MINA

Investigator

Janice Thompson, University of Birmingham

Team

Joy Merrell, Swansea University
Barry Bogin, University of Loughborough
Vanja Garaj, Brunel University
Professor Petra Meier, University of Sheffield
Professor Michael Heinrich, University of London

Partners and collaborators

Katy Gardner, University of Sussex
Christina Victor, University of Reading
University of Dhaka in Bangladesh
The NGO Jubo Academy
Local UK Black and minority ethnic (BME) organisations

Contact

Janice Thompson
Email: j.thompson.1@bham.ac.uk

Background

As in the general population, nutrition plays a crucial role in the health status of the Bangladeshi population. Despite this, there is no clear understanding of how eating patterns and migration affects this group’s nutritional status and experiences of ageing. Without this information we cannot develop effective culturally tailored interventions.

MINA aimed to address these gaps by combining approaches, methods, and expertise not used in previous research to gain an in-depth understanding of Bangladeshi women’s nutritional status, food practices, beliefs and experiences of ageing in the UK and Bangladesh.

Aims and objectives

The aim of this project was to develop processes and products to reduce existing health inequalities and promote healthy, active ageing among Bangladeshi women by gaining a better understanding of the impact of migration on nutritional status, food practices and beliefs, and experiences and perceptions of ageing amongst this group.

The project drew upon existing UK national survey data to improve our understanding of mechanisms underlying well-documented health inequalities experienced by Bangladeshi women with a focus on nutrition-related behaviours and conditions.

The project then expanded on these data by conducting an in-depth exploration of the bio-social ecology of ageing in older Bangladeshi women (45+ years old) who migrated from Bangladesh to the UK, younger women (18-35 years old) born to migrants in the UK, and women of the same two age groups living in Bangladesh.

A public health perspective incorporating a social model of health was used, which allowed us to locate individuals in their social context and explore the impact of psychological, social, cultural and environmental factors on ageing, nutrition, health and related behaviours.

Additional information was gathered to explore the food ethnobotanical knowledge and food environments of Bangladeshi women living in the UK and in Bangladesh.

The goal was to compare this information to determine how food-related knowledge was shared amongst two distinct generations, how knowledge sharing and food environments may differ between those living in the UK and those living in Bangladesh, and determine how these differences impact on the biological and social aspects of ageing amongst Bangladeshi women.

Design

The research questions for this study were as follows:

Does migration impact on nutritional status, food practices, health, and ageing among first generation Bangladeshi women?
What is the impact of migration on lifestyle changes in middle and later life of first generation Bangladeshi women?
How does migration affect nutritional status, food practices, health, and ageing of the successive generation of women living in the UK?
How does migration affect changes in nutritional status, food practices, health, and ageing compared with non-migrating women of similar age in Bangladesh?

A mixed methods approach utilising biological measures, in-depth interviews, observations, and survey data was used to answer these questions. A secondary analysis of existing data of the Health Survey for England was conducted to investigate underlying mechanisms that might explain existing health inequalities, with our focus being on nutrition-related behaviours and conditions.

We tried to answer questions on the relative importance of risk factors such as income, education, health behaviours, health care contacts, and living conditions in explaining why Bangladeshi women experience poorer health than women of other ethnicities.

Nutritional status, bone health, and physical function was measured using anthropometry, Quantitative Ultrasound (QUS) of the heel of the foot, and a standardised battery of tests for leg muscle strength, walking speed, and standing balance.

A structured questionnaire and in-depth interviews was used to

obtain detailed accounts of the migration and biographical experiences and explore the impact on nutritional status, health behaviours and transmission of nutritional knowledge
explore the influence of cultural beliefs on nutrition, health, and health seeking behaviours and how this has changed across the lifespan and between generations
explore the impact of social inequalities on nutrition and health status
explore changes in the roles, position and responsibilities of women in the household and the impact on their nutrition, the family unit and wider community
obtain detailed accounts of the women’s perceptions and expectations of an older person in their community
gain an understanding of the extent and nature of transnational ties and their influence on issues related to nutrition and ageing.

Interviews, observations, and photo- and videoethnographic techniques were used to document typical food environments (including acquisition, preparation and consumption) and traditional plant food uses, their social and medicinal meanings, and management of allotments and home gardens in the UK and Bangladesh.

The information resulting from the use of these methods provided a unique understanding of cultural, social and environmental factors which influenced nutritional health status and health behaviours amongst Bangladeshi women living in the UK and in Bangladesh. Specifically these included food production, social and cultural meanings of food, access and availability of foods, and food environments encompassing living and housing conditions.

Policy implications

Policy and practice implications focussed primarily on reducing health disparities and improving the nutritional and health status of ageing Bangladeshi adults. The goal was to use the results of this study to improve access to culturally appropriate foods and food environments, and to inform the development and implementation of culturally sensitive and tailored interventions.

Product development opportunities included:

Resources (eg website and multimedia educational materials) for health and social care practitioners to raise their cultural awareness and improve the care delivered to older people from Bangladeshi communities.
A multimedia collection (photographic, video, internet) of Bangladeshi food related stories, an interactive video-cookbook of traditional Bangladeshi meals, and a scratch-and-sniff food plant book for use by the Bangladeshi community.
Providing guidance on the design of food environments to avoid potential negative consequences of migration on nutrition and ageing, which may result in future product design interventions (eg in the kitchen environment).
Providing guidance on the design of care homes for older adult migrants, including information on physical design, social needs, and culturally sensitive treatment of Bangladeshi elders.