Substituting white rice with brown and black rice as an alternative to prevent diabetes mellitus type 2: a case-study among young adults in Yogyakarta, Indonesia

Abstract

Purpose

The purpose of this study is to explore the preference and acceptance of white rice substitution with brown and black rice among young adults in Indonesia to prevent diabetes.

Methods

This study used a qualitative design. Rice preference deeply explored using focus group discussion as a case-study. 85 informants with an average of ages 20 years old were divided into several groups. Several topics to discuss include the reasons to accept or reject brown and black rice, knowledge, attitude, motivation, and potency to substitute white rice.

Results

Price was the main barrier to substitute white rice to brown and black rice. The participants have known brown rice from parents, mass media, and friends. Most of them were still unfamiliar with black rice. Culture also affected the preferences of the participants. To motivate people to change their white rice diet, creative packaging and segmentation of the sale were recommended.

Conclusion

Substituting white to brown and black rice is still a challenge for young adults in Indonesia. Several barriers such as culture, accessibility, and affordability need to be considered. Further efforts are important to manage a program to increase brown and black rice consumption.

Diabetes, especially type 2 diabetes mellitus (T2DM), is a chronic disease which has alarmingly increased every year. The World Health Organization (WHO) reported that in 2014, around 422 million adults were living with diabetes [1]. As one of the developing countries which face the double burden of malnutrition, both under and over-nutrition problems, Indonesia is also struggling with diabetes. The Indonesian Basic Health Research 2018 mentioned an increasing prevalence of diabetes in adults from 1.5% in 2013 to 2% by 2018 [2]. People with diabetes are endangered with various complications such as damage in the heart, blood vessels, eyes, nerves, and kidneys. Diabetes also has economic consequences since it needs life-long treatment for a person to improve their quality of life [3].

Non-Communicable Disease Risk Factor Collaboration [4] predicted that the chance to reduce the burden of diabetes is lower than 1% worldwide. A study by van Puffelen et al. [5] mentioned that the longer people have diabetes the lower their physical activity, likewise with other daily habits could change. It raises an urgency to study in depth the magnitude of the challenge about how to prevent diabetes by promoting healthy lifestyle approaches. Several studies suggested modifying the main risk factors, including food consumption in order to prevent diabetes [6, 7]. One example to modify food consumption is by substituting or complementing rice with another staple food.

Rice is the main staple food consumed by most people in Asian countries, including Indonesia. The Ministry of Trade of Republic of Indonesia [8] estimated that aggregate demand of rice by 2020 will reach 16.1 million tons, much higher than flour, soybeans, and sugar at 2.1 million tons, 1.9 million tons, and 2.6 million tons, respectively. A meta-analysis by Hu, Pan, Malik, and Sun [9] mentioned there is a significant correlation between high amounts of white rice consumption with the risk of T2DM. White rice is known to have a higher glycemic index (64 to 93) than other types of staple foods such as brown rice (55), whole grain (41), and barley (25). There is also a positive correlation between glycemic index, glycemic load, and the risk of diabetes [10]. Several studies suggested modification of staple foods using other types of food with lower glycemic index [9–11].

Many studies have been conducted to understand the effects of substituting or complementing white rice with brown rice or legumes and seeds in order to prevent T2DM [11–13]. This study aimed to add the novelty in the research by examining the potential of substituting brown and black rice for white rice. Black rice is one of the new kinds of agricultural products from Indonesia. Together with brown rice, black rice is higher in fiber and antioxidants than white rice [14]. Unfortunately, the consumption of brown and black rice is less popular among Indonesian people. By doing this study, the researcher expects to better understand the opinions of young adults in Yogyakarta, Indonesia about the potential of substituting brown and black rice for white rice.

Qualitative study is a type of research to understand social phenomenon, human behavior, and how a culture can be developed as it is now. It has the uniqueness to deepen an experience or phenomenon which cannot be described in numeric [15]. Although it uses social and psychological approach, qualitative study has been widely used for health research, including nutrition. Dearie et al. [16] conducted semi-structured interviews towards 15 Fijian, aged 26 to 71 years old. The research gave a wide and deep explanation of the local attitude and perception of diabetes. There were no numeric data, but this research can dig in several points as a key factor to increase their awareness of diabetes. There were other qualitative research focus on diabetes management but always results in different recommendation due to specific context and condition [17–19].

This study aimed to investigate the potential of substituting white rice with either brown or black rice in the daily dietary intake among Indonesians as a collaborative effort for Global Nutrition and Epidemiology Transition (GNET). Indonesia is very rich in local food. This food diversity can be used as alternatives to address nutrition-related disorders in this country [20–23]. This research is important to investigate other alternatives of high-quality carbohydrate sources (brown rice or black rice) as alternative staple foods in order to prevent diabetes among Indonesian population.

Methods

Study setting

The study used qualitative design with a case-study approach. A case-study involving university students in Yogyakarta, Indonesia was done to collect information about rice preference and acceptance. This study was conducted from November 2018 to March 2019.

Participants selection used purposive and snowballing sampling as stated by Gentles, Charles, Ploeg, & McKibbon [24]. It had several inclusion criteria, (1) an active university student, (2) in a healthy condition, and (3) did not smoke. In this study, open recruitment using social media was carried out to identify the eligible study participants. Due to the nature of the qualitative study, the sample size did not calculate. Participants recruitment was continued until information saturation was achieved [25]. As open recruitment could not meet the number of participants to achieve information saturation, the researcher used snowballing sampling to identify other participants.

Yogyakarta was chosen since it has been known as the “student’s city” in Indonesia, where many students from different cultural background come to Yogyakarta to pursue their under- and postgraduate study. Therefore, with this academic background, it was expected that the students would be the best study participants and express their preferences and acceptance of three varieties of rice from different points of view, regardless of ethnicity, dietary pattern and culture.

Ethics Committee of the Faculty of Medicine, Public Health, and Nursing granted the researchers ethical permission before conducting the study, following the Declaration of Helsinki (reference number KE/FK/1308/EC/2018). All participants completed informed consent forms after receiving explanation about the purposes of the study.

Food preference and acceptance assessment

Preference and acceptance of white, brown, and black rice were evaluated using a qualitative design with the focus group discussion (FGD) method. One group of FGD consisted of 8–12 participants. This is in accordance with Nyumba et al. [26] who mentioned in their article that the participant of FGD ranged from 3 to 21 people, with a median of 10. Maximum variation sampling was used in this study to reckon the extreme characteristics in a heterogeneous population [24]. The authors consider that the field of education in a university may differ and vary from one student to another which can affect their eating preferences. The cluster of knowledge (medical, science and technology, agriculture, and social humanities) was then taken into account when designing the focus group discussion session. The number of discussion session was adjusted by the level of information saturation. One facilitator led the discussion to explore the information needed. Several points that were discussed can be seen in Table 1.

Table 1.

Selected points to be discussed in the focus group held in Yogyakarta Province, Indonesia

Reasons to or not to consume brown and black rice;

Knowledge about brown and black rice and why people prefer white rice;

Attitude towards substituting white rice with brown and black rice; and

Motivation and personal belief to substitute white with brown and black rice.

Data analysis

Information obtained from the focus group discussions were recorded, transcribed verbatim and then classified into several categories of themes following methods explained by Thorne [27]. The data were then synthesized to create meaningful, structured, and systematic details to be discussed. The discussion will be supported by comparing to literature. The trustworthiness of the research was reached by data triangulation in which the researcher ask the same question to different participants and collect data from different sources [28]. Example excerpts were written in table results with the reference in brackets. For example, [E1.1a], “E” for excerpt, “1” for the first theme, “1” for the first sub-theme, and “a” for the first quote in the sub-theme. Identity of individual remained anonymous and only given information on the gender and age.

Results

Characteristics of the panellists

A number of 85 students were enlisted as the participants. More than 50% were aged 21–22 years old and most of them identified as Javanese. However, there were also some tribal ethnics such as Minang, Batak, and Malay from Sumatra Island and Sundanese from Java Island, as shown in Table 2.

Table 2.

Participants’ characteristics (n = 85)

Characteristics	Frequency (n, %)
Sex
Male	31 (36)
Female	54 (64)
Age (years old)
18–20	39 (46)
21–22	46 (54)
Parental income (million IDR)
< 1,50	4 (5)
1,50-2,49	12 (14)
2,50 - 3,49	6 (7)
3,50 - 5,00	21 (25)
5,00 - 10,00	28 (33)
>10,00	14 (16)
Body mass index (kg/ m2) a
Underweight (<18.5)	13 (15)
Normal (18.5–23)	49 (58)
Overweight (23–27.5)	17 (20)
Obese (>27.5)	6 (7)
Tribe
Javanese	67 (79)
Sundanese	3 (4)
Minang	4 (5)
Malay	3 (4)
Chinese	1 (1)
Othersb	7 (7)
Cluster of knowledge
Agriculture	18 (21)
Medical	22 (26)
Science and technology	23 (17)
Social humanities	22 (26)

^aAccording to the categorization by World Health Organization [29]

^bArab-Ternate-Java, Balinese, Batak, Cirebon, Lampung, Padang-Java, Rejang

Food preference and acceptance assessment

In terms of focus group discussions, 8 group discussions were held to discuss the acceptance of white, brown, and black rice by the participants. The discussions focused on the factors affecting rice preference, perception towards brown and black rice substitution, and knowledge about brown and black rice. Complete results can be seen in Table 3.

Table 3.

Perception towards white rice substitution to brown and black rice

No	Themes	Sub-themes	Example of excerpts
1	Staple food choices	White rice as staple food	[E1.1a] “… at home (I) just eat white rice, … at boarding house is the same, just white rice, at food stalls only white rice” (male, 22 years old) [E1.1b] “I used to eat white rice” (female, 22 years old) [E1.1c] “… Habit at home, I eat white rice. Here (boarding house) also eat white rice” (female, 21 years old)
		Brown rice and white rice as staple foods	[E1.2a] “if I were at home… I dominantly eat white rice, but I used to know brown rice as well, I can eat 3 to 5 times brown rice in a month. Sometimes I search for brown rice at campus” (female, 19 years old) [E1.2b] “I used to eat brown rice at home” (male, 22 years old) [E1.2c] ““if me for the first time I follow (my) parents, in the past I have an opportunity to replace it, really only brown rice, that was the first time I eat it, yes indeed the taste is little different, the texture too, the taste is more bland, but sooner or later, (I) get used to it” (female, 18 years old)
		Combination of brown and white rice as staple food	[E1.3a] “There were several times, maybe 3–4 months ago, when I lived with my sibling, I usually eat white rice mixed with brown rice” (female, 20 years old) [E1.3b] “If for example at home because (my) parents have diabetes, there is brown and white rice, so it’s up to me to eat brown or white rice, but often mixed” (female, 20 years old) [E1.3c] “I used to eat white mixed with brown rice since senior high school” (female, 21 years old)
		Other types of staple food	[E1.4a] “in fact, I search for something practical, such as white rice, sometimes bread, sometimes oatmeal too… I prefer bread or oatmeal, or something like corn, I can accept them more” (female, 21 years old) [E1.4b] “…people said (brown rice is) more nutritious than white rice, if my preference, I prefer uduk rice (white rice cooked with coconut milk and spices) so if it is brown rice, I prefer if mixed with uduk rice, so there is taste, a little” (male, 19 years old)
2	Knowledge about brown rice	Source of information	[E2.1a] “I used to know brown rice in the form of porridge…” (female, 20 years old) [E2.1b] “I know brown rice from baby food…” (female, 21 years old) [E2.1c] “… beside from mother, my father used brown rice as chicken food” (female, 19 years old) [E2.1d] “I know from the market sold various rice, there are brown and white” (male, 22 years old) [E2.1e] “Know brown rice from parents, they are farmers so that means growing brown rice too in the fields, so if every harvest time there is a part of the harvest set aside for my family, be like family’s barns …” (male, 21 years old) [E2.1f] “I know from parents, lecture, internet…” (female, 18 years old) [E2.1g] “I know from my friends…” (female, 19 years old)
		Health benefits of brown rice	[E2.2a] “if brown rice I think it’s higher in protein, because maybe there is a mixture, actually rice is white… actually is white right? … just heard that the protein is higher, better, maybe the other can explain” (male, 22 years old) [E2.2b] “I have heard from my friends that brown rice is high fiber and is lower in sugar than white rice” (male, 20 years old) [E2.2c] “I’ve heard from research that brown rice is suitable for people who wants diet or prevent diabetes because it has higher nutrient content than white rice” (male, 19 years old) [E2.2d] “from myth… myth circulating mentioned that brown rice prolong satiety and just, if eat, if I usually take (white) rice in a certain amount, when I take brown rice (in the same amount) with conditions equally hungry, much more full of brown rice, don’t know why, myths of research” (female, 22 years old) [E2.2e] “my mother in fact has already suggested by friend, a nutrition analyst, if it’s better to consume brown rice from now …” (female, 22 years old) [E2.2f] “if brown rice I think it’s higher in protein, because maybe there is a mixture, actually rice is white… actually is white right? … just heard that the protein is higher, better, maybe the other can explain” (male, 22 years old)
3	Brown rice consumption	Curiosity to try brown rice	[E3.1a] “I eat brown rice because I want to try, just want to know what is brown rice” (male, 22 years old) [E3.1b] “... maybe don’t have a problem related to taste or texture, I think it’s good, but, my family is not only me … brown rice is more expensive, so it’s more affordable to buy white rice, brown rice is not tasty (if combined) with soup, like that” (female, 19 years old) [E3.1c] “I curious about the taste” (female, 20 years old) [E3.1d] “I have eaten brown rice, just a little” (male, 19 years old)
		Nutrients content and health benefits	[E3.2a] “I often eat brown rice at home, because at home.. we think that brown rice has high fiber,.. also low sugar” (female, 19 years old) [E3.2b] “I once tried (brown rice), it’s just because my sibling has diet, because its glucose content is lower than white rice” (female, 21 years old) [E3.2c] “I tried brown rice several times, because I heard that brown rice has smaller calorie, lower than white rice” (female, 22 years old) [E3.2d] “At home, (my mother) serves me brown mixed with white and black rice because my father and sibling are fat and my mother was informed that mixing brown and black rice can make slim” (female, 19 years old)
		Health condition	[E3.3a] “I was sick when I was in middle school… it was like for one to two weeks I had to eat brown rice” (male, 21 years old) [E3.3b] “Brown rice at home… sometimes my mother cook for my father’s diet, it’s often white and brown rice at home” (female, 21 years old) [E3.3c] “My mother has pre-diabetes symptoms, her food is replaced with the healthier one … (she) never eat white rice anymore, sometimes eat brown rice too” (female, 19 years old) [E3.3d] “Several months ago my father have diabetes symptoms, several times replaced with brown rice” (female, 18 years old)
		Do not like the sensory properties of brown rice	[E3.4a] “…at home I use brown rice more often, because my father don’t like the smell of brown rice, finally mixed with white rice” (female, 19 years old) [E3.4b] “At first I try brown rice is only brown rice, but the taste is really bland, the texture is also bad, the taste too… so finally at home (I) often eat brown mixed with white rice” (female, 20 years old) [E3.4c] “I have eaten white rice mixed with brown rice because I do not like the taste of brown rice because the taste is a bit odd” (female, 21 years old)
		Never buy brown rice	[E3.5a] “I have never consumed (brown rice), because I live in boarding house, mother brought me not brown rice, because there was no brown rice available at home” (female, 18 years old)
		Do not have specific reason to eat brown rice	[E3.6a] “if there are white and brown rice, I prefer white rice, because (I) don’t have any reason to try it” (female, 20 years old)
4	Knowledge about black rice	Do not know black rice	[E4.1a] “in the place sold various rice, there are brown and white rice, the black one I thought it was glutinous rice” (male, 22 years old) [E4.1b] “Honestly I just heard black rice here, haven’t heard black rice before, only know black glutinous rice” (male, 22 years old)
		Perception that black rice and black glutinous rice are the same	[E4.2a] “For black rice, I only know that it is the same with sticky rice, so for black rice, I usually eat it like a porridge” (male, 20 years old)
		Know black rice	[E4.3a] “From internet like YouTube channel, something like that, telling about diet, about health, always mentioned black rice…” (female, 22 years old) [E4.3b] “From Bobo magazine, there are infographic about brown and black rice, but I have not eaten it yet” (male, 20 years old) [E4.3c] “…just found out when shopping at the supermarket the rice was lined up per packet, there was brown rice there was black…” (female, 21 years old) [E4.3d] “…For black rice, I know from my friend who studied organic market and (he stated that) the antioxidant is high…” (female, 21 years old) [E4.3e] “as far as I know something like black rice has been modified, either modification from the farm I don’t know, what I know from the research is that brown and black rice are good for people who wants to diet or people who want to prevent diabetes, because the nutrient is higher than white rice, like that” (male, 19 years old)
5	Black rice consumption	Never heard or see black rice	[E5.1a] “(I) have never heard black rice before” (female, 20 years old) [E5.1b] “(I) have never eaten black rice” (male, 19 years old)
		Lazy to buy	[E5.2a] “… for black rice, rarely see who has it, so (I) can’t ask, lazy to buy too” (male, 19 years old)
		Expensive price	[E5.3a] “I see black rice in the market, the price is more expensive than brown rice, (while brown rice) is more expensive than white rice… it makes people afraid to buy black rice” (male, 19 years old)
		Curious to eat black rice	[E5.4a] “I just want to try (black rice)” (male, 21 years old) [E5.4b] “At home, (my mother) serves me brown mixed with white and black rice because my father and sibling are fat and my mother was informed that mixing brown and black rice can make slim” (female, 19 years old)
		Nutrient content	[E5.5a] “…. Maybe if myself prefer black rice if there is a choice … I heard the more the color, the darker the color, the higher the antioxidants, but for myself, the more expensive a food it means the higher (its) quality … indeed, it now leads to healthier food, even if we have been educated, (I) mean knowing there is price and quality, I still choose the quality” (male, 21 years old)
6	White rice substitution to black and brown rice	Health benefits	[E6.1a] “... if nutrition information is included, it’s enough to change people.. (I mean) most of them. Especially for the elderly, people with illness, got diabetes, maybe they knew about nutrition” (male, 20 years old) [E6.1b] “In my opinion ... it depends ... for example groups at risk will feel certain when getting information about the nutritional value and ... will be far more interested (to substitute) than those who haven’t ...” (female, 20 years old)
		Economic aspects	[E6.2a] “from economic aspect I can afford the more nutritious rice, just buy it, but for lower (economic) group, it’s more important to feel full, not thinking about the nutrient content, because if it’s expensive, can’t afford the food for family” (female, 18 years old) [E6.2b] “… the price (of white rice) is affordable (than brown and black rice) because most Indonesians are middle to low economic groups... if you want to change all levels of society ...”(female, 20 years old) [E6.2c] “…it’s harder for us to buy it if, I think, … white rice is still present ... maybe the price (should be) equal or what, and highlight the benefits ... from the consumption of this rice ...” (male, 22 years old)
		Promotion possibilities	[E6.3a] “… maybe because I am the type of person who is easily influenced by the promotions, I might be interested in the beginning … do I match the product? Then I can adjust the product, what’s the benefits… based on what I have sacrificed” – Respondent (female, 21 years old) [E6.3b] “… well the product should be more, what, promoted in a group, for example… mmm like people with diabetes… (they) mustn’t thinking, although the price is a bit more expensive, but they are more concerned with health” – Respondent (female, 20 years old) [E6.3c] “if what is highlighted is the uniqueness of the rice … I think it’s better to mix (the rice) to sell, but back again … the consideration is still, segmentation, like any kind of marketing, people (who live in boarding house) won’t buy it like that (if rice do not mixed),” (male, 22 years old)

Discussion

The evaluation of food preference are important to understand the perspectives from the prospective customers. In this case, the discussion was conducted with 85 participants who are university students in Yogyakarta Province, Indonesia. University students represent adolescents and persons approaching early adulthood as people prone to have high risk of type 2 diabetes mellitus [6, 30]. Furthermore, Indonesia is a country with high diversity of ethnics and culture, as demonstrated by the participation of students who came from different regions of Indonesia, although the number is much smaller than the Javanese (33% vs 67%). This ethnic diversity may affect the dietary pattern and food preference of all of the participants.

Accessibility, taste, price, and preparation time were the main reasons why the participants preferred to consume white rice compared to brown or black rice as the staple food. White rice is the most common staple food consumed by Indonesian people. Riawanti [31] mentioned in her article that through Revolusi Hijau (Green Revolution) in 1970s, the government made an order to plant the rice across the country at any cost. Although the rice production increased to the highest level in Indonesia history at that time, it had the consequences of replacing other types of staple food such as yam, sago and corn and made the staple foods consumed by Indonesian people less diversified [32]. To substitute for white rice, other foods such as corn, yam, and flour-based foods are better known by Indonesian people [33].

Several participants mentioned that they were used to consuming brown rice in their daily diet. The reasons were they considered healthy lifestyle, have a family member with diabetes, or trying new diet. Brown rice is known to have high nutrient content such as vitamins, minerals, fibers, antioxidants, and other benefits [34, 35]. Several studies have demonstrated the benefits of brown rice on insulin response, endothelial function, and blood glucose [35, 36]. These benefits caused the people who were aware about health to try a new diet, especially if they have a specific illness such as diabetes. The participants who have family member with diabetes tended to support them by following their diet. Some participants also stated that they ate brown rice since there was an ease of access to obtain the rice. For example, when they ate at a restaurant or university canteen which served brown rice, they choose brown rice over white rice. This is supported by Kearney [37] who stated that the availability and access of a food will affect the level of consumption. Although most of the participants were favorable toward brown rice, one respondent said that they preferred black rice knowing that it has higher nutrient value than white or brown rice. However, most of the participants said that it was the first time they tasted black rice. It can be assumed that beside white rice, brown rice is better known and familiar to the participants.

The participants obtained information about brown and black rice from several sources: parents, mass media, Internet, friends, and a few participants mentioned school and nutritionist. Kingston [38] wrote, according to Milton (2009), there were two dimensions of knowledge dissemination. One of them was about collecting and connecting information. Collecting here means how people receive information and connecting means how people communicate information. School personnel and nutritionists are both examples of how collecting information often happens while information from parents, friends, and mass media are considered forms of connecting information.

Journalism, as in mass media (TV, radio, Internet, social media, etc.), can have a significant role to spread information to a wider population. However, sometimes there is false information spread which leads to disinformation. Sometimes, there is also incomplete information which causes the people to not be able to differentiate whether the information is a myth or fact [39]. This may have happened in this study, as seen in some opinions of the participants. One of them assumed that brown rice is higher in protein than white rice. Another respondent conveyed the myth about brown rice will prolong satiety but was not able to explain the mechanism of satiety due to different type of rice. There was also a respondent who mentioned that brown and black rice was the result of the agricultural modification. These statements indicate that some participants were doubtful with their own knowledge regarding the benefits of brown or black rice.

Pandey et al. [34] wrote that the protein content of brown rice is 7.1–8.3 g, higher than white rice which is only 6.3–7.1 g. Another study by Azis, Izzati, and Haryanti [40] mentioned the protein content of brown rice reaches 13.3 g while black rice is 13.7 g. The different levels of protein content in the rice can be caused by different methods of protein analysis or different ways of cultivation. However, it demonstrates that the protein content of brown rice is truly higher than the white rice. Secondly there was the myth that brown rice will prolong satiety. Satiety is a concept when someone feels full, and is affected by multi-factors. Satiety is not only due to the nutrient content of the food, but also cognitive and sensory responses of an individual [41]. A study by Wang, O’Neill, Thomas, and Slavin [42] proposed that white and brown rice are equally satiating in spite of the different fiber contents. It was also supported by a systematic review which mentioned that there were not any specific types of fibers that were correlated with satiety and food intake [43]. Thirdly there was the statements about the agricultural modification of brown and black rice. The respondent thought that rice was originally white and should be modified genetically to have brown and black colored rice. According to Awan, Ahmadizadeh, Jabran, Hashim, and Chauhan [44] rice was domesticated 11,000–12,000 BC in China. Now, there are several types of rice known as aromatic rice, glutinous rice, non-glutinous rice, and others with a wide variety of cultivation techniques. Other cultivars are non-aromatic and non-glutinous rice, including black rice. Black rice is originally black and has a special value for its nutrient content such as vitamins and minerals. However, it is correct that there are several studies about rice modification that address nutritional disorders [45–47].

The preference of rice texture is mostly affected by the culture. It is supported by the study of food choice in Italia which mentioned that socio-culture is one of the factors affecting food choice [48]. People who came from Sumatra Island were used to harder texture of rice while people from Java Island are more likely used to soft texture of rice. This can be caused by the difference in geographical area and the local wisdom. The differences in geographical structures result in various types of rice cultivars in Indonesia. Moreover, it corresponds with the local wisdom as shown in the way of cooking and their food preferences [49].

The participants were hesitant to say whether they agree or not with the possibility to replace white rice with brown and black rice. This hesitancy is seen by their statement that white rice substitution can only happen over a long time, mainly depending on the price comparability of the three types of rice and the availability of brown and black rice in the market. Higher cost was often mentioned as one of the main barriers to substitute the white rice with brown or black rice. This was compounded by the fact that the Indonesian Government has subsidized white rice for poor families [50]. This has an impact on the higher availability of white rice in the market and makes it much more affordable to the lower economic group. Although it is a good strategy from the government to enhance national food security, it also means there is an inherent struggle to promote brown and black rice in the market competition with white rice.

Economy plays a major role as one consideration to substitute white rice with brown and black rice. A respondent suggested consumer segmentation as a method to increase motivation to change. Segmentation means focusing the sale into specific groups considering their lifestyle and culture [51]. The respondent reasoned that people who lived at boarding houses would not be interested to substitute white rice because the rice was easier to obtain and to cook. Meanwhile, behavior change in a very short period is difficult to occur among low-income households. According to one respondent, the nutrient content of the food was not a priority for lower-income households, but instead it was taste, price, and type of foods which made them full faster that shaped their preferences and choices. Lower income families cannot afford to buy expensive foods often if at all. However, higher income households may purchase a wider selection according to the types of food [52].

This article also has a limitation. It does not cover all aspects of the participants’ preference for rice quality and preparation. Indonesia consists of a large variety of rice cultivar, even though in one type of rice color. Similarly, there are many methods to prepare rice. Thus, the researcher argued that it can be deeper learned in another study. Meanwhile, this research focused on the staple food eating habit of the participants especially factors affecting their rice preference. The high number of participants makes this study more generalizable. This also includes participants who came from western to eastern Indonesia with various education background so that they give a broader understanding of rice consumption among youth in Indonesia.

Conclusion

Substituting white to brown and black rice is still a challenge for people in early adulthood in Indonesia. This suggests that white rice substitution should begin with habituation from family. Family, especially parents, is the prime source of information to introduce other types of rice. On the other hand, the higher price of brown and black rice acts as the main barrier. Most participants said that the higher price, lower availability and less accessibility aspects of brown and black rice are not suitable for people from lower to middle-income families. Other barriers mentioned were the cultural aspects which affect the acceptance of rice. Market segmentation, including highlighting the health benefits of brown and black rice, was suggested by participants to increase the level of success of substituting white to brown and black rice to prevent T2DM in Indonesia.

Compliance with ethical standards

The authors have no conflict of interest to declare.