Culturally tailored support to enhance DASH diet adherence in midlife and older African American women

Abstract

Objective: This qualitative study examined the cultural food preferences and resources of African American women with self-reported hypertension to guide the development of a culturally tailored Dietary Approaches to Stopping Hypertension (DASH) manual.
Methods: Eleven women from a church congregation in the Southwest United States participated in two focus groups. Transcripts were analyzed using content analysis with independent coding and consensus validation.
Results: Six themes and four subthemes emerged: (1) providing perspectives on diet among older African American women; (2) understanding awareness and education needs regarding the DASH diet with subthemes of nutrition-skills and literacy-level adaptation; (3) community disparities in access to healthy foods with subthemes of affordability and nutrition and thrifty nutrition; (4) navigating tradition by addressing challenges of southern cooking heritage; (5) exploring the use of diverse home appliances in meal preparation;and (6) enhancing the DASH manual with tailored insights.
Conclusions: Findings emphasize the need for culturally tailored, literacy-sensitive, and resource-conscious materials to promote DASH adherence. A tailored manual may reduce structural and cultural barriers, improve dietary practices, and address hypertension disparities among African American women.

Keywords

African American women / Culturally tailored intervention / Dietary adherence / DASH diet / Food access / Health disparities / Hypertension / Qualitative research

References

[1] Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/ AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension [Internet]. 2025. Available from: https://www.ahajournals.org/doi/10.1161/HYP.0000000000000249https://www.ahajournals.org/doi/10.1161/HYP.0000000000000249

[2] Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association. Circulation [Internet]. 2023 Feb 21; 147(8). https://doi.org/10.1161/CIR.0000000000001137

[3] Hines AL, Zare H, Thorpe RJ. Racial Disparities in Hypertension Among Young, Black and White Women. J Gen Intern Med [Internet]. 2022 June; 37(8): 2123-5. PMid:34472018 https://doi.org/10.1007/s11606-021-07073-0

[4] Abrahamowicz AA, Ebinger J, Whelton SP, et al. Racial and Ethnic Disparities in Hypertension: Barriers and Opportunities to Improve Blood Pressure Control. Curr Cardiol Rep [Internet]. 2023 Jan; 25(1): 17-27. PMid:36622491 https://doi.org/10.1007/s11886-022-01826-x

[5] Jones HJ, Sternberg RM, Janson SL, et al. A Qualitative Understanding of Midlife Sources of Stress and Support in African-American Women. J Natl Black Nurses Assoc. 2018; 27(1): 24-30.

[6] Kalinowski J, Kaur K, Newsome-Garcia V, et al. Stress interventions and hypertension in Black women. Womens Health. 2021; 17: 1-14. PMid:34254559 https://doi.org/10.1177/17455065211009751

[7] Groves A, Gipson-Jones T, Montgomery AJ, et al. Low-Sodium Dietary Perceptions and Experiences of African American women with Hypertension. J Natl Black Nurses Assoc. 2020 July; 31(1): 47-52.

[8] Okoro ON, Hillman LA, Cernasev A. Intersectional invisibility experiences of low-income African-American women in healthcare encounters. Ethn Health [Internet]. 2022 Aug 18; 27(6): 1290-309. PMid:33734922 https://doi.org/10.1080/13557858.2021.1899138

[9] U.S Department of Health and Human Services; National Institutes of Health;National Heart, Lung and Blood Institute. Your Guide to Lowering Your Blood Pressure with DASH. 2006; 1-55.

[10] Wright KD, Klatt MD, Adams IR, et al. Mindfulness in Motion and Dietary Approaches to Stop Hypertension (DASH) in Hypertensive African Americans. J Am Geriatr Soc [Internet]. 2021 Mar; 69(3): 773-8. PMid:33227157 https://doi.org/10.1111/jgs.16947

[11] Krueger RA, Casey MA. Focus groups: A practical guide for applied research. 5th ed. Thousand Oaks, California: Sage Publications; 2015.

[12] Tracy SJ. Qualitative research methods. United Kingdom: Wiley-Blackwell; 2013.

[13] Liamputtong P. Thousand Oaks, Focus group methodology: Priniciple and practice. California: Sage Publications; 2011. https://doi.org/10.4135/9781473957657

[14] Creswell JW, Creswell JD. Research design: Qualitative, quantitative, and mixed methods approaches. 5th ed. Thousand Oaks, California: Sage Publications; 2018.

[15] Merriam SB. Qualitative research: A guide to design and implementation. San Francisco, CA: John Wiley & Sons; 2009.

[16] Thomas E, Magilvy JK. Qualitative rigor or research validity in qualitative research. J Spec Pediatr Nurs. 2011; 16(2): 151-5. PMid:21439005 https://doi.org/10.1111/j.1744-6155.2011.00283.x

[17] Denzin NK, Lincoln YS. The Sage handbook of qualitative research. 3rd ed. Thousand Oaks, California: Sage Publications; 2005. 1210 p.

[18] Liamputtong P. Focus group methodology: principles and practice. London: SAGE Publications; 2011. https://doi.org/10.4135/9781473957657

[19] Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs [Internet]. 2008 Apr [cited 2015 Aug 10]; 62(1): 107-15. PMid:18352969 https://doi.org/10.1111/j.1365-2648.2007.04569.x

[20] Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study: Qualitative descriptive study. Nurs Health Sci [Internet]. 2013 Sept [cited 2015 Aug 10]; 15(3): 398-405. PMid:23480423 https://doi.org/10.1111/nhs.12048

[21] Peek ME, Harmon SA, Scott SJ, et al. Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes. Transl Behav Med [Internet]. 2012 Sept; 2(3): 296-308. PMid:24073128 https://doi.org/10.1007/s13142-012-0125-8

[22] Winham DM, Knoblauch ST, Heer MM, Thompson SV, Der Ananian C. African-American Views of Food Choices and Use of Traditional Foods. Am J Health Behav [Internet]. 2020 Nov 1; 44(6): 848-63. PMid:33081881 https://doi.org/10.5993/AJHB.44.6.9

[23] Baker EA, Barnidge EK, Schootman M, et al. Adaptation of a Modified DASH Diet to a Rural African American Community Setting. Am J Prev Med [Internet]. 2016 Dec [cited 2025 Sept 16]; 51(6): 967-74. PMid:27633485 https://doi.org/10.1016/j.amepre.2016.07.014

[24] Ibe CA, Haywood DR, Creighton C, et al. Study protocol of a randomized controlled trial evaluating the Prime Time Sister Circles (PTSC) program’s impact on hypertension among midlife African American women. BMC Public Health [Internet]. 2021 Dec; 21(1): 610. PMid:33781228 https://doi.org/10.1186/s12889-021-10459-8

[25] Farmer N, Powell-Wiley TM, Middleton KR, et al. A community feasibility study of a cooking behavior intervention in African-American adults at risk for cardiovascular disease: DC COOKS (DC Community Organizing for Optimal culinary Knowledge Study) with Heart. Pilot Feasibility Stud [Internet]. 2020 Dec; 6(1): 158. PMid:33088581 https://doi.org/10.1186/s40814-020-00697-9

[26] Joo JY, Liu MF. Effectiveness of Culturally Tailored Interventions for Chronic Illnesses among Ethnic Minorities. West J Nurs Res [Internet]. 2021 Jan; 43(1): 73-84. PMid:32400300 https://doi.org/10.1177/0193945920918334

[27] Odoms-Young A, Brown AGM, Agurs-Collins T, et al. Food Insecurity, Neighborhood Food Environment, and Health Disparities: State of the Science, Research Gaps and Opportunities. Am J Clin Nutr [Internet]. 2024 Mar; 119(3): 850-61. PMid:38160801 https://doi.org/10.1016/j.ajcnut.2023.12.019

[28] Lofton S, Kersten M, Lubimbi N, et al. How community capacity building in urban agriculture can improve food access in predomi-nantly Black communities. J Community Pract [Internet]. 2022 Oct 2; 30(4): 395-417. https://doi.org/10.1080/10705422.2022.2138667

[29] Sharpe PA, Liese AD, Bell BA, et al. Household food security and use of community food sources and food assistance programs among food shoppers in neighborhoods of low income and low food access. J Hunger Environ Nutr [Internet]. 2018 Oct 2; 13(4): 482-96. PMid:30854155 https://doi.org/10.1080/19320248.2017.1364188