Barriers and facilitators to following the Dietary Guidelines for Americans reported by rural, Northern Plains American-Indian children

Public Health Nutr. 2015 Feb;18(3):482-9. doi: 10.1017/S136898001400041X. Epub 2014 Mar 28.


Objective: The Dietary Guidelines for Americans (DGA) promote healthy dietary choices for all Americans aged 2 years and older; however, the majority of Americans do not meet recommendations. The goal of the present study was to identify both barriers and facilitators to adherence to DGA recommendations for consumption of five recommended food groups: grains (specifically whole grains), vegetables, fruits, meat/beans and milk (specifically reduced-fat/non-fat), among American-Indian children.

Design: Nominal group technique sessions were conducted to identify and prioritize children's perceived barriers and facilitators to following the DGA, as presented in the 'MyPyramid' consumer education icon. After response generation to a single question about each food group (e.g. 'What sorts of things make it harder (or easier) for kids to follow the MyPyramid recommendation for vegetables?'), children individually ranked their top five most salient responses. Ranked responses are presented verbatim.

Setting: A rural Northern Plains American-Indian reservation, USA.

Subjects: Sixty-one self-selected fifth-grade children.

Results: Core barriers for all food groups studied included personal preference (i.e. 'don't like') and environmental (i.e. 'cost too much'; 'store is too far to get them'; 'grandma don't have'). Core facilitators included suggestions, i.e. 'make a garden and plant vegetables'; 'tell your friends to eat healthy'.

Conclusions: Barriers and facilitators are dissimilar for individual food groups, suggesting that dietary interventions should target reduction of barriers and promotion of facilitators specific to individual food groups recommended by the DGA.

Keywords: American-Indian children; Barriers and facilitators; Dietary Guidelines for Americans; Nominal group technique.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Child
  • Child Behavior* / ethnology
  • Child Nutritional Physiological Phenomena* / ethnology
  • Culturally Competent Care
  • Diet / adverse effects*
  • Diet / economics
  • Diet / ethnology
  • Family Characteristics / ethnology
  • Female
  • Food Preferences / ethnology
  • Food Supply / economics
  • Group Processes
  • Humans
  • Indians, North American
  • Male
  • North Dakota
  • Nutrition Policy*
  • Patient Compliance* / ethnology
  • Residence Characteristics
  • Rural Health* / economics
  • Rural Health* / ethnology