Research report What are the main barriers to healthy eating among families? A qualitative exploration of perceptions and experiences of Tehranian men ☆ Maryam Farahmand a , Parisa Amiri b, *, Fahimeh Ramezani Tehrani a , Amir Abbas Momenan c , Parvin Mirmiran d , Fereidoun Azizi e a Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran b Research Center for Social Determinants of Endocrine Health & Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran c Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran d Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran e Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ARTICLE INFO Article history: Received 30 April 2013 Received in revised form 3 February 2015 Accepted 19 February 2015 Available online Keywords: Healthy nutrition Barriers Qualitative study Non-communicable diseases A B ST R AC T Despite women playing a pivotal role in shaping nutritional patterns in their families, it is the men whose ideas and preferences, after children, influence the selection and consumption of daily foods among Iranian families. This study focused on exploring the main barriers to healthy eating as experienced by male par- ticipants of the Tehran Lipid Glucose Study (TLGS). A grounded theory approach was used for analyzing participants’ experiences and their perceptions regarding these barriers. Participants were 98 men, aged 25–65 years, selected and recruited from the TGLS cohort. Data collection was conducted through four- teen semi-structured focus group discussions, between 2008 and 2009. All interviews and focus group discussions were audio recorded and transcribed verbatim. Constant comparative analysis of the data was conducted manually according to the Strauss and Corbin analysis method. The most important bar- riers to healthy eating were: (i) Personal factors, which included two subthemes – lack of knowledge and personal taste, (ii) Communication and modeling included two subthemes – other individuals and media/advertisements; (iii) Modernization included two subthemes – nutrition transition and women’s role; and (iv) Lack of access to healthy foods, which included four subthemes – Inadequate confidence, perceived risk, high cost and time limitations. Appropriate attention and prioritized policy-making to modify the socio-environmental barriers to healthy eating were explored in the current study, along with effective educational programs that could help to promote healthy eating among Iranian families. © 2015 Published by Elsevier Ltd. Introduction The prevalence of non-communicable diseases (NCDs) has in- creased significantly worldwide (Vongpatanasin, 2008), and they are the most important cause of mortality and morbidity in Iran (Azizi et al., 2002; Sarraf-Zadegan et al., 1999). Based on the Tehran Lipid and Glucose Study (TLGS) findings, the prevalence of general obesity between the years 2006 and 2009, classified by BMI ≥30, was 21% and 38.6% in men and women respectively, demonstrat- ing an alarming status and calling for urgent action to implement effective lifestyle modifications (Hosseinpanah, Barzin, Eskandary, Mirmiran, & Azizi, 2009). Results of previous studies indicate that there is a strong link between unhealthy lifestyles and NCDs (WHO, 2002). It is estimated that in the United States, 300,000 deaths per year are related to physical inactivity and poor dietary intake pat- terns (McGinnis & Foege, 1993). Thus, lifestyle modifications, increasing physical activity and healthy eating habits are consid- ered as the main cost-effective strategies in controlling NCDs (Darnton-Hill, Nishida, & James, 2004; Nissinen, Berrios, & Puska, 2001; Unwin & Alberti, 2006). Previous research conducted on urban Iranian populations shows major changes in food consumption patterns, including food con- sumption with low nutrient density at all income levels and over- consumption of food in over a third of households (Ghassemi, ☆ Acknowledgements: This study is funded by the Research Institute for Endo- crine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The authors express their appreciation to the authorities and personnel of the Lipid and Glucose Evaluation unit and wish to thank Ms. Niloofar Shiva for critical editing of English grammar and syntax of the manuscript. * Corresponding author. E-mail address: amiri@endocrine.ac.ir (P. Amiri). http://dx.doi.org/10.1016/j.appet.2015.02.025 0195-6663/© 2015 Published by Elsevier Ltd. Appetite ■■ (2015) ■■–■■ ARTICLE IN PRESS Please cite this article in press as: Maryam Farahmand, et al., What are the main barriers to healthy eating among families? A qualitative exploration of perceptions and experiences of Tehranian men , Appetite (2015), doi: 10.1016/j.appet.2015.02.025 Contents lists available at ScienceDirect Appetite journal homepage: www.elsevier.com/locate/appet Q2 Q1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81