Understanding barriers and facilitators of healthy diet and physical activity among African immigrants in the US: a qualitative study

Objectives: Africans who migrate to the US are initially leaner than US-born Black Americans of the same age. However, over time, they become affected by obesity, possibly due to exposure to the obesogenic food environment and sedentary lifestyle in the US. We aimed to understand barriers and facilitators to healthy diet and physical activity among African immigrants in the US. Methods: Using qualitative methods, we conducted eight focus groups remotely with 31 African immigrants (BMI ≥ 27 kg/m2) living in the US. We recruited African immigrants born in Ghana, Nigeria, Kenya, Uganda, Botswana, Ethiopia, South Africa, Sudan, and Zimbabwe. Participants completed a 5-minute screening survey to assess their eligibility. In focus groups, participants were queried about barriers and facilitators to the consumption of vegetable, lean proteins, and less sugary beverage consumption, physical activity. Data were recorded and fully transcribed. We analyzed the data using inductive qualitative content analysis, achieving inter-rater reliability of 81.8%. Results: We identified 11 barriers to a healthy diet, including differences in the taste of fruits and vegetables in the US compared to their home African countries, difficulty finding traditional African fruits and vegetables in the US, and not being accustomed to consuming raw vegetables. We identified 5 healthy diet facilitators, including making smoothies to obtain fruit servings and buying in bulk. We identified 4 barriers to physical activity, including a lack of time and paying for gym memberships. We also identified 5 physical activity facilitators, including weight gain and having friends and family with whom to exercise. Conclusions: African immigrants share similar barriers and facilitators to healthy diet and physical activity as others but also have unique barriers and facilitators that need to be addressed in tailored lifestyle interventions. Incorporating these in future lifestyle interventions may enhance relevance, engagement, and more sustainable behavior change.