R E S E A R C H A RT I C L E

Personal and Family Food Choice Schemas of Rural Women in Upstate New York
C H R I S T I N E B L A K E , MS, RD; C A RO L E A. B I S O G N I , P H D
Division of Nutritional Sciences, Cornell University, Ithaca, New York

ABSTRACT

INTRODUCTION The involvement of many factors in food choice is well recognized, but the different ways in which individuals make food choices in various roles and contexts are poorly understood.1,2 An exploration of cognitions related to food choice in different social and physical settings could provide useful information for programs designed to promote changes in food choice behaviors.3,4 In interpretivist studies, investigators focus on participants perspectives. Researchers venture outside preconceived beliefs for participants to tell their own stories.5 Recent interpretivist studies have resulted in multiple perspective and life course models of food choice that consider the ecological, sociological, psychological, cultural, and life experience factors that influence food practices.6-8 These models are based on qualitative, in-depth interviews with adults and attempt to explain the factors and processes involved in food choice from the perspectives of the interview participants. These models depict a persons food choices as resulting from his or her life course events and experiences, current physical and social environments, ideals, personal factors, and resources. These factors serve to shape the personal food system in which individuals mentally construct the options, trade-offs, rules, and routines for eating in daily life.7,8 These mental processes include negotiations among food choice values such as sensory perceptions, monetary considerations, convenience, managing social contexts, and physical well-being; personal definitions for healthful eating; classication of foods and eating situations; and balancing priorities across personally meaningful timeframes.4,9-11 These studies demonstrate the complexity of the mental processes that guide food choice behaviors and stress that further research is needed to explain the intricacies of the processes.9 Although these models recognize the importance of social context and managing social relationships in food choice,7,8 they have not attended to the cognitive processes that a person may use in food choice depending on the persons role as an eater or a provider of foods for others.8,12 Other interpretivist studies of food choice have indicated that identities and roles must be considered when trying to
282

Objective: The purpose of this study was to gain conceptual understanding of the cognitive processes involved in food choice among low- to moderate-income rural women. Design: This interpretivist study used grounded theory methods and a theory-guided approach. Participants/Setting: Sixteen women aged 18 to 50 years from varied household compositions were purposively recruited in an upstate New York rural county. Methods: Semi-structured interviews were conducted. Verbatim transcripts were analyzed using the constant comparative method. Results: Study participants held both personal and family food choice schemas characterized by food meanings and behavioral scripts. Food meanings encompassed self-reported beliefs and feelings associated with food. Food choice scripts described behavioral plans for regularized food and eating situations. Five personal food choice schemas (dieter, health fanatic, picky eater, nonrestrictive eater, inconsistent eater) and 4 family food choice schemas (peacekeeper, healthy provider, struggler, partnership) emerged. Conclusions and Implications: The ndings advance conceptual understanding of the cognitive processes involved in food choice by demonstrating the existence of different food choice schemas for personal and family food choice situations. Further study is needed on food choice schemas in different populations in various food and eating situations. KEY WORDS: food choice, schema, rural women, qualitative
(J Nutr Educ Behav. 2003;35:282-293.)

This project was supported by funds (Special Needs Grant #94-34324-0987) from the Cooperative State Research, Education and Extension Service, US Department of Agriculture, to the Division of Nutritional Sciences at Cornell University. Address for correspondence: Christine Blake, MS, RD, Division of Nutritional Sciences, 335 Martha Van Rensselaer Hall, Cornell University, Ithaca, NY 14853; Tel: (607) 255-3435; Fax: (607) 255-0178; e-mail: cey2@cornell.edu. 2003 SOCIETY FOR NUTRITION EDUCATION

Journal of Nutrition Education and Behavior Volume 35 Number 6

November December 2003

283

understand food choice,11,12 and schema theory13-17 was recommended as a way to understand how people manage their identities and roles in eating.11 According to Olson, research on food schemas is important because much of the intersubject variation in food choice is due to the effects of different knowledge structures on perceptual processing.13 In addition, greater understanding of knowledge structures can help food and nutrition researchers develop more effective nutrition education messages.17 Schema theory has roots in cognitive anthropology,18 cognitive psychology,19-23 articial intelligence, and linguistics.24 People have many highly context-specific schemas related to various domains, including food choice, that serve to organize and provide coherence to perceptions.13 Food choice schemas consist of long-term, enduring personal knowledge structures that contain hierarchically arranged classication systems of food meanings.These include beliefs about food and affects related to food (such as attitudes and feelings) triggered in response to certain foods or eating situations and situational food choice scripts that guide behavior.13,14,17 Food choice scripts are the organized knowledge people hold regarding a particular situation and the way events in that situation unfold.20,21 At the level of food and eating, these are the plans that people have for familiar food and eating situations. An individual makes personal sense of life course events and experiences through the process of interpretation guided by existing schema structure and content.21,22,25 These schemas are continually modied in response to new foodrelated experiences or information.17,26 To make sense of new experiences or information, people draw on existing knowledge stored in memory and combine it with coded incoming information leading to maintenance or modication of personal knowledge structures. Modifications in structure and content of the schema may inuence behavior change through changes in behavioral scripts.13,17 Prior applications of schema theory to food and nutrition issues have primarily concentrated on the area of eating disorders.14-16,27-31 The identification and understanding of weight-related schemas16,30 and food-related schemas14,29 have been cited as signicant to the treatment of eating disorders such as bulimia and anorexia nervosa. Other areas of application related to nutrition and health include novel food schema,32 food classification,33 beliefs in health anxiety,34 food acceptance,13 and exercise schemas.35 The existing food choice literature includes limited information from the perspectives of rural women, particularly those with low incomes, who are difficult for researchers to access. Studies of other populations of women have reported that life stage influences womens motives for preventive dietary behavior because of womens changing perceptions of health status, body weight, and social roles.36 Social roles shape womens attitudes and beliefs about personal nutrition care and can be both a positive and a negative inuence on preventive dietary behaviors, varying according to changing interpretations of family roles at different life stages.37

A disproportionate number of female-headed households experience chronic poverty and its deleterious effects, predisposing them to risk of poor nutritional status.38 Studies comparing rural and urban women show that rural women live in poverty in greater numbers,39 generally have less formal education,40 and are at higher risk for food insecurity.41 Women of lower socioeconomic status have been shown to be at risk for lower intakes of fruits and vegetables,42,43 and for rural women, availability of all food categories declines as food insecurity worsens.44 Food insecurity has been related to disordered eating behaviors,44 and low-income women often skip a meal to provide more food for their children.45 Understanding the cognitive processes involved in food choice in this population is particularly important, considering their overall vulnerable position in society and their potential impact on the health status of other family members. This study was designed to gain conceptual understanding of the cognitive processes involved in food choice in various situations among low- to moderate-income women living in a rural area.The study was part of a larger investigation designed to understand the perspectives on food and eating of rural women with low to moderate incomes.46

METHODS This interpretive investigation used a combination of grounded theory methods 47,48 and a theory-guided approach,49 a research approach used in previous studies of food choice.5,7,9,50 Grounded theory methods were used to ensure that the resulting theory was inductively derived and was grounded in the participants real-life experiences. A theory-guided approach allowed the researchers to use existing theoretical frameworks to inform data collection and analysis and to compare the emerging conceptual model with existing theories.49 Three convenience sampling strategies, including purposive, opportunistic, and snowball sampling, were used to ensure adequate recruitment because this population is typically difficult to access.Women were deemed eligible for the study if they were 18 years of age or older, of low to moderate income and education, living in the dened geographic region, reported current or prior eligibility for social welfare programs such as food stamps, and identied themselves as the household food manager.Ten participants were recruited through referrals made by a local family social service organization, 2 through opportunistic sampling, and 4 through snowball sampling. Recruitment stopped when analysis of the data from 16 women indicated that theoretical saturation had been achieved and that new informants would not add new analytical insights.51 Prospective participants were asked questions about their choices, preferences, feelings, and childhood experiences related to food and that of their families. They were also asked to provide demographic information, including age, income, education, household composition, marital status,

284

Blake and Bisogni/FOOD CHOICE SCHEMAS OF RURAL WOMEN IN UPSTATE NEW YORK

and social welfare program eligibility. Participants were all white and ranged in age from 18 to 50 years, with a mean age of 32 years. Household incomes ranged from less than $5000 to more than $50 000 per year, with 11 participants reporting incomes of less than $26 000 per year. Participants education levels ranged from 8 to 17 years. Eleven participants reported 12 years or less of education, with 5 participants completing 10 years or less. Thirteen participants had children ranging in age from 6 months to 14 years old, and one participant had an adult son who lived with her and her husband.Two participants had no children.Thirteen participants were married or had partners; 2 were separated or divorced, and 1 was single. In addition, 2 of the participants had elderly or disabled individuals living with them. Four of the participants had grown up in alternative living situations, including foster care, group homes, or relatives other than parents. Eleven of the participants had lived locally all of their lives and had never lived in a metropolitan area. All of the others had grown up in rural areas and had moved to the area as teenagers or adults (Table 1). The university committee on human subjects reviewed and approved the research protocol. Open-ended, in-depth interviews lasting 30 to 120 minutes were conducted in locations chosen by the participants. Follow-up interviews were conducted with 9 of the 16 participants to gain clarication and elaboration on some information provided during the rst interview. A semistructured interview guide was used in all interviews (Table 2). The Food Choice Process Model8 and the Life Course Model of Food Choice6,12 provided constructs to guide the interview protocol.The questions were adapted to each persons situation, and the interviewer probed for more detail as relevant themes emerged in the conversation. Topics included food

preferences, food roles, upbringing, fruits and vegetables, conict management, eating inuences, educating children, health denitions, eating locations, others food habits, cultural values, environmental inuences, and food identity. All interviews were audiotape recorded and transcribed verbatim. Immediately after each interview, eld notes were completed to record a summary of the interview, visual observations, a description of the setting, and any relevant observations that may not have been captured on tape.The information was used during analysis to aid the researchers memory and to provide a context for the transcribed interview. Participant observation was carried out at food shopping centers, restaurants, and community events. Conversations about food were elicited when opportunities arose.These participant observations allowed for contact with local residents and retailers in natural settings. Flyers and advertisements for upcoming events related to food, takeout menus from local food establishments, the local newspaper, and restaurant menus were reviewed for food availability. Field notes were recorded after each experience with attention to themes of food availability and food meanings. These observations strengthened understanding of the community and were used in the development of interview questions during the early stages of the investigation. Participant observations conducted throughout the course of the study provided additional data, which were used to rene interview question probes.48 The data analysis reported in this article about the cognitive processes involved in personal and family eating was part of a larger analysis focused on developing a theoretical understanding of the factors and processes involved in the participants food choices. Data analysis began with a review of transcripts for emerging categories, themes, and relationships between these categories and themes. Coding of the

Table 1.

Participants Descriptions, Personal Food Choice Schema Typologies, and Family Food Choice Schema Typologies Marital Status Partner Single Married Separated Married Partner Married Partner Married Divorced Partner Partner Married Married Married Married Years of Education 12 17 12 10 10 10 8 9 13.5 13.5 12 12 13.5 10 16 12 Household Size 4 4 3 4 5 4 5 5 5 2 5 5 5 5 5 3 Household Income, $ $15 000 > 50 000 15 000 15 000 7500 35 000 10 000 Declined 25 000 < 5000 25 000 15 000 25 000 45 000 > 50 000 15 000 Personal Food Choice Schema Nonrestrictive Nonrestrictive Picky eater Dieter Nonrestrictive Inconsistent Picky eater Health fanatic Picky eater Picky eater Nonrestrictive Inconsistent Picky eater Picky eater Health fanatic Dieter Family Food Choice Schema Peacekeeper Partnership Partnership Struggler Partnership Peacekeeper Peacekeeper Healthy Provider Peacekeeper Struggler Peacekeeper Healthy Provider Peacekeeper Partnership Healthy Provider Peacekeeper

Participant 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Age 18 21 25 25 26 26 26 30 32 32 34 37 38 43 45 50

Journal of Nutrition Education and Behavior Volume 35 Number 6

Table 2. Guide 1. Can you describe the foods that you usually eat? Give me an example of a typical day. Are all the days the same? Probes: days off work, weekends, holidays, seasons. What foods do you never eat? Why? What foods do you tend to eat most often? Why? Have you always eaten this way? How much has your upbringing influenced what you eat? In what ways has the way that you eat changed over the years? Specific foods? Do you see yourself influencing how others eat? How do you influence what others eat? How do other people influence what you eat? Tell me about a typical dinner? Who prepares it? Who decides what will be served? What are these decisions based on? Probes: preferences of others in the household, selfpreference, health considerations (whose?). Tell me about a typical meal with friends or relatives. Where do you usually eat? If at home, where else do you eat besides home? When you eat at ___________, do you choose foods differently than you might at home? Probes: When you eat at home versus when you eat at someone elses house or a restaurant? What kinds of foods? How do you decide on what foods to choose in these different types of situations? How does the way that you eat compare with others that you know? In your family? Coworkers? Someone from another place? Can you please complete the following statements? Im not a____________ eater. I am a _______________eater. What type of eater would other people say that you are? Probes: husband, daughter, mother, etc. Selected Questions from the Semi-structured Interview

November December 2003

285

2. 3.

ings, and food choice scripts were suitable labels for the common sets of cognitions that emerged in the data. Several steps were taken to ensure the credibility of the ndings, including peer debrieng, member checks, advisor consultations, audit trails, prolonged engagement, data triangulation, and the researchers experience.48 Throughout the analysis, the groupings of participants were checked against all cases in an iterative process, and the researchers modied the groupings until they represented all cases.47,48 RESULTS Personal Food Choice Schemas Five personal food choice schemas emerged from the analysis, including dieter,health fanatic,picky eater,nonrestrictive eater, and inconsistent eater.Table 3 presents the food meanings and scripts associated with each personal food choice schema. Dieters. The two dieters reported dieting for most of their lives and explained that weight loss diets and binging and purging behaviors had become part of their everyday way of eating. One woman explained her experiences with dieting over the years: I thought I was a horse at 95 pounds, I thought I was huge, but I look back on the pictures now, and Im like, oh gosh! If I could only be like half of that now. Ive been dieting, for 7 years I gained 100 pounds when I was pregnant. I mean I was 95 pounds, I was a little tiny thing, and now Im really pissed I couldnt get it off, so hopefully this Zone thing [diet] will work; otherwise, you know, Ill just die. The dieters stated that their focus on weight interfered with their daily lives:So the more you make yourself throw up or whatever, the more nauseous you are all the time, and its really hard to take care of kids when youre nauseous all the time. These women conceptualized foods in terms of their potential to promote or inhibit weight gain, with little emphasis given to other qualities of a food, such as healthfulness. Health fanatics. The two health fanatics expressed devotion to making sure that they were eating healthfully. They described themselves with statements such as I think Im a healthy eater or Ive always been more health food, health fanatic. Personal eating for these women involved health maintenance and disease prevention.They were conscious of the link between diet and disease and expressed confidence in their personal ability to maintain health through food choices: I like every vegetable and just about every fruit. Theyre healthy, I thrive on the healthy part of it, I guess. Cancer runs in the family and stuff too, so its scary. So Im trying to stay as healthy as I can. Especially getting older I try to maintain a healthier diet, just for that purpose.

4.

5.

6. 7.

8.

9.

*Adapted from previous studies.6,8,11

data was ongoing and included open, axial, and selective coding.47,48 Using a constant comparative approach, the list of categories was considered saturated when analysis of new data did not yield additional categories.48 When analysis revealed that personal eating situations, family eating situations, and the cognitive processes related to food and eating were important themes in the data, these themes became the focus of the analysis. Because cognitions related to food and eating seemed to inuence food choices, the researcher investigated several related constructs, including locus of control,52 self-efficacy,53 and schema.19 Analysis resulted in descriptions of how the participants conceptualized their food situations, with an emphasis on how women characterized personal versus family food situations. As distinct sets of meanings and scripts for food choice emerged from this analysis, the researchers clustered the women into groups with common sets of meanings and scripts for personal and family food situations. The groups were labeled with the words that the women used to identify their approaches to personal and family food choice. Then, to assist in the interpretation of the cognitive processes being examined in this analysis, the researchers consulted the schema literature.18,19,21-24,26 The researchers determined that personal and family food choice schemas, food mean-

286
Table 3.

Blake and Bisogni/FOOD CHOICE SCHEMAS OF RURAL WOMEN IN UPSTATE NEW YORK
Summary of Food Meanings and Food Choice Scripts in Participants Personal Food Choice Schemas

Personal Food Choice Schema Dieter

Food Meanings Food as enemy Weight loss/control is primary concern Guilt about eating Eating healthy is primary concern Guilt about eating bad foods Food as disease prevention Believe personal eating habits are unhealthy, strange, or abnormal Guilt about personal eating habits Self-conscious eating in front of others Angry if others push foods No guilt about food Limited concern for weight control or health when choosing foods Feel that they are abnormal in their way of eating Food is not a primary concern at this point in life owing to other stressful life events

Food Choice Scripts Starvation Binge/purge behaviors Food quantity restriction Weight loss diet plans

Health fanatic

Avoid junk food Focus on learning about food and health Regularly practice other health behaviors such as exercise Only eat familiar foods Only eat preferred foods Avoid eating in front of child Will not try new foods Will not eat at others houses

Picky eater

Nonrestrictive eater

Eat almost anything Willing to try new foods No set mealtimes or places Quantity of food consumed is not consistent day to day Sometimes particular about what they eat and other times will eat anything

Inconsistent eater

Part of their health maintenance strategies included avoiding or limiting foods they considered junk food or unhealthy and feeling guilty if they gave in to cravings: Once in a blue moon I will buy hot dogs because I will crave them. But thats very seldom.And then I buy the white hot dogs that dont have the sodium nitrate in [them]. I try my hardest to stay away from that stuff. Its really hard to just alway stay away from it. The health fanatics had life experiences similar to those of dieters, such as divorce, nancial difficulties, and struggles with weight; however, they had adopted healthful eating and lifestyle practices in which weight control was not the primary motivator.They attributed their adoption of healthful eating habits to education they had received through formal classes, community programs, or nutrition education materials. Picky eaters. The 6 picky eaters described themselves using statements such as I am a picky eater or Im very choosy in what I eat. These women reported that they believed their diets to be unhealthy overall. They explained that they did not select foods based on health quality and that they had very specic food likes and dislikes on which they would not compromise. One woman described her basis for choosing foods, stating,I wont buy the things that I didnt like. Even though I know that theyre good for me, I wont buy them. The picky eaters felt that they were unique in their eating habits and made statements such as nobody eats like me. They reported that other people found their eating habits to be weird, strange, or abnormal. All picky

eaters explained that others criticized their eating habits, telling them that they were eating incorrectly or should be willing to try different foods. These women reported that because of prior criticism, they avoided eating in front of other people: So, if Im at somewhere else, I dont eat. I just dont like eatin at other peoples houses. Havin them look at me while Im eatin. The picky eaters expressed dissatisfaction with their eating habits, explaining, Im not a very good eater and I wish I wasnt so picky. They explained that part of their dissatisfaction was related to concern for their influence on their childrens eating habits and that they verbally instructed their children not to eat like them. They also reported that they often avoided eating in front of their children. Most picky eaters attributed their choosiness to specic events in childhood that had turned them off certain foods. In many cases, these women were unwilling to try the offending food again regardless of the circumstances. One woman explained her dislike for sh:I found a bone in my sh patty [as a child]. So, that right there. Forget it! No sh! Nonrestrictive eaters. The 4 nonrestrictive eaters were very different from the picky eaters in the way in which they conceptualized food and made food choices.They described themselves using statements such as I am not a picky eater and I am a big eater. These women explained that they would eat what was available to them, often overeating. One woman said,I eat a lot. I do eat a lot! The nonrestrictive eaters did not make food choices for health or dieting reasons, and they were relaxed about when, what, and where they ate. They described themselves as

Journal of Nutrition Education and Behavior Volume 35 Number 6

November December 2003

287

average in their eating habits and were able to identify individuals whom they saw as either more or less health conscious than themselves. These participants expressed some dissatisfaction with their tendency to overeat and a desire to be more restrained. One woman explained that she tried to go on a diet but was unable to because she did not like to restrict what she ate:I went on Slim Fast for a while.Tried to lose weight. Over a couple of weeks, I just decided I like to eat better. Inconsistent eaters. The two inconsistent eaters reported no patterns related to food and eating.They reported some periods of low appetite and food aversion, with little food intake alternating with other periods of high appetite, food cravings, and overeating. One woman explained how her hunger directed her eating practices: I am not a consistent eater. Oh, I could go days. I am one of these people that eat when Im hungry. Ill always eat dinner. But like theres some days where I will eat during the day constantly. Im like starving! And then theres other days where, even at dinner, Im not very hungry. My system will tell me when Im hungry. These women believed that they did not eat normally and that the other people around them were more normal in their eating habits. However, inconsistent eaters described acute stressful life events that were occupying a great deal of their physical, emotional, and mental energy. One participant with a seriously ill mother reported that food might be more important to her under different circumstances. A mother of a chronically ill young child said that she was able to ensure that her family ate well but that her own food practices had become inconsistent since her child became ill. Both women explained that when life situations were not so stressful, they were much more conscious of what, how, and when they ate.

These women expressed concerns about the example that they were setting for their children that were similar to the concerns of the picky eaters. One woman said,I have no set eating patterns, and, God knows, I hope this kid never eats like I do. Family Food Choice Schemas The analysis of responses related to family food situations resulted in the identification of 4 different food choice schemas: peacekeeper, healthy provider, struggler, and partnership. A summary of the food meanings and food choice scripts associated with each family food choice schema is presented in Table 4. Peacekeepers. The 7 peacekeepers explained that they accommodated the preferences and demands of as many family members as possible, often regardless of their own preferences or needs.Their ultimate goal at mealtimes was to keep people happy and not cause any conicts. These women said that they often prepared more than one type of main dish at meals to satisfy all other family members. However, in these cases, the women usually did not change their own eating habits and preferences but found ways to meet their own needs without compromising the needs and preferences of the other family members involved. So if were not all together, I might cook two meals, one for my son and one for my husband, and then cook whatever I cook for my husband for my older son when he gets home from basketball. Depending on my mood, I might eat some of that, or I might just forget it. Ill serve them what I think they want and what they need, and if I dont like it, Ill choose something else. These women also reported that they did not force children to eat foods. At the most, they would ask the child to

Table 4.

Summary of Food Meanings and Food Choice Scripts in Participants Family Food Choice Schemas

Family Food Choice Schema Peacekeeper

Food Meanings Primary concern is to avoid conflict Own needs and preferences are secondary

Food Choice Scripts Accommodate needs and preferences of others Satisfy own needs and preferences only after those of others satisfied Provide alternatives Careful organization of all food activities Keep track of what family members eat Encourage and enforce healthy eating habits of family members Use social welfare system to obtain food for extended periods of time Use alternative free food sources Purchase processed and takeout foods to make up for lack of food preparation skill/ability Share responsibility for shopping and cooking with other family members Pool household financial resources to obtain food

Healthy provider

Primary concern is health quality of foods Health quality of family food choices reflect quality of care (parental/spousal/other) Primary concern is to obtain adequate quantities of food Feelings of inadequacy and inability with food preparation and budgeting financial resources

Struggler

Partnership

Primary focus is fair distribution of family food choice activities Ultimately feel responsible for food-related activities Limited enjoyment of cooking/prefer to have others cook Satisfaction with shared food provider role

288

Blake and Bisogni/FOOD CHOICE SCHEMAS OF RURAL WOMEN IN UPSTATE NEW YORK

try a food, but they would provide an alternative if the child continued to refuse the food:[I make] what [my son] wants, cause he wont eat it, and if it gets to be the point where I really want that, I would make that for myself and x him something so we dont ght about it. Healthy providers. The 3 healthy providers focused on the health benefits and consequences of foods when they explained how they fed their families. They believed that the foods they provided influenced the current health of their family members and would establish healthful eating habits for later life. One woman described how she fed her family: The apples, the oranges, you know, the vitamin C, its just I kind of believe that kind of stuff cut down on the colds, cut down on the illnesses. I guess food is one of the things that you really believe is gonna help [kids] be healthy. And I really believe that. These women described being very aware of what other family members ate, including extended family members. One healthy eater explained, Oh, I totally keep track of what everybody eats.Although they did not force foods on their spouses and partners, these women were more concerned about promoting healthful eating than minimizing conflict and encouraged their spouses and partners to adopt healthful eating habits. One healthy eater explained how she influenced her spouse, stating,I think Ive changed my husbands eating habits. Like, he turned vegetarian a number of years after I was. Another healthy eater said, Well, its not good for [my husband] either.You know, all this old adage about organ meat is not so good, thats Organ meat is not good for you. It is very high in cholesterol. You know, it is horrible for him. So, if he gets it once a year, thats [it]. The healthy providers often compared their childrens eating habits with those of others.These women were often shocked to learn how others ate and what other mothers fed to their children, and they believed that they were doing the right thing. One mother described her reaction to the foods that other children ate: They bring Twinkies! And bring Ho Hos and all this stuff! and all this stuff, that they see on TV and they hear. Some , people must just disregard [it]! I dont know. I thought everybody ate the way that we ate.You know, everybody paid attention in making sure their vegetable was on the table, and their starch was on the table, and their protein was on the table. I thought everybody cooked like that. Its in the Betty Crocker cookbook in the front pages! It tells you right in there, way back 50 years ago! You know, the 4 basic food groups, and what should be on the table for every meal. I thought it was common knowledge! The healthy providers reported that they avoided things that they considered to be junk food and discouraged other family members from eating these types of foods by limiting

the household supply of such items. Because of their unwillingness to provide such foods to family members, others often criticized them and called them fanatical. One woman stated,[My mother] thinks Im a fanatic about what my kids eat because I dont buy chocolate, I dont buy candy. Strugglers. The two strugglers reported dealing with chronic, difficult nancial and social situations. They were unemployed, with limited incomes, and trying to raise young children on their own.The strugglers often discussed food in terms of what they could afford and the strategies that they employed to ensure that their children would be fed. They relied on social welfare services such as food stamps, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and food pantries to obtain enough food for themselves and their children, but this was often difcult. For these women, food was primarily thought of in terms of affordability: I have to be very picky about the food that I choose to buy. Because I have to remember its only for Joseph and I, and I only get 85 dollars a month in food stamps, and I try not to go over that amount because during the month I have to go out and buy milk. And my food stamps have to help me with that because its too expensive. I dont have enough cash to keep buying milk every 2 days, every 3 days, depending on how much milk Joseph and I drink. Both of the strugglers described difficult childhood experiences; they had been raised in alternative living situations in which they had limited exposure to food-related activities. As adults, they found it difficult to provide food for themselves and their children, and they attributed this problem to never learning how to budget money for food or how to cook. One woman explained, I was in foster care in a group home after 10. Thats why I couldnt [cook] or nothing because [the food] was brought from the main [kitchen]. I mean I didnt know how to boil water 7 years ago. The participants who presented the struggler food choice schema described challenging food situations, with a lack of personal resources being a major inuence on their food situations. For the strugglers, providing food was a difficult, confusing, and painful experience. Partnership. The 4 women who presented a partnership family food choice schema had family members or partners who made a significant contribution to all food-related activities, including shopping and cooking. Some of these women described the family partnership as a fend for yourself system in which anyone who was able to cook would provide for himself or herself unless all members of the family were going to eat at the same time. These women explained that they often felt responsible for these activities but were secure in the knowledge that their partners or other family members would contribute a great deal of effort voluntarily on a regular basis.

Journal of Nutrition Education and Behavior Volume 35 Number 6

November December 2003

289

The women who were married described strong relationships with their spouses that involved partnerships in more than just the food activities.Those who were unmarried and living with family explained that within the household, nancial resources were pooled, and everyone made an equal effort in all household tasks. Relationships between Personal and Family Food Choice Schemas Participants personal food choice schemas and family food choice schemas are shown in Table 1 with corresponding demographic information. Few patterns emerged between personal food choice and family food choice schemas. However, one trend that appeared was that both health fanatics were also healthy providers. In addition, the participant who presented a healthy provider family food choice schema and an inconsistent personal food choice schema explained that she used to be a healthy eater and that she was currently inconsistent in her personal eating habits owing to stress. Under different circumstances, she may have presented a health fanatic food choice schema.

Conceptual Model The Figure presents the conceptual model that emerged from this analysis for the role of food choice schemas in food choice.At the center of the model are womens personal and family food choice schemas, the cognitive processes that link the many forces shaping food choice to food behavior. A womans personal food choice and family food choice schemas may be very similar or different.The schemas consist of meanings related to food and eating as well as scripts for food choice in different settings. In this study, the womens personal and family food choice schemas were shaped by many forces, including their current resources, social contexts, and personal factors, as well as their life course experiences. Current resources included income and assistance programs, physical and emotional energy to attend to food choice, and knowledge and skills related to food buying and cooking. Social contexts inuencing food choice schemas included parenting and caregiving roles and support from spouses and other household members. Important personal factors were body image and weight concerns, interest and concern for health, and taste preferences. Among

Figure. Conceptual model for role of food schema in linking current situation and shaping factors to food behaviors among low- to moderate-income women living in rural New York.

290

Blake and Bisogni/FOOD CHOICE SCHEMAS OF RURAL WOMEN IN UPSTATE NEW YORK

the life course experiences that were important in shaping food choice were exposure to food preparation in upbringing, specic food episodes resulting in dislikes, and educational experiences related to nutrition.

DISCUSSION This investigation set out to gain a conceptual understanding of the cognitive processes involved in the food choices of low- to moderate-income rural women, a hard to reach population for which information about food choices is lacking.40,54 The use of the grounded theory methods47,48 and a theory-guided approach49 provided the opportunity to build on prior work while merging perspectives from several elds with the perspectives of the participants so that the participants cognitions related to food choice could be understood. The approach and methods allowed for new ideas and relationships to emerge that address the need for creative approaches to understanding food choice.3 Recognizing the role of food choice schemas in personal and family food choice advances understanding of food choice by emphasizing the meanings that people hold about food and how these meanings are linked to situational actions through the scripts that people construct. Meanings have long been recognized as important in food choice,55 but the ways in which meanings are linked with food practices are not well developed. Grounded theory models of food choice recognize some of the cognitive processes involved in food choice, such as the inuences of life course events and experiences, classication of foods and eating situations, negotiation of values, and balancing of priorities.6,8 However, meanings have not been given explicit attention in these models. The study results emphasize that models of food choice have to emphasize the meanings and scripts that clients construct for food choice.This recommendation also emerged in other interpretivist studies of food choice.10,50 A study of food choice among college athletes found that athletes meanings, feelings, and approaches to eating varied in a cyclical pattern throughout the year according to the season of competition.50 A study of how adults living in an urban area of upstate New York conceptualize and manage healthful eating found that individuals denitions of healthful eating and related classications of foods and eating situations were associated with different eating strategies.10 The model that emerged in this study advances conceptual understanding of food choice by recognizing that women have both personal and family food choice schemas and that these schemas may differ in meanings and scripts for food behavior. Existing food choice models do not portray distinctions of this type, although the importance of social relationships and context in shaping situational food choice is recognized.7,8 Other studies of domestic activities related to diet have noted the complexity and variability in relationships, responsibilities, and situations that underlie daily

household food activities,56 but few studies have explored both womens personal approaches to eating and their approaches to providing food for their families as well. An exception is work by Devine and Olson that examined how womens family roles may conict with personal nutrition care.36,37 As indicated by the conceptual model, a host of factors interact in shaping the food choices of the study participants, including resources, social environments, personal factors, and life course experiences.The ndings are similar to prior studies of food choice in different populations.7,8 The finding that women with relatively similar sociodemographic characteristics held different personal and family food choice schemas and different combinations of these schemas demonstrates the importance of psychosocial factors in explaining food behavior. All of the interviewees were white women of low to moderate income from the same rural area. Represented in the data were 5 personal food choice schemas, 4 family food choice schemas, and 10 combinations of personal and family food choice schemas.Very few associations between food choice schemas and sociodemographic characteristics emerged, indicating the variation in the ways in which these women constructed their food choices. In designing this study, the researchers expected the participants rural experiences to emerge as important factors shaping the cognitive processes involved in food choice. However, this could not be inferred from the data. Interviews with individuals from the same sociodemographic group who lived in an urban area may have enabled the rural/urban distinction to emerge. It is also possible that the rural/urban distinction is not as important in shaping cognitions related to food as some other factors, such as education, age, or psychosocial factors. Diversity in the ways in which women approach family food choice was also found in a study of middle-income mothers.57 Some of the family food choice schemas held by the women in this study are similar to those that emerged in Kirk and Gillespies study.57 The healthy provider schema in this study is related to the nutritionist perspective in that study, and the peacekeeper schema in this study is related to their family diplomat perspective. Kirk and Gillespie reported that women in their study used 3 to 5 of the 5 perspectives when making food choices, including other perspectives (meaning creator, economist, and manager/organizer) that did not emerge in our study.57 These perspectives may not have emerged in this study of low- to moderateincome women because of the different historical context and socioedemographic characteristics of the study sample. Several food schemas that the women in this study expressed are consistent with other ndings related to the meanings and approaches that people hold for food and eating in the United States. The dieter personal food choice schema is consistent with the reports of chronic dieting and the wide concern about body image as related to eating in this culture.58 The health fanatic food choice schema is con-

Journal of Nutrition Education and Behavior Volume 35 Number 6

November December 2003

291

sistent with other studies reporting the predominance of health concerns as an influence on food behavior in the United States.59 The picky eater, inconsistent eater, health fanatic, and nonrestrictive eater food choice schemas that emerged in this study are similar to the ndings from a study of identities and eating among middle-income white adults that reported picky, nonrestrictive, health conscious, and inconsistent as words adults used to describe themselves as eaters.11 In the present study, the picky eater and inconsistent eater labels express negative connotations that are consistent with the participants overall description of themselves and their eating habits. The study of identities also reported that being a picky eater had negative connotations, similar to the feelings expressed by the picky eaters in the present study.11 Although this study explored cognitions related to food choice at one point in time, the results demonstrate the dynamic nature of food choice schemas. The inconsistent eaters reported being in a transitional state in terms of food and eating, providing evidence that these food choice schemas are not static phenomena but that they change over time. Previous work on the life course has demonstrated that individuals follow food choice trajectories that often change direction at signicant life stages, such as marriage, personal illness, or retirement.6 One limitation of this study was its small sample of white women from one rural county in New York. The specic types of personal and family food choice schemas that emerged in the study cannot be generalized to the larger population, particularly those of other ethnocultural groups. Although the specic food choice schema labels used in this investigation may not be relevant to other populations, the concept of personal and family food choice schemas that emerged from this research may be useful in understanding food choice in other populations. Another limitation of the study is that the interview guide did not probe comprehensively on participants food schemas because the concepts of personal and family food schema emerged during analysis. Had the interviewer set out to conduct a comprehensive exploration of schema, some other data collection approaches, such as pile sorting and rating scales,60 would have been useful. Finally, this study focused on understanding participants cognitions related to food and eating, and the researcher did not collect food consumption data in a systematic way, such as in food records or dietary recalls for the woman or her family.

level of investigation in the form of food choice schema from which to view the phenomenon. The study results should be helpful to other investigators interested in food choice or the eating practices of rural women. More interpretivist work is needed to examine the nature and operation of food choice schemas in different populations.This work could focus on how food choice schemas develop and change over time by looking at meanings and scripts related to food. Future research could draw on the literature on life course experiences related to food choice,5,11 the acquisition of meanings related to food and eating,55 and the classication of foods and creation of food choice scripts.33 More work is needed on the relationship between food choice schemas and food choice behaviors, and future investigations should incorporate measures of dietary intake. Nutritionists are often expected to develop interventions that promote healthful food choices among low- to moderate-income populations. However, these interventions are frequently ineffective in attracting the attention of those most in need and limited in their ability to promote healthful eating habits.61 Renement of program design and tailoring of messages could improve the quality of such interventions.The results of this study suggest that it is important to distinguish between personal and family food choice schemas. In practice settings, this could be accomplished by adapting nutrition screening and assessment questions to distinguish between family food and personal food.Assessment of an individuals food choice schema in a one-on-one counseling setting could allow the nutritionist to individually tailor nutrition education messages. In group settings, an assessment of food choice schema could be used to set up education classes containing individuals with similar food choice schemas, allowing for more effective tailoring of nutrition education to that particular group. At the population level, an understanding of common cultural schemas or the diversity of schemas within a cultural group could provide valuable information for program planning and message development. For each of these examples, a distinction can be made between family food choice situations and personal food choice situations. Interventions designed to promote change in the individual participant could focus on personal food choice schemas, whereas interventions focused on other family members using the women as gatekeepers could attend primarily to the family food choice schemas. By taking steps to understand food choice schemas, nutritionists might be able to create interventions that are both meaningful to participants and more likely to succeed in fostering adoption of healthful food choices.

IMPLICATIONS FOR RESEARCH AND PRACTICE ACKNOWLEDGMENTS This interpretivist study of the food choices of a sample of low- to moderate-income women living in a rural area contributes new conceptual understanding to the cognitive processes involved in food choice. These results build on existing knowledge about food choice and provide a new This project was supported by funds (Special Needs Grant #94-34324-0987) from the Cooperative State Research, Education and Extension Service, US Department of Agriculture, to the Division of Nutritional Sciences at Cornell

292

Blake and Bisogni/FOOD CHOICE SCHEMAS OF RURAL WOMEN IN UPSTATE NEW YORK
20. Abelson RP. The psychological status of the script. Am Psychol. 1981;36:715-729. 21. Feldman RS. Social Psychology. 2nd ed. Upper Saddle River, NJ: Prentice Hall; 1998. 22. Rumelhart DE. Schema and the cognitive system. In:Wyer RS Jr, Siwl TK, eds. Handbook of Social Cognition. Hillsdale, NJ: Lawrence Erlbaum; 1984: 161-188. 23. Cicchetti D, Toth ST, eds. Emotion, Cognition, and Representation.Vol. 6. Rochester, NY: University of Rochester Press; 1995. 24. Schank R, Abelson R. Scripts, Plans, Goals, and Understanding. Hillsdale, NJ: Lawrence Erlbaum; 1977. 25. Fiske ST,Taylor SE. Social Cognition. 2nd ed. New York, NY: McGrawHill; 1991. 26. Rosch E, Lloyd BB, eds. Cognition and Categorization. Hillsdale, NJ: Lawrence Erlbaum; 1978. 27. Meyer C,Waller G. Subliminal activation of abandonment- and eatingrelated schemas: relationship with eating disordered attitudes in a nonclinical population. Int J Eat Disord. 2000;27:328-334. 28. Spranger SC,Waller G, Bryant-Waugh R. Schema avoidance in bulimic and non-eating disordered women. Int J Eat Disord. 2001;29:302-306. 29. Waller G, OhanianV, Meyer C, Osman S. Cognitive content among bulimic women: the role of core beliefs. Int J Eat Disord. 2000;289:235-241. 30. Fairburn CG, Cooper P. Eating disorders. In: Hawton K, Salkoviskis PM, Kirk J, Clark DM, eds. Cognitive Behaviour Therapy for Psychiatric Problems. Oxford, UK: Oxford University Press; 1989:277-314. 31. Schotte DE, McNally RJ, Turner ML. A dichotic listening analysis of body weight concern in bulimia nervosa. Int J Eat Disord. 1990;9: 109-113. 32. Loewen R, Pliner P. Effects of prior exposure to palatable and unpalatable novel foods on childrens willingness to taste other novel foods. Appetite.1999;32:351-366. 33. Ross BH, Murphy GL. Food for thought: cross-classication and category organization in a complex real-world domain. Cogn Psychol. 1999;38:495-553. 34. Wells A, Hackman A. Imagery and core beliefs in health anxiety: content and origins. Behav Cogn Psychother. 1993;21:265-273. 35. Yin Z, Boyd MP. Behavioral and cognitive correlates of exercise selfschemas. J Psychol. 2000;134:269-282. 36. Devine CM, Olson CM.Womens dietary prevention motives: life stage inuences. J Nutr Educ. 1991;23:269-274. 37. Devine CM, Olson CM. Womens perceptions about the way social roles promote or constrain personal nutrition care. Women Health. 1992;19:79-95. 38. Lichter DT, McLaughlin DK. Changing economic opportunities, family structure, and poverty in rural areas. Rural Sociol. 1995;60:688-706. 39. Richardson H. The health plight of rural women. Womens Health. 1987;12:41-54. 40. Walker LO, Walker ML, Walker ME. Health and well being of childbearing women in rural and urban contexts. J Rural Health. 1994;10: 168-172. 41. Alaimo K, Briefel RR, Frongillo EA, Olson CM. Food insufficiency exists in the United States: results from the Third National Health and Nutrition Examination Survey (NHANES III). Am J Public Health. 1998;88:419-426. 42. Devine C, Wolfe W, Frongillo E, Bisogni CA. Life course events and experiences: association with fruit and vegetable consumption in three ethnic groups. J Am Diet Assoc. 1999;99:309-314.

University. Any opinions, ndings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reect the view of the US Department of Agriculture.The authors thank the study participants for making this possible.

REFERENCES
1. Counihan CM. The Anthropology of Food and Body: Gender, Meaning, and Power. New York: Routledge; 1999. 2. Rozin P.The importance of social factors in understanding the acquisition of food habits. In: Capaldi ED, Powley TL, eds. Taste, Experience, and Feeding. Washington, DC: American Psychological Association; 1990:255-270. 3. Baranowski T, Cullen KW, Baranowski J. Psychosocial correlates of dietary intake: advancing dietary intervention. Annu Rev Nutr. 1999;19: 17-40. 4. Connors M, Bisogni C, Sobal J, Devine C. Managing values in personal food systems. Appetite. 2001;36:189-200. 5. Patton MQ. Qualitative Evaluation and Research Methods. Newbury Park, Calif: Sage Publications; 1990. 6. Devine C, Connors M, Bisogni C, Sobal J. Life course inuences on fruit and vegetable trajectories: a qualitative analysis of food choices. J Nutr Educ. 1998;31:361-370. 7. Falk LW, Bisogni CA, Sobal J. Food choice processes of older adults. J Nutr Educ. 1996;28:257-265. 8. Furst T, Connors M, Bisogni CA, Sobal J, Falk LW. Food choice: a conceptual model of the process. Appetite. 1996;26:247-266. 9. Falk LW, Connors M, Sobal J, Bisogni C, Devine C. Managing healthy eating: definitions, classification and strategies. Health Educ Behav. 2001;28:425-439. 10. Furst TM, Connors M, Sobal J, Bisogni CA, Falk LW. Food classications: levels and categories. Ecol Food Nutr. 2000;39:331-355. 11. Bisogni CA, Connors M, Devine C, Sobal J.Who we are and how we eat: a qualitative study of identities in food choice. J Nutr Educ Behav. 2002;34:128-139. 12. Devine C, Sobal J, Bisogni CA, Connors M. Fruit and vegetable choices in three ethnic groups: interactions of ideals, identities and roles. J Nutr Educ. 1999;31:86-93. 13. Olson JC. The importance of cognitive processes and existing knowledge structures for understanding food acceptance. In: Solms J, Hall RL, eds. Criteria of Food Acceptance. Zurich, Switzerland: Forster Publishing Ltd; 1981:69-81. 14. Cooper M. Cognitive therapy in anorexia nervosa and bulimia nervosa: a review. Behav Cogn Psychother. 1997;25:113-145. 15. Young JE. Cognitive Therapy for Personality Disorders: A Schema-Focused Approach. 3rd ed. Sarasota, Fla: Professional Resources Press; 1999. 16. Vitousek KB, Hollon SD. The investigation of schematic content and processing in eating disorders. Cogn Ther Res. 1990;14:191-214. 17. Axelson ML, Brinberg D. The measurement and conceptualization of nutrition knowledge. J Nutr Educ. 1992;24:239-246. 18. DAndrade R. The Development of Cognitive Anthropology. New York, NY: Cambridge University Press; 1995. 19. Markus H. Self-schemas and processing information about the self. J Pers Soc Psychol. 1977;35:63-78.

Journal of Nutrition Education and Behavior Volume 35 Number 6

43. National Research Council. Diet and Health: Implications for Reducing Chronic Disease Risk.Washington, DC: National Academy Press; 1989. 44. Kendall A, Olson CM, Frongillo EA. Relationship of hunger and food insecurity to food availability and consumption. J Am Diet Assoc. 1996;96:1019-1024. 45. Grant DK. The effects of being poor in the 1990s. Nutr Food Sci. 1997;2-3:AI(6). 46. Blake CE. Emergence of Food Schema as an Inuence on Food Choice: A Qualitative Investigation of Rural Womens Food Choice [masters thesis]. Ithaca, NY: Cornell University; 2000. 47. Strausse A, Corbin J. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park, Calif: Sage Publications; 1990. 48. Creswell JW. Qualitative Inquiry and Research Design: Choosing among Five Traditions.Thousand Oaks, Calif: Sage; 1998. 49. Greene JC. The role of theory in qualitative program evaluation. In: Flinders D, Mills GE, eds. Theory and Concepts in Qualitative Research: Perspectives from the Field. New York, NY:Teachers College Press; 1993: 24-45. 50. Smart LR, Bisogni C. Personal food systems of male college hockey players. Appetite. 2001;36:57-70. 51. Sobal J. Sample extensiveness in qualitative nutrition education research. J Nutr Educ. 2001;33:184-193.

November December 2003

293

52. Rotter JB. Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr. 1966;80(1):1-28. 53. Bandura A. Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes. 1991;50:248-287. 54. Fitchen JM. Poverty in Rural America:A Case Study. Boulder, Colo:Westview Press; 1981. 55. Fischler C. Food, self, and identity. Social Science Information. 1988;27: 275-292. 56. Devault ML. Comfort and struggle: emotion work in family life. Annals of the American Academy of Political and Social Science. 1999;561:52-63. 57. Kirk MC, Gillespie AH. Factors affecting food choices of working mothers with young families. J Nutr Educ. 1990;22:161-168. 58. Gordon RA. Eating Disorders: Anatomy of a Social Epidemic. London: Blackwell; 2000. 59. Rozin P, Fischler C, Imada S, Sarubin A, Wrzesniewski A. Attitudes to food and the role of food in life in the U.S.A., Japan, Flemish Belgium and France; possible implication for the diet-health debate. Appetite. 1999;33:163-180. 60. Weller SC, Romney AK. Systemic Data Collection. Beverly Hills, Calif: Sage; 1988. 61. Travers KD. The social organization of nutritional inequities. Soc Sci Med. 1996;43:543-553.

Invitation for Letters to the Editor

The Journal of Nutrition Education and Behavior welcomes timely and succinct letters expressing responsible criticism or reaction to material published in previous issues and letters calling attention to topics of general interest to nutrition education professionals. Letters should be addressed To the Editor.The Editor may send letters to other persons for reaction or rebuttal. Submission of a letter to the editor constitutes permission for the Journal of Nutrition Education and Behavior to publish it in our pages with appropriate editing and abridgment. Authors of letters to the editor must acknowledge nancial and other conicts of interest within the letter and/or in an author affiliation footnote to accompany the letter. Letters should be typewritten and double-spaced with 1" margins. Letters regarding articles published in JNEB will receive priority preference for publishing. Send letters to: Sandra K. Shepherd, PhD, RD, Editor Journal of Nutrition Education and Behavior Department of Nutrition University of North Carolina at Chapel Hill 800 Eastowne Drive, Suite 100 Chapel Hill, NC 27514 Tel: (919) 408-3320, ext. 34; fax: (919) 408-0674; e-mail: Editor@jneb.org.