A photovoice study exploring perceptions of healthy eating, nutrition and healthy ageing in older Black African adults in the United Kingdom

A healthy diet is a key determinant of healthy ageing (1) . Research indicates that individuals from Black African communities (both born in the UK and migrants communities) often have bicultural dietary patterns including both Westernised and African dietary practices (2) . While this is known for the general Black African adult population, there remains a dearth of research on older African adults who may experience a complex nutrition landscape owing to an interplay of perceptions of healthy/unhealthy diets, social and cultural factors which can have negative outcomes for nutrition and health in later life. The aim of this study was to explore perceptions of eating well and healthy diets as determinants of inequalities in nutrition and healthy ageing in older African adults. A mixed methods cross-sectional study was conducted in older Africans, ≥ 55 years in the UK. Qualitative data was collected using Photovoice (3) , an innovative visual, community-based participatory research (CBPR) method whereby participants take photographs to document, reflect upon health and social issues from their own perspective. As a research method, photovoice provides an alternative to the traditional barriers and enablers approach to understanding complex health challenges and is suited for use for populations who have been disenfranchised by traditional research methods (4) . A purposive sample of 12 participants were provided with cameras and encouraged to take photos describing what they considered as healthy and unhealthy food and thoughts on eating well and older adult’s health. Semi-structured interviews were conducted to gain insights into the photos. Thematic analyses using both deductive and inductive approaches of photos and transcripts were conducted to develop and refine emerging themes using a framework. Participants were 62 ± 5.4 years and, 75% female. The majority were married (58.3%), living with family (41.7%), educated to postgraduate degree level (50.0%) and fulltime employed (66.7%). Emerging themes around healthy eating included variety and dietary diversity, organic foods, traditional foods, plant-based foods and healthy cooking methods. Themes around unhealthy food included ultra-processed foods, take-out foods, appearance, preservatives and consuming fats and oils. Hydration, social eating, accessing health and dietary advice, eating food that meets ageing needs, nostalgic eating and physical activity were the key themes that emerged around eating well and older adults’ health. This research provides new insights on perceptions of healthy eating among older African adults using photovoice, a novel participatory research method. The findings contribute to a better understanding of perceptions of healthy diets as a determinant influencing nutrition and healthy ageing in older African adults. There is a need for further research to understand i) how these perceptions influence dietary intake and ii) the complex interactions in nutritional knowledge, tradition, cultural and social factors to inform the design of effective community-based nutrition intervention tailored to ethnic identity of older African adults.