title: Perceived barriers and facilitators of using dietary modification for CKD prevention among African Americans of low socioeconomic status: a qualitative study.
abstract: BACKGROUND
  Factors influencing the use of dietary interventions for modification of CKD risk among African Americans have not been well-explored. We assessed perceived barriers and facilitators of CKD prevention through dietary modifications among African Americans with low socioeconomic status (SES) and at high risk for CKD.
  
  
  METHODS
  We conducted a qualitative study involving three 90 minute focus groups of low SES (limited education, unemployed, uninsured, or income<$25,000/year) African American residents of Baltimore, Maryland (N=17), who were aged 18-60 years, with no known history of CKD and (1) a family history of end stage renal disease and (2) self-reported diabetes, hypertension, cardiovascular disease, HIV or obesity. A trained moderator asked a series of 21 closed and open-ended questions. Group sessions were recorded, transcribed, and two independent investigators reviewed transcripts to identify common themes.
  
  
  RESULTS
  Participants' mean (SD) age was 39.8 (12.4) years. Most (59%) were female and earned <$5,000/year (71%). One quarter (24%) had self-reported diabetes and over half had hypertension (53%). Few (12%) perceived their CKD risk as high. Perceived barriers to CKD prevention through dietary change included the expense and unavailability of healthy foods, family member preferences, convenience of unhealthy foods, and inability to break lifelong habits. They identified vouchers for healthy foods, family-based interventions, nutritional counseling and group gatherings for persons interested in making dietary changes as acceptable facilitators of dietary CKD prevention efforts.
  
  
  CONCLUSIONS
  Low SES African Americans at high risk for CKD had limited perception of their risk but they identified multiple barriers and potential facilitators of CKD prevention via dietary modifications which can inform future studies and public health interventions.
authors.forename: Amber E
authors.initials: AE
authors.lastname: Johnson
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
authors.forename: Cheryl A M
authors.initials: CA
authors.lastname: Anderson
authors.forename: Tatpong
authors.initials: T
authors.lastname: Chit-ua-aree
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kahan
authors.forename: LaPricia Lewis
authors.initials: LL
authors.lastname: Boyér
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. dcrews1@jhmi.edu.
authors.forename: Deidra C
authors.initials: DC
authors.lastname: Crews
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology*; D001294:Attitude to Health; D054626:Consumer Health Information; D003376:Counseling; D005247:Feeding Behavior; D005260:Female; D017144:Focus Groups; D005518:Food Preferences; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D051436:Renal Insufficiency, Chronic / Q000208:ethnology* / Q000517:prevention & control*; D012307:Risk Factors; D012923:Social Class; D055815:Young Adult