Dietary Habits, Health Beliefs and Quality of Life among Chinese-Canadians

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Kwok, Stephanie Wai-Hai
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Mount Saint Vincent University
Chinese are the largest Asian subgroup in Canada and to varying degrees have adopted eating and lifestyle patterns of North Americans (e.g. high-fat, low fruit/vegetable diets; sedentary). They may therefore be more susceptible to higher rates of chronic diseases, including cardiovascular, hypertension, diabetes, obesity, and/or certain types of cancers. Very few research studies have examined the relationships between dietary habits and health beliefs among Chinese immigrants in North America, and virtually no research has been done to determine how either of these factors affects quality of life. The purpose of this study is to identify the dietary habits, health beliefs, and quality of life of Chinese immigrants residing in Toronto, Ontario, and to determine the effects of these dietary and health-related practices on subjective quality of life. The WHOQOL-BREF quality of life assessment model, with the incorporation of a diet-related index, was used as a theoretical framework for this study. Using a probability sampling method, subjects were recruited from five of more than 50 organizations serving Chinese immigrants in the Greater Toronto Area. The study population consisted of 106 healthy immigrants originating from Mainland China, Hong Kong and Taiwan, ranging in ages from 45 to 64 years. A telephone interview (15-20 minutes) employing a cross-sectional questionnaire was used to solicit information regarding dietary habits, health beliefs and perceived quality of life. Each interview was conducted in participant’s native language (Cantonese or Mandarin). All data were analyzed through SPSS statistical software. MSVU Ethics Review Board approved the ethical issues of this research. This study indicated that dietary acculturation is a gradual and continuous process, which does not occur at the same rate for all immigrants. While breakfast was the first meal to be “Westernized” after immigration, largely for reasons of convenience, about 72% and 98% of the subjects chose Chinese staple foods (rice, stir-fry, noodles, and soups) for lunch and dinner, respectively. Contrary to traditional Chinese habits, 62% of participants snacked between meals. Participants reported regular intakes of fruits and vegetables (87%), and frequent practice of fat- reduced behaviours (70%) in their diet. Most participants (79%) incorporated both Chinese and Western foods and cooking methods in their diets. Traditional Chinese health belief acculturation is also a continuous process. Traditional health practices of food modification during and after illnesses, seasonal adjustment of foods, and the balance of ‘cold’ or {Yin) and ‘hot’ (or Yang) foods to promote good health were very prevalent. Participants commonly used foods such as ginger root, ginseng, Chinese black mushroom, walnut, bitter melon, pork liver, and sea cucumber for preventing and treating illnesses. Participants were also categorized into one of three groups; those exhibiting the strongest levels of agreement with the traditional Chinese health belief questions were categorized as THB- Strong. The other two groups were THB-Moderate and THB-Weak. Compared to THB- Moderate and THB-Weak, subjects in THB-Strong group less frequently reduced the amount of added oil in cooking and/or trimmed visible fats from meat, but were more likely to reduce the intakes of deep-fried and fried foods, replace high fat foods with lower fat alternatives, and reduce meals consumed at Chinese restaurants. This finding agrees with traditional Chinese cooking in that oil and fat are considered important components of flavour, and that traditional Chinese health belief emphasizes on avoid eating deep-fried and fried foods. A substantial number of participants were satisfied with their overall quality of life (75%) and general health (60%), had good perceived physical (84%) and psychological health (68%), social relationships (80%), and environmental well-being (76%). Simple regression models revealed that overall quality of life could be predicted based on participants’ perception of their physical state, psychological well-being, and environmental conditions, and was positively associated with the length of residency in Canada (p = 0.001), English language proficiency {p = 0.006), and moderate degree of traditional health beliefs (p = 0.04). General health can be predicted based on participants’ perception of their physical health, psychological well-being, and social relationships, and was positively associated with the male gender (p = 0.01) and English language proficiency (p = 0.03). Chinese media (88%), friends and family (68%) were their primary sources of nutrition information. However, only 16% of the female and 1% of the male respondents had sought nutrition advice from dietitians. Less than 30% of participants reported engaging in at least 60 minutes of light intensity activities daily as recommended by the Canada’s Physical Activity Guide. Male participants were found to be less physically active than their female counterparts. On a positive note, less than 3% of the participants reported that they had worried about not having enough money to buy foods in the past month. These subjects were relatively younger, had lower educational attainment and English proficiency, suggesting that the issues of food security for this group be assessed in future studies. This study is one of the first few studies to directly relate the nutrition aspects with perceived quality of life among healthy immigrants. It is also the first study applying a traditional Chinese health belief grouping for Chinese Canadians, helpful in understanding concerns and preferences regarding diet and health. Results will provide an important basis needed to design and implement nutrition interventions to encourage immigrants to maintain a healthful traditional Chinese diet and health beliefs, and to make wise decisions when selecting Western foods. Using these results, dietitians are strongly encouraged to take a more proactive role in disseminating nutrition messages to minority populations. And finally, this study lays the groundwork for future research on dietary practices, health beliefs and nutrition-related quality of life of Chinese Canadians.
Quality of life , Health attitudes , Food habits , The WHOQOL-BREF quality of life assessment model , Chinese-Canadians