A multilevel assessment of barriers to adoption of Dietary Approaches to Stop Hypertension (DASH) among African Americans of low socioeconomic status

J Health Care Poor Underserved. 2011 Nov;22(4):1205-20. doi: 10.1353/hpu.2011.0142.


Background: We examined perceptions of Dietary Approaches to Stop Hypertension (DASH) and the food environment among African Americans (AA) with high blood pressure living in two low-income communities and objectively assessed local food outlets.

Methods: Focus groups were conducted with 30 AAs; participants discussed DASH and the availability of healthy foods in their community. Sessions were transcribed and themes identified. Fifty-four stores and 114 restaurants were assessed using the Nutrition Environment Measures Survey (NEMS).

Results: Common themes included poor availability, quality, and cost of healthy foods; tension between following DASH and feeding other family members; and lack of congruity between their preferred foods and DASH. Food outlets in majority AA census tracts had lower NEMS scores (stores: -11.7, p=.01, restaurants: -8.3, p=.001) compared with majority White areas.

Conclusions: Interventions promoting DASH among lower income AAs should reflect the food customs, economic concerns, and food available in communities.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Black or African American / psychology*
  • Diet / psychology
  • Dietary Fats
  • Female
  • Focus Groups
  • Food* / economics
  • Fruit
  • Health Behavior
  • Humans
  • Hypertension / diet therapy
  • Hypertension / ethnology*
  • Hypertension / prevention & control*
  • Male
  • Middle Aged
  • North Carolina
  • Residence Characteristics
  • Restaurants
  • Social Environment
  • Socioeconomic Factors*
  • Vegetables


  • Dietary Fats