001; 28: 425-439
      , 
      • Chambers S.
      • Lobb A.
      • Butler L.T.
      • Traill W.B.
      The influence of age and gender on food choice: a focus group exploration.
      Int J Cons Stud. 2008; 32: 356-365
      , 
      • Farrimond H.
      • Saukko P.M.
      • Qureshi N.
      • Evans P.H.
      Making sense of being at ‘high risk’ of coronary heart disease within primary prevention.
      Psychol Health. 2010; 25: 289-304
      , 
      • Jabs J.A.
      • Devine C.M.
      • Sobal J.
      A model of the process of adopting vegetarian diets: health vegetarians and ethical vegetarians.
      J Nutr Educ. 1998; 30: 196-202
      , 
      • Beagan B.L.
      • Chapman G.E.
      Eating after breast cancer: influences on women’s actions.
      J Nutr Educ Bahav. 2004; 36: 181-188
      , 
      • Krutulyte R.
      • Grunert K.G.
      • Scholderer J.
      • et al.
      Motivational factors for consuming omega-3 PUFAs: an exploratory study with Danish consumers.
      Appetite. 2008; 51: 137-147
      , 
      • Reedy J.
      • Haines P.S.
      • Steckler A.
      • Campbell M.K.
      Qualitative comparison of dietary choices and dietary supplement use among older adults with and without a history of colorectal cancer.
      J Nutr Educ Behav. 2005; 37: 252-258
      , 
      • Bhaskaran S.
      • Hardley F.
      Buyer beliefs, attitudes and behaviour: foods with therapeutic claims.
      Journal of Consumer Marketing. 2002; 19: 591-606
      , 
      • Rainey C.J.
      • Mayo R.M.
      • Haley-Zitlin V.
      • Kemper K.A.
      • Cason K.L.
      Nutritional beliefs, attitudes and practices of elderly, rural, Southern women.
      J Nutr Elder. 2000; 20: 3-27
      , 
      • Folta S.C.
      • Goldberg J.P.
      • Lichtenstein A.H.
      • Seguin R.
      • Reed P.N.
      • Nelson M.E.
      Factors related to cardiovascular disease risk reduction in midlife and older women: a qualitative study.
      Prev Chron Dis. 2008; 99: 717-722
      		I don't want a stroke… so I try to leave the cheese alone…
      • Falk L.W.
      • Bisogni C.A.
      • Sobal J.
      Food choice processes of older adults.
      J Nutr Educ. 1996; 28: 257-265
      Disease management
      • King K.M.
      • Thomlinson E.
      • Sanguins J.
      • LeBlanc P.
      Men and women managing coronary artery disease risk: urban-rural contrasts.
      Soc Sci Med. 2006; 62: 1091-1102
      , 
      • Miller D.
      • Brown J.L.
      Marital interactions in the process of dietary change for type 2 diabetes.
      J Nutr Educ Behav. 2005; 37: 226-234
      , 
      • Smith S.L.
      • Quandt S.A.
      • Arcury T.A.
      • Wetmore L.K.
      • Bell R.A.
      • Vitolins M.Z.
      Aging and eating in the rural, southern United States: beliefs about salt and its effect on health.
      Soc Sci Med. 2006; 62: 189-198
      , 
      • Falk L.W.
      • Sobal J.
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      Managing healthy eating: definitions, classifications, and strategies.
      Health Educ Behav. 2001; 28: 425-439
      , 
      • Gregory S.
      Living with chronic illness in the family setting.
      Soc Health Illn. 2005; 27: 372-392
      , 
      • Gellar L.A.
      • Schrader K.
      • Nansel T.R.
      Healthy eating practices: perceptions, facilitators, and barriers among youth with diabetes.
      Diabetes Educ. 2007; 33: 671-679
      , 
      • Gustafsson K.
      • Ekblad J.
      • Sidenvall B.
      Older women and dietary advice: occurrence, comprehension and compliance.
      J Hum Nutr Diet. 2005; 18: 453-460
      , 
      • Beverly E.
      • Miller C.
      • Wray L.
      Spousal support and food-related behavior change in middle-aged and older adults living with type 2 diabetes.
      Health Educ Behav. 2008; 35: 707-720
      , 
      • Falk L.W.
      • Bisogni C.A.
      • Sobal A.
      Food choice processes of older adults: a qualitative investigation.
      J Nutr Educ. 1996; 28: 257-265
      , 
      • Gerstle J.
      • Varenne H.
      • Contento I.
      Post-diagnosis family adaptation influences glycemic control in women with type 2 diabetes mellitus.
      J Am Diet Assoc. 2001; 101: 918-922
      , 
      • Malpass A.
      • Andrews R.
      • Turner K.M.
      Patients with type 2 diabetes experiences of making multiple lifestyle changes: a qualitative study.
      Patient Educ Couns. 2009; 74: 258-263
      , 
      • Hollingdale R.
      • Sutton D.
      • Hart K.
      Facilitating dietary change in renal disease: investigating patients’ perspectives.
      J Renal Care. 2008; 34: 136-142
      , 
      • Savoca M.R.
      • Arcury T.A.
      • Leng X.
      • et al.
      Association between dietary quality of rural older adults and self-reported food avoidance and food modification due to oral health problems.
      J Am Geriatr Soc. 2010; 58: 1225-1232
      		I manage my diabetes on my own. We were eating so differently that I said you know what… we can eat together, but I am going to prepare my own food and do my own thing because this is not good for me.
      • Beverly E.
      • Miller C.
      • Wray L.
      Spousal support and food-related behavior change in middle-aged and older adults living with type 2 diabetes.
      Health Educ Behav. 2008; 35: 707-720


      I'm in control because fear made me control my diabetes.
      • Malpass A.
      • Andrews R.
      • Turner K.M.
      Patients with type 2 diabetes experiences of making multiple lifestyle changes: a qualitative study.
      Patient Educ Couns. 2009; 74: 258-263
      Intolerances
      • Falk L.W.
      • Bisogni C.A.
      • Sobal J.
      Food choice processes of older adults.
      J Nutr Educ. 1996; 28: 257-265
      , 
      • Ristovski-Slijepcevic S.
      • Chapman G.E.
      • Beagan B.L.
      Engaging with healthy eating discourse(s): ways of knowing about food and health in three ethnocultural groups in Canada.
      Appetite. 2008; 50: 167-178
      , 
      • Rainey C.J.
      • Mayo R.M.
      • Haley-Zitlin V.
      • Kemper K.A.
      • Cason K.L.
      Nutritional beliefs, attitudes and practices of elderly, rural, Southern women.
      J Nutr Elder. 2000; 20: 3-27
      		It used to be that I could eat anything without difficulty but your system changes and I think I recognize that now.
      • Falk L.W.
      • Bisogni C.A.
      • Sobal J.
      Food choice processes of older adults.
      J Nutr Educ. 1996; 28: 257-265


      …as my body is getting older, there are certain things that my body cannot tolerate… so slowly I change my habits…72
      Psychosocial well-being
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      • te Molder H.
      • Koelen M.M.
      • van Woerkum C.M.J.
      ‘I eat healthfully but I am not a freak.’ Consumers’ everyday life perspective on healthful eating.
      Appetite. 2009; 53: 390-398
      , 
      • Crossley M.L.
      ‘Could you please pass one of those health leaflets along?’ Exploring health, morality and resistance through focus groups.
      Soc Sci Med. 2002; 55: 1471-1483
      , 
      • Travis S.E.
      • Bisogni C.A.
      • Ranzenhofer L.
      A conceptual model of how US families with athletic adolescent daughters manage food and eating.
      Appetite. 2010; : 108-117
      , 
      • Ristovski-Slijepcevic S.
      • Chapman G.E.
      • Beagan B.L.
      Engaging with healthy eating discourse(s): ways of knowing about food and health in three ethnocultural groups in Canada.
      Appetite. 2008; 50: 167-178
      , 
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      , 
      • House J.
      • Su J.
      • Levy-Milne R.
      Definitions of healthy eating among university students.
      Can J Diet Pract Res. 2006; 67: 14-18
      , 
      • Crawford P.B.
      • Gosliner W.
      • Anderson C.
      • et al.
      Counseling Latina mothers of preschool children about weight issues: suggestions for a new framework.
      J Am Diet Assoc. 2004; 104: 387-394
      , 
      • Chapman G.E.
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      • Beagan B.L.
      Meanings of food, eating and health in Punjabi families living in Vancouver, Canada.
      Health Educ J. 2011; 70: 102-112
      , 
      • Jallinoja P.
      • Pajari P.
      • Absetz P.
      Negotiated pleasures in health-seeking lifestyles of participants of a health promoting intervention.
      Health. 2010; 14: 115-130
      , 
      • Rowe J.
      Voices from the inside: African American women's perspectives on healthy lifestyles.
      Health Educ Behav. 2010; 37: 789-800
      , 
      • James D.C.S.
      Factors influencing food choices, dietary intake, and nutrition-related attitudes among African Americans: application of a culturally sensitive model.
      Ethn Health. 2004; 9: 349-367
      , 
      • Gough B.
      • Conner M.T.
      Barriers in healthy eating amongst men: a qualitative analysis.
      Soc Sci Med. 2006; 62: 387-395
      , 
      • Sandelowski M.
      • DeVellis B.
      • Campbell M.
      Variations in meanings of the personal core value ‘Health’.
      Patient Educ Couns. 2008; 73: 347-353
      , 
      • Gustafsson K.
      • Ekblad J.
      • Sidenvall B.
      Older women and dietary advice: occurrence, comprehension and compliance.
      J Hum Nutr Diet. 2005; 18: 453-460
      , 
      • Arcury T.A.
      • Quandt S.A.
      • Bell R.A.
      Staying healthy: the salience and meaning of health maintenance behaviors among rural older adults in North Carolina.
      Soc Sci Med. 2001; 53: 1541-1556
      , 
      • Owen J.
      • Metcalfe A.
      • Dryden C.
      • Shipton G.
      ‘If they don't eat it, it's not a proper meal’: images of risk and choice in fathers’ accounts of family food practices.
      Health Risk Soc. 2010; 12: 395-406
      , 
      • Fuller T.L.
      • Backett-Milburn K.
      • Hopton J.L.
      Healthy eating: the views of general practitioners and patients in Scotland.
      Am J Clin Nutr. 2003; 77: 1043S-1047S
      , 
      • Harrison M.
      • Jackson L.A.
      Meanings that youth associate with healthy and unhealthy food.
      Can J Diet Pract Res. 2009; 70: 6-12
      , 
      • Quandt S.A.
      • McDonald J.
      • Arcury T.A.
      • Bell R.A.
      • Vitolins M.Z.
      Nutritional self-management of elderly widows in rural communities.
      Gerontologist. 2000; 40: 86-96
      		…you have also got to be relaxed and happy about what you are doing. I don't think it's healthy if you get too fanatical about how much of how many bits and pieces are in every bit of food. You've got to get a happy balance.
      • Fuller T.L.
      • Backett-Milburn K.
      • Hopton J.L.
      Healthy eating: the views of general practitioners and patients in Scotland.
      Am J Clin Nutr. 2003; 77: 1043S-1047S


      Health, it's such a broad issue because it goes from your environment to your lifestyle, and we have a whole lot of pollution, we have smog in the air, even now it can affect health. So it comes from different aspects of our—mentally, socially, physically, spiritually; good health depends on all that.
      • Rowe J.
      Voices from the inside: African American women's perspectives on healthy lifestyles.
      Health Educ Behav. 2010; 37: 789-800


      It's [healthy eating] eating food to nourish your spirit as well as your body…and, you know, so it's really being connected to where it comes from as well as where it's going, like to feel good.
      • Ristovski-Slijepcevic S.
      • Chapman G.E.
      • Beagan B.L.
      Engaging with healthy eating discourse(s): ways of knowing about food and health in three ethnocultural groups in Canada.
      Appetite. 2008; 50: 167-178


      You strive to find a balance between spoiling yourself, feeling good and being healthy. You may sometimes gorge yourself and bargain with your health to buy yourself mental well-being.
      • Roos G.
      • Prättälä R.
      • Koski K.
      Men, masculinity and food: interviews with Finnish carpenters and engineers.
      Appetite. 2001; 37: 47-56


      It [dietary advice] doesn't interest me. I eat what I like and what makes me feel good.”
      • Gustafsson K.
      • Ekblad J.
      • Sidenvall B.
      Older women and dietary advice: occurrence, comprehension and compliance.
      J Hum Nutr Diet. 2005; 18: 453-460
      Personalization
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      A qualitative study exploring socio-economic differences in parental lay knowledge of food and health: implications for public health nutrition.
      Public Health Nutr. 2005; 8: 290-297
      , 
      • O’Key V.
      • Hugh-Jones S.
      ‘I don’t need anybody to tell me what I should be doing.’ A discursive analysis of maternal accounts of (mis)trust of healthy eating information.
      Appetite. 2010; 54: 524-532
      , 
      • Shaw A.
      Discourses of risk in lay accounts of microbiological safety and BSE: a qualitative interview study.
      Health Risk Soc. 2004; 6: 151-171
      , 
      • Lupton D.A.
      Lay discourses and beliefs related to food risks: an Australian perspective.
      Sociol Health Illn. 2005; 27: 448-467
      , 
      • Chapman G.E.
      • Beagan B.
      Women’s perspectives on nutrition, health, and breast cancer.
      J Nutr Educ Behav. 2003; 35: 135-141
      , 
      • Dibsdall L.A.
      • Lambert N.
      • Frewer L.J.
      Using interpretative phenomenology to understand the food-related experiences and beliefs of a select group of low-income UK women.
      J Nutr Educ Behav. 2002; 34: 298-309
      , 
      • Falk L.W.
      • Bisogni C.A.
      • Sobal J.
      Food choice processes of older adults.
      J Nutr Educ. 1996; 28: 257-265
      , 
      • Ristovski-Slijepcevic S.
      • Chapman G.E.
      • Beagan B.L.
      Engaging with healthy eating discourse(s): ways of knowing about food and health in three ethnocultural groups in Canada.
      Appetite. 2008; 50: 167-178
      , 
      • Niva M.
      ‘All foods affect health’: understandings of functional foods and healthy eating among health-oriented Finns.
      Appetite. 2007; 48: 384-393
      , 
      • Smith S.L.
      • Quandt S.A.
      • Arcury T.A.
      • Wetmore L.K.
      • Bell R.A.
      • Vitolins M.Z.
      Aging and eating in the rural, southern United States: beliefs about salt and its effect on health.
      Soc Sci Med. 2006; 62: 189-198
      , 
      • Bentley M.
      • Gavin L.
      • Black M.M.
      • Teti L.
      Infant feeding practices of low-income, African-American, adolescent mothers: an ecological, multigenerational perspective.
      Soc Sci Med. 1999; 49: 1085-1100
      , 
      • Gough B.
      • Conner M.T.
      Barriers in healthy eating amongst men: a qualitative analysis.
      Soc Sci Med. 2006; 62: 387-395
      , 
      • Ristovski-Slijepcevic S.
      • Chapman G.E.
      • Beagan B.L.
      Being a ‘good mother’: dietary governmentality in the family food practices of three ethnocultural groups in Canada.
      Health (London). 2010; 14: 467-483
      , 
      • Underwood S.
      • Pridham K.
      • Brown L.
      • et al.
      Infant feeding practices of low-income African American women in a central city community.
      J Commun Health Nurs. 1997; 14: 189-205
      , 
      • Lupton D.
      • Chapman S.
      ‘A healthy lifestyle might be the death of you’: discourses on diet, cholesterol control and heart disease in the press and among the lay public.
      Sociol Health Illn. 1995; 17: 477-494
      , 
      • Falk L.
      • Bisogni C.A.
      • Sobal J.
      Diet change processes of participants in an intensive heart program.
      J Nutr Educ. 2000; 32: 240-250
      , 
      • Janas B.G.
      • Bisogni C.A.
      • Sobal J.
      Cardiac patients’ mental representations of diet.
      J Nutr Health. 1996; 28: 223-229
      , 
      • Maskarinec G.
      • Murphy S.
      • Shumay D.M.
      • Kakai H.
      Dietary changes among cancer survivors.
      Eur J Cancer Care. 2001; 10: 12-20
      , 
      • Maubach N.
      • Hoek J.
      • McCreanor T.
      An exploration of parents’ food purchasing behaviours.
      Appetite. 2009; 53: 297-302
      , 
      • Smith-DiJulio K.
      • Windsor C.
      • Anderson D.
      The shaping of midlife women’s views of health and health behaviors.
      Qual Health Res. 2010; 20: 966-976
      , 
      • Paisley J.
      • Sheeshka J.
      • Daly K.
      Qualitative investigation of the meanings of eating fruits and vegetables for adult couples.
      J Nutr Educ. 2001; 33: 199-207
      , 
      • Zehle K.
      • Wen L.M.
      • Orr N.
      • Rissel C.
      ‘It’s not an issue at the moment’: a qualitative study of mothers about childhood obesity.
      Am J Matern Child Nurs. 2007; 32: 36-41
      , 
      • McGee B.B.
      • Richardson V.
      • Johnson G.S.
      • et al.
      Perceptions of factors influencing healthful food consumption behavior in the lower Mississippi delta: focus group findings.
      J Nutr Educ Behav. 2008; 40: 102-109
      , 
      • Gustafsson K.
      • Ekblad J.
      • Sidenvall B.
      Older women and dietary advice: occurrence, comprehension and compliance.
      J Hum Nutr Diet. 2005; 18: 453-460
      , 
      • Lawton J.
      • Ahmad N.
      • Hanna L.
      • Douglas M.
      • Bains H.
      • Hallowell N.
      ‘We should change ourselves, but we can’t’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes.
      Ethn Health. 2008; 13: 305-319
      , 
      • Palojoki P.
      • Tuomi-Gröhn T.
      The complexity of food choices in an everyday context.
      International Journal of Consumer Studies. 2001; 25: 15-23
      , 
      • Chapman K.
      • Ogden J.
      How do people change their diet? An exploration into mechanisms of dietary change.
      J Health Psychol. 2009; 14: 1229-1242
      		Well, I think again it's just, listening to everything but then making your own, making your own mind up, you know, what's best for you. I think if you listened to everything you wouldn't eat anything, would you?27

      We do what works for us… how it fits in with our ideas.
      • Zehle K.
      • Wen L.M.
      • Orr N.
      • Rissel C.
      ‘It’s not an issue at the moment’: a qualitative study of mothers about childhood obesity.
      Am J Matern Child Nurs. 2007; 32: 36-41


      You take what's right for you and use it.
      • Zehle K.
      • Wen L.M.
      • Orr N.
      • Rissel C.
      ‘It’s not an issue at the moment’: a qualitative study of mothers about childhood obesity.
      Am J Matern Child Nurs. 2007; 32: 36-41


      But I'm a diabetic. I'm not going to lie. I eat whatever I feel like I want to eat. I'll just accept the consequences later, down the line.
      • McGee B.B.
      • Richardson V.
      • Johnson G.S.
      • et al.
      Perceptions of factors influencing healthful food consumption behavior in the lower Mississippi delta: focus group findings.
      J Nutr Educ Behav. 2008; 40: 102-109
      Restriction and control
      • Benford R.
      • Gough B.
      Defining and defending ‘unhealthy’ practices: a discourse analysis of chocolate ‘addicts’ accounts.
      J Health Psychol. 2006; 11: 427-440
      , 
      • Lupton D.A.
      Lay discourses and beliefs related to food risks: an Australian perspective.
      Sociol Health Illn. 2005; 27: 448-467
      , 
      • Smart L.R.
      • Bisogni C.A.
      Personal food systems of male college hockey players.
      Appetite. 2001; 37: 57-70
      , 
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      • Sobal J.
      Who we are and how we eat: a qualitative study of identities in food choice.
      J Nutr Educ Behav. 2002; 34: 128-139
      , 
      • Ross S.
      ‘Do I really have to eat that?’: A qualitative study of schoolchildren’s food choices and preferences.
      Health Educ J. 1995; 54: 312-321
      , 
      • Bassett R.
      • Chapman G.E.
      • Beagan B.L.
      Autonomy and control: the co-construction of adolescent food choice.
      Appetite. 2008; 50: 325-332
      , 
      • Chapman K.
      • Ogden J.
      A qualitative study exploring how mothers manage their teenage children’s diets.
      Vulnerable Child Youth Stud. 2009; 4: 90-100
      , 
      • Janas B.G.
      • Bisogni C.A.
      • Sobal J.
      Cardiac patients’ mental representations of diet.
      J Nutr Health. 1996; 28: 223-229
      , 
      • Anving T.
      • Sellerberg A.
      Family meals and parents’ challenges.
      Food Cult Soc. 2010; 13: 201-214
      , 
      • Paisley J.
      • Sheeshka J.
      • Daly K.
      Qualitative investigation of the meanings of eating fruits and vegetables for adult couples.
      J Nutr Educ. 2001; 33: 199-207
      , 
      • Connors M.
      • Bisogni C.A.
      • Sobal J.
      • Devine C.M.
      Managing values in personal food systems.
      Appetite. 2001; 36: 189-200
      , 
      • Cullen K.W.
      • Baranowski T.
      • Rittenberry L.
      • Olvera N.
      Social-environmental influences on children’s diets: results from focus groups with African, Euro- and Mexican-American children and their parents.
      Health Educ Res. 2000; 15: 581-590
      , 
      • Savoca M.
      • Miller C.
      Food selection and eating patterns: themes found among people with type 2 diabetes mellitus.
      J Nutr Educ. 2001; 33: 224-233
      , 
      • Dixey R.
      • Sahota P.
      • Atwal S.
      • Turner A.
      Children talking about healthy eating: data from focus groups with 300 9-11-year-olds.
      Nutr Bull. 2001; 26: 71-79
      , 
      • Dwyer J.
      • Needham L.
      • Simpson J.R.
      • Heeney E.S.
      Parents report intrapersonal, interpersonal, and environmental barriers to supporting healthy eating and physical activity among their preschoolers.
      Appl Physiol Nutr Metab. 2008; 33: 338-346
      		They [kids] don't like broccoli, so if we are having broccoli we make them eat 1 or 2 pieces. They go, ‘Ugh,' but they'll eat a piece.
      • Bassett R.
      • Chapman G.E.
      • Beagan B.L.
      Autonomy and control: the co-construction of adolescent food choice.
      Appetite. 2008; 50: 325-332


      I will say to them: ‘you can help yourself to anything in the line of fruit or vegetables but if you want something sweet you have to ask permission and not just take it.
      • Chapman K.
      • Ogden J.
      A qualitative study exploring how mothers manage their teenage children’s diets.
      Vulnerable Child Youth Stud. 2009; 4: 90-100


      My Mom was worried that I might get diabetes so she put me on this no flour, no corn, no sugar thing. I'm getting paid not to eat those foods.
      • Bassett R.
      • Chapman G.E.
      • Beagan B.L.
      Autonomy and control: the co-construction of adolescent food choice.
      Appetite. 2008; 50: 325-332
      Table 3Life Stages and Life Events That People Relate to Their Meanings for Healthy Eating
      Life Stages and Life Events and ExperiencesExamples of Participants' Interpretations
      Childhood
      • Husby I.
      • Heitmann B.L.
      • O'Doherty J.K.
      Meals and snacks from the child’s perspective: the contribution of qualitative methods to the development of dietary interventions.
      Public Health Nutr. 2009; 12: 739-747
      , 
      • Ross S.
      ‘Do I really have to eat that?’: A qualitative study of schoolchildren’s food choices and preferences.
      Health Educ J. 1995; 54: 312-321
      , 
      • Brett J.A.
      • Heimendinger J.
      • Boender C.
      • Morin C.
      • Marshall J.A.
      Using ethnography to improve intervention design.
      Am J Health Promot. 2002; 16: 331-340
      , 
      • Anving T.
      • Sellerberg A.
      Family meals and parents’ challenges.
      Food Cult Soc. 2010; 13: 201-214
      , 
      • Roos G.
      Our bodies are made of pizza—food and embodiment among children in Kentucky.
      Ecol Food Nutr. 2002; 41: 1-19
      , 
      • Cullen K.W.
      • Baranowski T.
      • Rittenberry L.
      • Olvera N.
      Social-environmental influences on children’s diets: results from focus groups with African, Euro- and Mexican-American children and their parents.
      Health Educ Res. 2000; 15: 581-590
      , 
      • Ludvigsen A.
      • Scott S.
      Real kids don’t eat quiche: what food means to children.
      Food Cult Soc. 2009; 12: 417-436
      , 
      • Gellar L.A.
      • Schrader K.
      • Nansel T.R.
      Healthy eating practices: perceptions, facilitators, and barriers among youth with diabetes.
      Diabetes Educ. 2007; 33: 671-679
      , 
      • McKinley M.C.
      • Lowis C.
      • Robson P.J.
      • et al.
      It’s good to talk: children’s views on food and nutrition.
      Eur J Clin Nutr. 2005; 59: 542-551
      , 
      • Dixey R.
      • Sahota P.
      • Atwal S.
      • Turner A.
      Children talking about healthy eating: data from focus groups with 300 9-11-year-olds.
      Nutr Bull. 2001; 26: 71-79
      , 
      • Campbell K.J.
      • Crawford D.A.
      • Hesketh K.D.
      Australian parents’ views on their 5-6-year-old children’s food choices.
      Health Promot Int. 2007; 22: 11-18
      , 
      • Hart K.H.
      • Bishop J.A.
      • Truby H.
      An investigation into school children’s knowledge and awareness of food and nutrition.
      J Hum Nutr Diet. 2002; 15: 129-140
      , 
      • Noble C.
      • Corney M.
      • Eves A.
      • Kipps M.
      • Lumbers M.
      Food choice and school meals: primary schoolchildren’s perceptions of the healthiness of foods and the nutritional implications of food choices.
      International Journal of Hospitality Management. 2000; 19: 413-432
      		We like candy… all kids like candy more than fruit.
      • Cullen K.W.
      • Baranowski T.
      • Rittenberry L.
      • Olvera N.
      Social-environmental influences on children’s diets: results from focus groups with African, Euro- and Mexican-American children and their parents.
      Health Educ Res. 2000; 15: 581-590


      Kids don't usually want to eat healthy food.
      • Ludvigsen A.
      • Scott S.
      Real kids don’t eat quiche: what food means to children.
      Food Cult Soc. 2009; 12: 417-436
      Adolescence
      • Sylow M.
      • Holm L.
      Building groups and independence.
      Childhood. 2009; 16: 213-228
      , 
      • Bassett R.
      • Chapman G.E.
      • Beagan B.L.
      Autonomy and control: the co-construction of adolescent food choice.
      Appetite. 2008; 50: 325-332
      , 
      • Travis S.E.
      • Bisogni C.A.
      • Ranzenhofer L.
      A conceptual model of how US families with athletic adolescent daughters manage food and eating.
      Appetite. 2010; : 108-117
      , 
      • Watt R.G.
      • Sheiham A.
      Towards an understanding of young people’s conceptualization of food and eating.
      Health Educ J. 1997; 56: 340
      , 
      • Croll J.K.
      • Nuemark-Sztainer D.
      • Story M.
      Healthy eating: what does it mean to adolescents?.
      J Nutr Educ. 2001; 33: 193-198
      , 
      • Contento I.R.
      • Williams S.S.
      • Michela J.L.
      • Franklin A.B.
      Understanding the food choice process of adolescents in the context of family and friends.
      J Adolesc Health. 2006; 38: 575-582
      , 
      • Skinner K.
      • Hanning R.M.
      • Tsuji L.J.
      Barriers and supports for healthy eating and physical activity for First Nation youths in northern Canada.
      Int J Circumpolar Health. 2006; 65: 148-161
      , 
      • Gellar L.A.
      • Schrader K.
      • Nansel T.R.
      Healthy eating practices: perceptions, facilitators, and barriers among youth with diabetes.
      Diabetes Educ. 2007; 33: 671-679
      , 
      • Harrison M.
      • Jackson L.A.
      Meanings that youth associate with healthy and unhealthy food.
      Can J Diet Pract Res. 2009; 70: 6-12
      , 
      • Kubik M.Y.
      • Lytle L.
      • Fulkerson J.A.
      Fruits, vegetables, and football: findings from focus groups with alternative high school students regarding eating and physical activity.
      J Adolesc Health. 2005; 36: 494-500
      , 
      • Neumark-Sztainer D.
      • Story M.
      • Perry C.
      • Casey M.A.
      Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents.
      J Am Diet Assoc. 1999; 99: 929-937
      , 
      • Power T.G.
      • Bindler R.C.
      • Goetz S.
      • Daratha K.B.
      Obesity prevention in early adolescence: student, parent, and teacher views.
      J Sch Health. 2010; 80: 13-19
      , 
      • Satia J.A.
      • Barlow J.
      • Armstrong-Brown J.
      • Watters J.L.
      Qualitative study to explore prospect theory and message framing and diet and cancer prevention-related issues among African American adolescents.
      Cancer Nurs. 2010; 33: 102-109
      		We can't be bothered with buying healthy snacks…Not raisins, either. We don't want to pay for the healthy stuff.
      • Sylow M.
      • Holm L.
      Building groups and independence.
      Childhood. 2009; 16: 213-228
      Adults and aging
      • Chapman G.E.
      • Beagan B.
      Women’s perspectives on nutrition, health, and breast cancer.
      J Nutr Educ Behav. 2003; 35: 135-141
      , 
      • Bisogni C.A.
      • Connors M.
      • Devine C.M.
      • Sobal J.
      Who we are and how we eat: a qualitative study of identities in food choice.
      J Nutr Educ Behav. 2002; 34: 128-139
      , 
      • Falk L.W.
      • Bisogni C.A.
      • Sobal J.
      Food choice processes of older adults.
      J Nutr Educ. 1996; 28: 257-265
      , 
      • Smith S.L.
      • Quandt S.A.
      • Arcury T.A.
      • Wetmore L.K.
      • Bell R.A.
      • Vitolins M.Z.
      Aging and eating in the rural, southern United States: beliefs about salt and its effect on health.
      Soc Sci Med. 2006; 62: 189-198
      , 
      • Paisley J.
      • Sheeshka J.
      • Daly K.
      Qualitative investigation of the meanings of eating fruits and vegetables for adult couples.
      J Nutr Educ. 2001; 33: 199-207
      , 
      • Farrimond H.
      • Saukko P.M.
      • Qureshi N.
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      No I don't bother at all about it [dietary advice]… I think when you are this old you shouldn't change your food habits.
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      		I don't think I am eating healthy at all (now that with a partner), because I eat a lot of take-out and I don't eat a lot of vegetables… before I used to have salads with my meal…
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      With the two of us present, there's a better chance that a more substantial or more nutritious meal will be prepared.
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      		Having kids myself makes me realize that I wasn't eating enough green vegetables…
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      In my teens, it was more on-the-run type [of eating]. . .It was not until I had [my daughter] that I started making sure there was always a hot dinner at night.
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      		My family doctor used to talk to me about diet before I had the heart problem and ended up in the hospital. But I was kind of ignoring her. That was a wake-up call for me, that trip to the hospital.
      • King K.M.
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      Men and women managing coronary artery disease risk: urban-rural contrasts.
      Soc Sci Med. 2006; 62: 1091-1102


      …I didn't need too much incentive [to become a vegetarian]. I had heart disease…
      • Jabs J.A.
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      J Nutr Educ. 1998; 30: 196-202


      I love broccoli, and now I eat it more because somebody put it in my head that it prevents breast cancer.
      • Beagan B.L.
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      J Nutr Educ Bahav. 2004; 36: 181-188
      Women's transitions
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      Dietary trajectories in the menopause transition among Quebec women.
      J Nutr Educ. 2000; 32: 320-328
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      • Gustafsson K.
      • Sidenvall B.
      Food-related health perceptions and food habits among older women.
      J Adv Nurs. 2002; 39: 164-173
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      • Fowles E.
      • Hendricks J.
      • Walker L.
      Identifying healthy eating strategies in low-income pregnant women: applying a positive deviance model.
      Health Care Women Int. 2005; 26: 807-820
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      • Edstrom K.M.
      • Devine C.M.
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      J Nutr Educ. 2001; 33: 215-223
      , 
      • Beagan B.L.
      • Chapman G.E.
      Family influences on food choice: context of surviving breast cancer.
      J Nutr Educ Behav. 2004; 36: 320-326
      , 
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      Weight maintenance and relapse in obesity: a qualitative study.
      Int J Obesity. 2003; 27: 955-962