Food Choice Drivers in the Context of the Nutrition Transition in Delhi, India

Objective: To understand factors that influence the process of food decision-making among urban Indian women in the context of the nutrition transition. Design: Mixed methods. Methods: Semistructured interviews and sorting of 12 a priori hypothesized drivers into categories of always, sometimes, and never influencing food choice. Setting: Delhi, India. Participants: Thirty-eight women aged 20-35 years selected from the roster of a prospective cohort study. Phenomenon of Interest: Drivers of food choice. Analysis: Interviews were transcribed verbatim and translated, then analyzed using an iterative, constant comparative process. Differences in pile sort rankings across tertiles of body mass index and wealth index were tested using Fisher exact tests. Result: Four primary themes emerged: (1) family influence; (2) cultural perceptions, with 3 subthemes of beliefs relating to (a) outside food and less healthful food, (b) seasonality, and (c) hometown food; (3) convenience, with 3 subthemes of (a) decisions regarding procurement of food, (b) not having time to cook, resulting in eating out or purchasing premade foods, and (c) eating whatever is available at home or is left over from previous meals; and (4) habit, with 2 subthemes of (a) subconscious decisions and (b) food roots. Responses from the pile sort activity revealed perceptions that food safety and health most influence food choice whereas marketing and advertisements least influence it. Conclusions and Implications: Young adult women in Delhi seem to rely on preferences of their families, habits and perceptions established in childhood, convenience, and food safety and health when making choices about food. These aspects of decision-making should be targeted in future interventions aimed at improving dietary intake in this population.