title: Considerations affecting dietary behaviour of immigrants with type 2 diabetes: a qualitative study among Surinamese in the Netherlands.
abstract: OBJECTIVE
  The purpose of this study was to explore the sociocultural factors affecting the dietary behaviour of Dutch Surinamese patients with type 2 diabetes.
  
  
  METHODS
  In this qualitative study, 32 Surinamese primary care patients with type 2 diabetes mellitus participated in semi-structured interviews (16 African Surinamese and 16 Hindustani Surinamese). Interviews were recorded and transcripts were analysed and coded into themes using principles of grounded theory and MAXQDA software.
  
  
  RESULTS
  Surinamese food was eaten regularly by all respondents. Most participants were aware of the need to change their diet but reported difficulty with changing their dietary behaviour to meet dietary guidelines. Many perceived these guidelines to be based on Dutch eating habits, making it difficult to reconcile them with Surinamese cooking and eating practices. Firstly, respondents indicated that they did not choose foods based on their nutritional qualities. Instead, choices were based on Surinamese beliefs regarding 'good' (e.g., bitter vegetables) or 'bad' (e.g., spicy dishes) foods for diabetes. Secondly, respondents often perceived recommendations such as eating at fixed times as interfering with traditional values, for example hospitality. Above all, the maintenance of Surinamese cooking and eating practices was regarded as extremely important since the respondents perceived these to be a core element of their identity as Surinamese.
  
  
  CONCLUSIONS
  For Surinamese diabetes patients, cooking and eating practices are related to deeply rooted cultural beliefs and values. The wish to maintain one's Surinamese identity may pose difficulty for patients' adherence to dietary guidelines, as these are perceived as being based on 'Dutch' habits. This suggests that immigrants with a long duration of residence in the host country like the Surinamese, who are seen as well integrated might benefit from culturally sensitive diabetes education that is adapted at surface and deep structure.
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. m.j.kohinor@amc.uva.nl
authors.forename: Mirjam J E
authors.initials: MJ
authors.lastname: Kohinor
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.forename: Mary
authors.initials: M
authors.lastname: Nicolaou
authors.forename: Joke A
authors.initials: JA
authors.lastname: Haafkens
mesh_terms: D000328:Adult; D000368:Aged; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy* / Q000208:ethnology; D003927:Diet, Diabetic / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data; D005247:Feeding Behavior / Q000208:ethnology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009426:Netherlands / Q000453:epidemiology; D009749:Nutrition Surveys; D036301:Qualitative Research; D012933:Social Identification; D013532:Suriname / Q000208:ethnology