Facilitators and barriers to dietary choices among older adults living in rural Edo, South-south, Nigeria

This qualitative study in rural Edo, Nigeria, reveals that while older adults possess knowledge of healthy diets and cultural preferences, their dietary choices are predominantly constrained by structural barriers such as economic instability, limited market access, and inadequate government policies, necessitating systemic interventions to support healthy ageing.

The Gist

Imagine a group of elders living in the quiet, rural villages of Edo State, Nigeria. They are the guardians of tradition, the farmers, and the grandmothers who know exactly which leaves make the best soup. But lately, their dinner tables are looking a little emptier, and their choices are becoming harder.

This study is like a deep-dive conversation with 22 of these elders to understand why they eat what they eat. The researchers didn't just ask, "What did you have for lunch?" They asked, "What forces are pushing and pulling at your plate?"

To make sense of the answers, the researchers used a tool called the Socio-Ecological Model. Think of this model as a set of Russian Nesting Dolls or concentric circles:

1. The Inner Circle (Individual): The person themselves.
2. The Middle Circles (Community & Environment): Their family, the market, the weather, and the roads.
3. The Outer Shell (Policy/System): The government and the economy.

Here is what the study found, broken down into simple, everyday concepts.

1. The Inner Circle: The Body and The Mind (Individual Factors)

The Good News: These elders are actually nutrition experts by intuition. They know that bitter leaf is good for the blood and that yams give energy. They have a "sixth sense" for natural, home-grown food and actively avoid "chemical" processed foods like instant noodles. They are like old-school chefs who trust their gut over a recipe book.

The Bad News: Their bodies are getting tired.

• The "Heavy Lifting" Problem: Imagine trying to cook a big meal when your knees ache and your back is stiff. For many, the simple act of chopping vegetables or walking to the garden has become a mountain to climb.
• The Doctor's Orders: Some have diabetes or high blood pressure. They want to eat their favorite traditional foods (like garri or fufu), but their bodies say "no." It's like being a car that runs on a specific fuel, but the only gas station nearby sells the wrong kind. They have to force themselves to eat differently, which is hard when you've eaten the same way for 60 years.

2. The Middle Circles: The Village and The Weather (Community & Environment)

The "Farm-to-Table" Reality: Most of these elders grow their own food. It's like having a personal supermarket in their backyard. When the harvest is good, they eat well. But this system is fragile.

• The Weather Rollercoaster: If the dry season is too harsh, the garden goes silent. No rain means no crops.
• The "Roadblock" of Fear: This is a major issue. There is violence and insecurity in the region (specifically from herdsmen conflicts). Imagine being a farmer who is too scared to go to their own field because of the threat of danger. Many have stopped farming entirely. If you can't go to the farm, you can't eat what you grow.

The Market as a Social Hub: The local market isn't just a place to buy food; it's like the village town square. Elders go there on specific days (every 4 days). They know the vendors by name, and sometimes, those vendors give them a "friendly discount" or save the best tomatoes for them. It's a social safety net. But if the market is empty because farmers are scared to bring goods, the elders have nowhere to turn.

3. The Outer Shell: The Government and The Wallet (Policy & System)

This is where the biggest barriers are. Imagine the government is a leaky roof that is supposed to protect the house from the rain, but instead, it's letting the storm in.

• The Empty Pockets (Inflation): The price of food has skyrocketed. A bag of rice that used to cost a little now costs a fortune. It's like your salary stayed the same, but the price of everything doubled overnight. Elders are forced to choose between "eating enough" and "eating well." They often choose to just fill their stomachs with cheap food, even if it's not healthy.
• The Forgotten Farmers: These elders feel abandoned by the government. They say, "We have never received a subsidy, a grant, or a single bag of fertilizer." They feel like the government talks about helping farmers but never actually shows up at the farm gate. It's like a coach shouting instructions from the sidelines but never giving the players any shoes to run in.
• The Widow's Struggle: For older women who have lost their husbands, the situation is even worse. They often lose their main source of income and have no pension. It's like losing your anchor in a stormy sea; they are left drifting with very little money to buy food.

The Big Picture: A Tug-of-War

The main takeaway from this paper is that these elders want to eat healthy. They know what is good for them. They have the knowledge.

However, they are stuck in a Tug-of-War:

• Team Healthy Eating: Their knowledge, their love for natural food, and their cultural traditions.
• Team Hardship: The rising prices, the fear of violence, the lack of government help, and their own aching bodies.

Who is winning? Currently, Team Hardship is winning. The structural problems (money, safety, policy) are so heavy that they crush the elders' ability to make the healthy choices they actually want to make.

What Needs to Happen?

The researchers suggest that we can't just tell these elders, "Eat more vegetables!" That's like telling someone with a flat tire to "just drive faster."

Instead, we need to fix the infrastructure:

1. Fix the Roads to Safety: Ensure farmers can go to their fields without fear.
2. Stabilize the Prices: The government needs to step in to stop food prices from swinging wildly.
3. Support the Farmers: Give seeds, tools, and money to the older farmers so they can keep growing food.
4. Protect the Vulnerable: Create special support programs for widows and the very old who can no longer work.

In short, these elders are ready to eat well, but they need the world around them to stop making it so difficult.

Technical Summary

1. Problem Statement

The global population of older adults is rapidly increasing, with the fastest growth occurring in low- and middle-income countries (LMICs) like Nigeria. Adequate nutrition is critical for healthy aging, preventing frailty, and managing non-communicable diseases (NCDs). However, there is a significant knowledge gap regarding the specific factors influencing dietary behaviors among older adults in rural African settings.

• Context: Existing literature in Nigeria is predominantly quantitative and narrow in scope (e.g., focusing only on fruit/vegetable intake), lacking qualitative depth on holistic dietary practices.
• The Gap: Rural older adults in Nigeria face unique structural, socioeconomic, and environmental constraints (e.g., limited infrastructure, market access, and insecurity) that are underrepresented in current research. Understanding these determinants is essential for developing effective public health interventions.

2. Methodology

• Study Design: An exploratory qualitative study utilizing a Socio-Ecological Model (SEM) framework to analyze factors across multiple levels (Individual, Environmental, Community, and Policy/System).
• Setting: Edo Central Senatorial District, Edo State, Nigeria. This is a predominantly rural area characterized by subsistence agriculture (cassava, yams, oil palm) and petty trading.
• Participants:
  • Sample Size: 22 older adults (aged 60+).
  • Sampling Strategy: Purposive sampling to ensure diversity in gender, socioeconomic status (retirees, farmers, traders), and dietary habits.
  • Demographics: Equal gender split (11 male, 11 female); predominantly married (16) or widowed (6); majority engaged in farming or trading.
• Data Collection:
  • Semi-structured, in-depth interviews conducted between July and September 2024.
  • Interviews were conducted in English or the local Esan language (7 participants), with audio recordings and rigorous translation/verification protocols.
  • Data collection continued until thematic saturation was reached.
• Data Analysis:
  • Thematic analysis following the six-phase approach by Braun and Clarke.
  • Transcripts were analyzed using NVivo 14 software.
  • Findings were mapped against the SEM domains, with an inductive approach used to capture emergent themes not fitting predefined categories.
• Ethical Considerations: Approved by the University of Sheffield and Ambrose Alli University ethics committees. Informed consent was obtained from all participants.

3. Key Contributions

• First Qualitative Study: This is the first study to provide in-depth, context-specific qualitative evidence on the dietary choices of rural older adults in Edo State, Nigeria.
• Holistic Framework: It moves beyond individual nutritional knowledge to demonstrate how dietary choices are shaped by a complex interplay of structural, environmental, and policy-level factors.
• Security and Climate Nexus: It uniquely identifies the impact of sociopolitical instability (Fulani herdsmen insurgency) and climatic variability (dry seasons) as direct barriers to food access, a factor often overlooked in standard nutritional studies.
• Policy Disconnect: It highlights the profound disconnect between government rhetoric on agricultural support and the lived reality of rural farmers who receive no subsidies or financial aid.

4. Key Results

The analysis identified 14 sub-themes organized into four SEM domains:

A. Individual-Level Factors

• Facilitators: High levels of nutritional knowledge regarding traditional, natural foods (e.g., leafy greens, beans) and a strong preference for minimally processed, home-grown foods.
• Barriers:
  • Health Status: Chronic conditions (diabetes, hypertension) necessitate dietary restrictions, but physical frailty, joint pain, and reduced mobility limit the ability to shop or cook, leading to reliance on easy-to-prepare but potentially less nutritious options.
  • Misconceptions: Some self-imposed restrictions based on cultural myths or perceived intolerances (e.g., avoiding specific staples like garri) rather than medical evidence.

B. Environmental-Level Factors

• Food Availability: Heavily dependent on seasonality. During dry seasons or off-harvest periods, dietary diversity collapses.
• Physical Access: Threatened by insecurity (herdsmen conflicts) which forces farmers to abandon land, and climatic extremes that disrupt crop cycles.
• Economic Access: Affordability is the primary driver. Participants prioritize "eating at all" over "eating well." Inflation and rising food prices (e.g., rice, garri) have made staples inaccessible, forcing reductions in portion sizes and meal frequency.

C. Community-Level Factors

• Food Environment: A hybrid sourcing model exists where subsistence farming is the primary source, supplemented by local markets.
• Market Access: Markets operate on 4-day cycles and serve as vital socio-cultural hubs. Long-term relationships with vendors provide informal credit and better prices, acting as a safety net.
• Culture & Norms: Strong attachment to traditional diets viewed as "addictive" (culturally essential) and healthy. Women typically hold decision-making power over meal preparation, influencing household diets.

D. Policy/System-Level Factors

• Government Support: A pervasive sense of policy alienation. Participants reported a total absence of government subsidies, grants, or agricultural input support despite the centrality of farming to their livelihoods.
• Price Regulation: Failure to control inflation and food prices. Participants view rising costs as a result of weak regulatory oversight, making balanced diets financially impossible for many.
• Economic Conditions: Chronic financial instability, exacerbated by widowhood and lack of pensions, forces a shift to survivalist eating strategies.

5. Significance and Implications

• Structural Determinants: The study concludes that dietary choices in this population are predominantly shaped by structural and food-system constraints rather than individual knowledge alone. Even with high nutritional awareness, older adults cannot maintain healthy diets due to poverty, insecurity, and lack of infrastructure.
• Policy Recommendations:
  • Strengthen Rural Food Systems: Support smallholder agriculture through inputs, subsidies, and security measures to ensure stable production.
  • Price Stabilization: Implement effective policies to control food inflation and protect low-income households.
  • Social Protection: Develop targeted social protection programs (e.g., pensions, food vouchers) specifically for older adults, particularly widows.
  • Culturally Sensitive Interventions: Public health strategies must leverage existing cultural knowledge of traditional foods while addressing misconceptions, rather than imposing external dietary models.
• Future Research: The authors call for quantitative studies to measure the specific impact of these policy failures on the nutritional status and health outcomes of the aging rural population.

Conclusion: The paper argues that improving nutrition for older adults in rural Nigeria requires a shift from individual-focused education to systemic interventions that address food security, economic stability, and rural safety.