Environmental, Social, and Structural Constraints for Health Behavior: Perceptions of Young Urban Black Women During the Preconception Period-A Healthy Life Trajectories Initiative

J Nutr Educ Behav. 2019 Sep;51(8):946-957. doi: 10.1016/j.jneb.2019.04.009. Epub 2019 May 15.


Objective: Obesity and noncommunicable disease are rapidly increasing in sub-Saharan Africa. Prevention efforts are critical, particularly for women before conception to maximize intergenerational effects. The authors sought to examine perceptions of health and everyday factors that influenced nutrition, exercise, and other health behaviors to inform a novel community preconception intervention.

Design: Four focus groups, each with 6-10 participants, were conducted using semistructured interview guides.

Setting: Urban Soweto, South Africa.

Participants: Young nulliparous women aged 18-24 years were recruited using snowball sampling.

Phenomenon of interest: Health behaviors of young women and barriers and facilitators to these behaviors.

Analysis: After inductive thematic analysis, data were further interpreted within the theoretical framework of the Behavior Change Wheel.

Results: The data suggested an obesogenic environment in which structural and social factors strongly influenced young women's health choices and limited their capacity for behavior change.

Conclusions and implications: Community interventions to improve young women's diet, physical activity, and health should recognize (1) the home and social contexts as a source of both role models and barriers to change, (2) the current normalization of obesity, and (3) contextual issues of safety and violence within the community. Understanding young women who overcome these barriers could be beneficial.

Keywords: body size; diet; exercise; food; health behavior.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Black People / statistics & numerical data*
  • Diet / methods
  • Exercise
  • Female
  • Focus Groups
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Interviews as Topic
  • Overweight / prevention & control
  • Residence Characteristics*
  • Social Environment*
  • Socioeconomic Factors
  • South Africa
  • Urban Population / statistics & numerical data*
  • Young Adult

Grants and funding