title: Perceived and actual cost of healthier foods versus their less healthy alternatives: a case study in a predominantly black urban township in South Africa.
abstract: OBJECTIVE
  There is an increasing awareness of the role played by the food retail characteristics in determining individuals' healthy food purchasing and consumption behaviors. The perceived costs of healthier food alternatives have been shown to contribute negatively to individual's food choices in developed societies. However, there is still a dearth of knowledge regarding this phenomenon in low to middle income countries particularly in Africa. This study explored health club member's experiences in buying healthier food options and compared their perceived cost of selected healthier and less healthy foods with actual market costs in a South African township.
  
  
  METHODS
  A cross-sectional study design using quantitative and qualitative research methods. The study was conducted in Khayelitsha, a township in the Western Cape Province in South Africa. Participants were 50 members of a health club, mostly female and above 50 years of age. The study was conducted in three phases. The first phase involved interviews with all 50 health club members. During the second phase ten purposively selected members participated in in-depth interviews based on their unhealthy food-purchasing and consumption patterns identified in the first phase. The third phase involved food price audits from supermarkets as well as convenient stores located in the study setting. Quantitative data were subjected to descriptive statistical analysis, while content analysis was used to analyze qualitative data.
  
  
  RESULTS
  Most of the members were illiterate and unemployed, largely dependent on government grants. Qualitative findings showed that low household incomes, their inability to read and interpret nutritional information and personal food preferences contributed to Health club members' unhealthy food-purchasing behaviour. When objectively measured in local stores, the healthier food options proved to be more expensive than their less healthy equivalents. This was consistent with subjects' perceptions about the relative cost of the same foods in their local stores.
  
  
  CONCLUSIONS
  Healthier foods tended to be more expensive than their less healthy options in local shops audited - both in reality and in the perceptions of health club members. Low income was reported to militate against health club members' healthy food-purchasing behaviour.
authors.affiliation: The Heart and Stroke Foundation South Africa. moise@heartfoundation.co.za
authors.forename: M
authors.initials: M
authors.lastname: Muzigaba
authors.forename: T
authors.initials: T
authors.lastname: Puoane
mesh_terms: D000328:Adult; D044383:Black People; D002755:Choice Behavior; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D005260:Female; D005502:Food / Q000191:economics*; D005518:Food Preferences; D005523:Food Supply / Q000191:economics*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D010465:Perception; D036301:Qualitative Research; D012923:Social Class; D012959:Socioeconomic Factors; D013019:South Africa; D011795:Surveys and Questionnaires; D014505:Urban Population