Graduation Year

2018

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Community and Family Health

Major Professor

Dinorah Martinez-Tyson, Ph.D.

Co-Major Professor

Lauri Wright, Ph.D.

Committee Member

Cheryl Vamos, Ph.D.

Committee Member

Robert Dedrick, Ph.D.

Committee Member

David Himmelgreen, Ph.D.

Committee Member

Enrique Teran, Ph.D.

Keywords

Geo-Nomics Theory and Framework, Global Nutrition, Kichwas, Mixed Methods, Lifestyle Assessment, Nutrition Transition Questionnaire

Abstract

The nutrition transition is a global phenomenon in which diets have become increasingly westernized and processed while lifestyles have shifted from labor intensive to sedentary, largely on account of the advent of technology, globalization n and urbanization. Despite the prevalence of this phenomenon, very little is known regarding how the nutrition transition has affected the risk of comorbid chronic diseases among indigenous Kichwas communities in Ecuador. Aims of this study are : 1) Identify specific health outcomes (such as diabetes, hypertension, and high cholesterol) associated with the lifestyle risk factors of the nutrition transition among the Andean Kichwas indigenous population; 2) Explore the sociocultural factors (such as gender roles, culinary traditions, urbanization and globalization) which influence dietary behavior and food choices within Kichwas indigenous households; 3) Assess the construct relevance of the Nutrition Transition Questionnaire (NTQ), a pilot instrument designed to measure key constructs of the nutrition transition within indigenous Kichwas Andean households. The current study is a convergent parallel mixed methods design that consists of two components: 1) Secondary data analysis of the internal reliability of the Nutrition Transition Questionnaire, a pilot instrument designed to assess obesogenic lifestyles at the individual and household levels; 2) Primary ethnographic qualitative data collection among the Kichwas community residing in the Imbabura province of Ecuador. Thirty-four interviews were conducted with nutritional gatekeepers (i.e. women who make the majority of household dietary decisions) to explore lifestyle trends related to diet and exercise within the Kichwas community. Twenty-five intercept interviews were conducted at various food vending locations throughout the community. Internal reliability of the NTQ was assessed using Cronbach’s alpha and inter-item correlations while qualitative data were analyzed using applied thematic analysis. Chronic disease occurrence in the sample was also assessed for diabetes, hypertension, high cholesterol and obesity. Results suggest that key constructs in the Nutrition Transition Questionnaire are relevant to assessing lifestyle risk and protection regarding chronic disease. Main qualitative themes include gender roles within food preparation; the impact of collective culture upon food choices and household dietary behavior; and the protection offered by access to home gardens. The discussion highlights several differences between this study population and other indigenous populations. It also posits that a new emergent theory, Geo-Nomics theory, can provide a useful future tool in framing additional ethnographic nutrition transition research. The conclusion indicates this study’s most useful contributions to the literature, which include the development of a potential thermos intervention to decrease fast food consumption when Kichwas men commute far from home to work.

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