Exploring Health Literacy as a Factor Contributing to Adoption of the 2005 Dietary Guidelines Among Adults in the Mississippi Delta

Year: 2007

Research Center: Southern Rural Development Center, Mississippi State University

Investigator: Zoellner, Jamie, Wendy Bounds, and Carol Connell

Institution: University of Southern Mississippi

Project Contact:
Jamie Zoellner
The University of Southern Mississippi
118 College Drive #5172
Hattiesburg, MS 39406
Phone: 601-266-4696


Nutrition literacy may be defined as “the capacity to obtain, process, and understand basic nutrition information needed to make appropriate dietary decisions.” Although education, health, and nutrition disparities are well documented in the Lower Mississippi Delta (Delta) region, no known published research has examined the health or nutrition literacy status of residents in the Delta. With the recent release of the 2005 Dietary Guidelines for Americans and MyPyramid Food Guidance System (MyPyramid), little is understood about the public’s exposure and perception of these new recommendations. This study utilized a quantitative phase and qualitative phase to explore nutrition literacy as a factor contributing or inhibiting adoption of the 2005 Dietary Guidelines among adult Mississippi Delta residents.

The objective of this cross-sectional study was to describe the nutrition literacy status among adults in the Lower Mississippi Delta region. Trained Community Health Advisors recruited participants and collected data. A proportional quota sample based on educational achievement was used. Participants included 177 adults, primarily African-Americans (81 percent). Survey instruments included a modified version of National Cancer Institutes Health Information National Trends Survey (HINTS) to assess capacity to obtain nutrition information and the Newest Vital Sign (NVS) to assess the capacity to process and understand nutrition information. Descriptive statistics, Chi-square, and ANOVA tests were used to examine survey data.

In the qualitative phase, in-depth structured-interviews were used to explore cultural perceptions of the MyPyramid key messages and identify factors that may impact adoption of these recommendations. Twenty-three adults, primarily African-American females, residing in the Lower Mississippi Delta participated in the interviews. Interview tapes were transcribed and systematic content analysis was used to evaluate the transcripts.

Of the 177 participants, 24 percent had a high likelihood of limited nutrition literacy skills, 28 percent had a possibility of limited nutrition literacy skills, and 48 percent had adequate nutrition literacy skills. Overall, the Internet was the least trusted and least used source for seeking nutrition information. Participants in lower nutrition literacy categories identified more barriers and less confidence in seeking information about nutrition compared with those in higher nutrition literacy categories. Only 12 percent of participants correctly identified the 2005 MyPyramid graphic, and the majority (78 percent) rated their dietary knowledge as poor or fair. Rates of limited health literacy among Delta adults were high compared with other national surveys. Relying on the Internet as a central mode of health communication may only be widening the health disparity gap among impoverished rural regions similar to the Delta. If researchers and educators intend to reduce the burden of nutrition-related chronic diseases and communicate scientifically-based nutrition information to rural, disadvantaged communities, they must understand the causes and consequences of limited nutrition literacy.

When asked to identify good reasons to follow the MyPyramid key messages, nonspecific references to improved health were most prevalent (n=130). However, participants also acknowledged the importance of getting vitamins and nutrients (n=81), and the impact food choices have on health conditions (n=77) and organ systems (n=65). Individual level factors (n=211), such as dislike for foods and tradition or customs, far outnumbered environmental level factors (n=48), such as cost and availability as perceived reasons preventing community members from adhering to the key messages. The most frequently mentioned suggestion for helping community members eat according to the MyPyramid were to raise awareness (n=93), provide information (n=65), and improve the taste of or provide opportunity to taste (n=49).

The qualitative nature of this study helped capture the cultural and social application of the MyPyramid among the Delta population and provided valuable information on factors promoting and inhibiting adoption of the key messages. The overall thematic responses regarding issues preventing compliance with the MyPyramid and factors for helping community members eat according to the MyPyramid indicate that both social marketing campaigns and intervention efforts focused on individual level factors are needed to promote the MyPyramid in this disadvantaged Delta region.

Direct inquiries about this study to the Project Contact listed above.