Healthicization and Lay Knowledge About Eating Practices in Two African American Communities

Abstract

In this manuscript, we expand upon sociological research in lay knowledge about health and healthicization by examining socially mediated ways in which 40 African American adults in two communities acquired information about eating practices. Participants employed a variety of socially informed information-seeking strategies. Many, but not all, used socially prescribed sources exhorting them to maximize their own health and reported an amalgam of experiences concerning their interpretation of healthist messages. Participants variously accepted messages about healthy eating or engaged in strategies of micro-resistance that decentered and/or reinterpreted health promotion discourse. Furthermore, participants used emic community-based resources including those that prioritized familial engagement over individual responsibility in eating practices or that drew upon alternative health practices. We discuss the implications our work has for further research on healthicization and lay knowledge about eating practices, in which community members are actively engaged in meaning-making within local socio-structural contexts.

In the United States and other western countries, because an ethos of healthicization prevails that holds individuals responsible for health-related choices they make in their everyday lives (Metzl & Kirkland, 2010), it is important to understand how people obtain information about food selection, preparation, and consumption practices. Although the new public health literature focuses on the health status of populations, critical theorists continue to criticize this body of literature—and the public health programs associated with it—for de-emphasizing socio-structural constraints, lack of resources, and complex ways in which social interactions produce and reinforce social meanings that constrain health-related choices, especially those confronted by members of poor communities (Ayo, 2012; Bell, Salmon, & McNaughton, 2011; Petersen, Davis, Fraser, & Lindsay, 2010). Many of these critical public health scholars accuse traditional public health research (based on the host–agent–environment model) of primarily including socio-cultural factors as variables and not featuring or critically interrogating the nuances of the socio-political context in which people live, health conditions occur, and health-related knowledge develops. As a result, critical theorists contend that much, but not all (Delormier, Frohlich, & Potvin, 2009), of the new public health research, despite its focus on population health, contributes to an individualizing perspective (Ayo, 2012).

We adopt a constructionist perspective, informed by critical theory, to re-center the salience of socio-cultural factors in health and eating practices recognized by a wide range of social scientists including critical theorists (Bell et al., 2011; Metzl & Kirkland, 2010), nutrition scientists (Devine, 2005), other public health theorists (Delormier et al., 2009), sociologists (DeVault, 1991; Lupton, 1996, 2013), and scholars in Library and Information Science (LIS; Tuominen & Savolainen, 1997; Veinot & Williams, 2012). Here, we present analyses based on 40 semi-structured interviews from the formative stage of a larger cross-disciplinary, multi-stage research project in two communities in Kentucky that explored the individual, familial, community, and structural factors influencing African American participants’ diet.¹ The project team initiated the study because African Americans are at increased risk, compared with Whites, for diet- and obesity-related diseases such as cardiovascular disease (CVD), diabetes, and stroke (Centers for Disease Control and Prevention, 2009). In the United States, Kentucky ranks as the ninth most obese state, and African-American Kentuckians exhibit higher rates of obesity (Levi et al., 2013), Type 2 diabetes (Kentucky Department of Public Health, 2013, p. 8), and hypertension (Harris, 2009, p. 41) than White Kentuckians. In this article, we draw upon the existing social science literature on lay knowledge and healthicization to examine how African American study participants acquired and then interpreted socially mediated information about food and dietary practices.

We make several contributions to the literature. First, although researchers (Kaziunas, Ackerman, & Veinot, 2013; Morey, 2007) previously have examined how African Americans and other minority groups (Ristovski-Slijepcevic, Chapman, & Beagan, 2008) acquire and/or use information related to a range of health behaviors, ours is the first known study focusing solely on dietary information-seeking behavior by African Americans, who do not share a common health condition.² Second, our study confirms findings from previous research that individuals have agency in whether and how they adopt information (Tuominen & Savolainen, 1997), including healthist messages (Dervin, 1998; Lupton, 1996). We contribute substantive findings by using a gradated and subtle concept of resistance (Armstrong & Murphy, 2012) to illustrate how some of our African American participants, in their specific social contexts, engaged in strategies of micro-resistance that decentered and/or reinterpreted health promotion discourse. Third, we identify the salience of African American families and emic community-based resources (including Tai Chi instructors) for translating food information into knowledge. Fourth, we extend the sociological focus on lay knowledge by drawing upon scholarship in LIS on information-seeking behaviors, and thereby illustrate the close connections between these concepts. Finally, using Habermas’ typology (1971), we identify several types of knowledge (technical knowledge, advice, and inspiration) and suggest that future research further explicate the relationship between information sources and these types of knowledge.

Background

Below, we use the sociological and LIS literature to define key concepts (information, information-seeking behaviors, knowledge, healthism, and healthicization), situate our article in the broader context of previous research, and address our primary analytic question: How do African Americans in two communities acquire information that shape how they understand and manage their dietary practices within the socio-cultural context of their lives and in ways that variously support or resist healthist expectations?

Information and Knowledge

LIS scholars make important distinctions between the related but separate concepts of knowledge and information (Dervin, 1998; Jordan, 1997; Wilson, 1977). Patrick Wilson (1977), a pioneer in information sciences, notes that information is the “representation of knowledge” (p. 5); it is not knowledge itself. Although diverse definitions exist, we adopt Wilson’s (2000) definition of information being discrete data elements that are organized within a framework (to characterize objects, situations, events, behaviors, or other entities). Humans interact with information through a variety of active or passive information-seeking activities (Wilson, 2000). Active, purposive information-seeking satisfies a goal, and is consistent with Savolainen’s (1995) concept of “everyday life information seeking,” encompassing cognitive and expressive information-seeking activities, and with Dervin’s (1998) “sense-making theory” in which individuals become aware of gaps in their previous information needs within a distinct time–space context and purposefully seek information from a variety of physical, social, and digital sources. Other researchers have explored more passive information-seeking activities, employing concepts such as “serendipitous information-retrieval,” in which individuals encounter information through happenstance (Toms, 2000). LIS scholars have found that members of minority groups, including African Americans, acquire and manage health-related information, often for specific diseases (Kaziunas et al., 2013; Morey, 2007) or to adhere to dietary recommendations to manage particular health conditions (Senteio & Veinot, 2014). Here, we extend this investigation and examine both passive and active information-seeking behaviors routinely used by African American adults, specifically and solely related to food and eating practices, and then explore whether and how the participants accepted healthist messages.

Although sociologists have developed a plethora of definitions of knowledge (McCarthy, 1996; Williams & Popay, 2001), they concur that knowledge is not based in individual cognitive processes but rather is a collective endorsement of information that requires a social assessment of “meaning.” Similarly, we accept the definition as “any and every set of ideas accepted by one or another social group or society of people, ideas pertaining to what they accept as real” (McCarthy, 1996, p. 2).³ Knowledge, therefore, is not equivalent to collective determinations of truth or reality.

Sociologists and other social scientists have explored the nature of lay knowledge (knowledge of the people—the laity—not of experts), most notably in the areas of the environment, health, technology, and public policy (Brown, 1992; Epstein, 1996; Irwin, 1995; Pols, 2014). Although these researchers might examine how lay people incorporate expert information into their understandings, primarily they have focused on the ways people acquire and deploy publicly available information in the course of their everyday lives. Increasingly over the last decade, social researchers have scrutinized lay knowledge about such quotidian matters such as diet and food choice. Investigators across multiple disciplines have noted that socio-cultural context informs and shapes attitudes about nutrition and eating practices (Devine, 2005; Lupton, 1996, 2013), and conceptualizations of what “healthy eating” means (Bisogni, Jastran, Seligson, & Thompson, 2012). Consequently, researchers have assessed how social class and ethnic/racial differences specifically affect eating practices (Ristovski-Slijepcevic et al., 2008) and concepts of healthy eating (Devine, 2005; Lupton, 1996, 2013). Some, in examining how African Americans define healthy eating, have compared individual definitions of the concept either to their practices (Lake et al., 2007) or to standardized criteria (Acheampong & Haldeman, 2013). Meanwhile, interpretivist researchers (Bisogni et al., 2012) have assessed the meanings that African Americans accord to “healthy eating.” Although these approaches tap the socio-cultural meanings that individuals give to various foods, researchers (outside of LIS) have largely ignored the conceptual distinction between information and knowledge, and therefore have not explicated the social processes by which African Americans acquire information and then transform it into knowledge.

Healthism

To address these concerns, we draw upon constructionist and critical analyses of “healthism,” defined as a philosophical orientation toward

the pre-occupation with personal health as a primary … focus for the definition and achievement of well-being; a goal which is to be attained primarily through the modification of life styles … healthism treats individual behavior, attitudes, and emotions as the relevant symptoms needing attention.

(Crawford, 1980, p. 368)

Analysts such as Crawford trace the emergence of the individualist ethos of healthism to the 1970s when people began to have greater access to information and knowledge became more democratized (Stehr, 2001). As a result, lay knowledge (culled from everyday information sources) about a range of health conditions and practices, including eating practices, has increased (Bell et al., 2011; Metzl & Kirkland, 2010). From a historical perspective, the individualistic focus of healthist discourse eclipsed a more collective perspective that prioritized responsibility for community well-being (Crawford, 2006). Health became a “super value,” subsuming all that the quest for a good life had previously entailed (Crawford, 2006). Furthermore, the boundaries of what health entails expanded; as Cheek (2008) notes, “being healthy increasingly means embracing a range of lifestyle choices and technologies that once would have been considered at the periphery of health” (p. 975). Health-promoting lifestyle choices now include not only those with potential negative health consequences such as rejection of tobacco and alcohol but also those which meet basic human needs such as diet, exercise, and sleep (Aphramor & Gingras, 2009; Bell et al., 2011; Biltekoff, 2013; Cheek, 2008). Finally, those who are privileged socially and economically are “able to position ‘health’ as a priority in their lives and have the economic and educational resources to do so” (Lupton, 2013, p. 297). Thus, healthist discourse has become a moral marker and driving force for creating what it is to be a good, successful, and responsible citizen (Biltekoff, 2013) and places the onus for “performativity” of health practices on the individual (Cheek, 2008).

Healthicization

Healthicization, a concept introduced by Conrad (1992),⁴ refers to a more proscriptive process, in which individuals are exhorted to change their behaviors and to actively seeking out healthist activities and knowledge. As Ayo (2012) notes, “the healthy lifestyle culture as we know it … can be seen as a monolithic one whereby values such as prudence, hard work, responsibility and asceticism are expressed” (p. 101, emphasis added). Good citizens are expected to make healthy choices (Petersen et al., 2010). Significantly, any deviation from the monolithic healthy lifestyle is not morally acceptable. Therefore, Armstrong and Murphy (2012) observe that resistance is not unidimensional (with active resistance and passive acceptance as two distinct endpoints) but a complex contextually mediated process in which some recommendations might be followed but “those that do not fit with existing experiences or beliefs are resisted” (p. 321). Similarly, critical scholars point out that healthist discourse “routinizes dominant understandings and eclipses alternative ways of telling and knowing ….” (Aphramor & Gingras, 2009, p. 97). Such discourse presents a “logic of choice,” offering individuals a range of ideal choices and actions to support healthy lifestyles and marginalizing any alternatives (Henwood, Harris, & Spoel, 2011). Those who violate social expectations and do not engage in individual health-promoting practices are subject not only to social approbation, but where egregious violations of moral responsibility exist, medical authorities use the presumption of risk to justify state surveillance and regulation (Ayo, 2012; Bell et al., 2011; Metzl & Kirkland, 2010).

Recently, social researchers have made important contributions to the literature on Black communities’ experiences of healthicization. Some have explored African Americans’ (Doldren & Webb, 2013) and Afro-Caribbeans’ (Ochieng, 2013) perceptions of barriers to healthy lifestyles and identified culturally specific factors (e.g., social exclusion) that mediate healthist messages. Other analysts have scrutinized the interstices of obesity, body image, and eating practice and explored the ways in which African Americans and other marginalized racial/ethnic groups question and develop counter-hegemonic understandings of the healthist framing of obesity discourse, normative body images, and/or healthy food practices (Acheampong & Haldeman, 2013; McPhail, 2013; Ochieng, 2013; Ristovski-Slijepcevic et al., 2008). Nonetheless, with few exceptions (Kean, Prividera, Boyce, & Curry, 2012), researchers have not investigated the ways in which specific social and racial groups, including African Americans, acquire information about eating practices—regardless of whether they seek out sources that explicitly encourage healthy eating.

Method

In this article, we report on data from a larger multi-stage study about fruit and vegetable consumption among African Americans in two Kentucky communities. West Louisville is an urban area with inequalities in education, income, and food security.⁵ In contrast, the small city of Hopkinsville, although food insecure, is more racially integrated with slightly higher levels of educational attainment and income. Located in north central Kentucky, West Louisville represents a geographically distinct and segregated section of the city of Louisville. A total of 79% of its residents (51,000 of 64,741) are African American (Crutcher, 2013). At the time of the study, West Louisville had one full-service grocer available per 25,000 residents (West Louisville Working Food Group, 2007). Hopkinsville is a county seat with 31,577 residents in a rural area of southwestern Kentucky. Compared with West Louisville, Hopkinsville has proportionately fewer (31.9%) African American residents and the median household income is higher (US$34,664 vs. US$21,733) but still below the state median of US$42,610 (U.S. Department of Census [USDOC], 2012). Greater Hopkinsville (Christina County) also has higher rates of food insecurity (21.1%) than the state (17.7%; Feeding America, 2011).

We have based this manuscript on data from semi-structured interviews conducted during the first stage of the larger study. Our overarching analytic question is, “How do African American adults in the selected communities adopt, understand, and live by their food practices?” Interviewers asked participants open-ended questions about household food purchasing, food security, eating practices, knowledge about nutrition, attitudes toward different types of food, perceptions of the socio-cultural influences on food choice, health status, and body image. Here, we only analyze the types of information sources mentioned by participants in response to the following open-ended statements and questions throughout the interview: “So the next few questions are about where you go for your information about food and about eating habits”; “Where do you get information about healthy eating?” “Who do you go to for advice about food and eating habits—and why?” “Who has inspired you in terms of what to eat?” “Has anyone ever inspired you to change your eating habits? How so?”

After pilot-testing the interview guide, we conducted 20 interviews in homes and public locations in each community (total = 40). To decrease (but not eliminate) differences in background and to potentially elicit a fuller recounting of participants’ life experiences, four African American members of the research team conducted the interviews. We selected the initial participants using the extended networks of research team members and administrative staff in the Communication and Pan African Studies Departments who either currently resided or had resided in West Louisville and/or Hopkinsville. We asked these individuals, as well as community organizations, to identify subsequent participants to diversify the age and gender composition of the sample. The team conducted interviews between November 2011 and February 2012.

Participants ranged in age from 25 to 80 years (M = 41.6 years). Approximately one third (n = 13) were male. Their self-perceptions about their eating behaviors varied, and were fairly evenly divided between those who described their diets as healthy, unhealthy, and “mixed.” The majority (n = 27) had at least some college or technical school education that is somewhat higher than found in their communities (46.3% of African Americans in Hopkinsville and 38% in Louisville have some collected education; USDOC, 2012). Although the academic leanings of the initial referents likely resulted in some bias seen in the relatively high educational levels of this snowball sample, the relatively low household income indicates socio-economic diversity. In Louisville, more than half of the participants had household incomes lower than US$20,000, and 80% had incomes lower than US$40,000. Hopkinsville participants had slightly higher household incomes: 35% reported household incomes less than US$20,000, and 55% disclosed levels less than US$40,000. A little more than one third (n = 15) of the participants received food assistance (Supplemental Nutrition Assistance Program [SNAP], and/or Women Infants and Children [WIC] subsidies).

We audiotaped our interviews, which lasted an average (mean) of 52 minutes. Each participant received a US$40 gift card. We assured participants that confidentiality would be maintained and redacted all identifiers from the transcripts. The University Institutional Review Board reviewed and approved the research.

We used the qualitative software, QDA Miner, and inductively analyzed transcripts of the interviews using grounded theory and the constant comparative method (Glaser & Strauss, 1967). The lead author initially coded a subset (n = 8) of transcribed interviews, using thematic analysis (Saldaña, 2013), to identify broad themes across interviews related to “lay knowledge.” Emergent categories included the source of information (e.g., family, Internet) as well as its purpose (e.g., instrumental/how-to, analytical). We used these initial themes as sensitizing concepts to guide the analysis of subsequent interviews. As we coded additional interviews, we used focused coding (Saldaña, 2013) and compared new interviews with emergent categories, re-conceptualized coding categories, and wrote analytic memos to clarify categories. We added axial codes (or sub-categories) that assessed additional dimensions about the contextual nature of the information sources (e.g., type of authority—technical, cognitive, moral) and the ways in which information was accepted or rejected as knowledge (e.g., agency and micro-resistance). The analytical framework reached theoretical saturation when additional interviews produced no new insights; we then used existing code categories to consistently code all interviews. All research team members reviewed and approved the codes and final analyses.

We employed a social constructionist approach, informed by critical public health, to inductively examine information sources of lay knowledge and explore the social meanings that study participant accorded these sources. In bracketing other issues including the participants’ definitions of healthy eating that deserve separate attention, we examined a range of information resources without restricting them solely to “healthy eating.” Finally, we explored the implications of our results for research on healthicization as we contextualized individual health practices against the backdrop of emic community-based resources including familial engagement and alternative health practices.

Results

Consistent with Giddens’ (1991) contention that we live in a data-inundated environment and have access to many expert sources, participants actively used a diverse range of resources to access information about food preparation and eating practices. All participants consulted at least one source for information about food and eating, including health professionals, the media (television, the Internet, print), specific family members, other significant individuals in their lives, and organizational or community programs. Most consulted several sources (M = 4.1, range = 1 to 9). In the subsections below, we analyze patterns among these sources and the social contexts in which participants sought and/or accessed information. Participants primarily described conscious, active strategies in acquiring information about food, although some also recounted instances of serendipitous information retrieval (Toms, 2000). Furthermore, although there are ways in which some study participants used these information sources to consciously create a healthy lifestyle (and embrace healthism), considerations and influences outside of a healthist context were also salient and influenced their adaptation of information about eating practices. In instances where individuals did not accept healthist exhortations to engage in healthy eating practices, their philosophies and actions reflected a contextually mediated and complex approach to resistance that moved beyond the dichotomy of active resistance and passive acceptance of healthism (Armstrong & Murphy, 2012). Finally, participants acquired several types of knowledge (technical knowledge, advice, and inspiration) through socially mediated information sources. Unlike previous studies on lay knowledge, our data reveal multidimensional, socially contextualized information-seeking processes. Based on the emergent codes from the interviews, we have used the concepts of agency, authority, and micro-resistance to analyze how participants used information sources to shape their everyday lay knowledge about diet and eating practices.

The Influence of Agency, Authority, and Healthism on Lay Knowledge

Study participants made only passing mention of formal authoritative and regulatory bodies as sources of knowledge, such as government food-related programs. According to Jordan (1997), although many ways of knowing exist, the social perception of authoritative knowledge is that it is legitimate, tacit, and naturally created; it “both builds and reflects power relationships within a community of practice” (p. 56). As a result, authoritative knowledge is persuasive, not because it is “correct” but because it has been socially constructed as a natural and taken-for-granted resource. Perhaps because of these characteristics, even though one third of the participants received some type of food assistance, only a few cited government programs as a source of information, and these participants expressed contrary assessments of the information. Some accepted the healthicization embedded in programs such as WIC that dictated which foods were healthy and worthy of consumption:

WIC has certain items that you can get which are supposedly healthy … You have to get fruits and vegetables. You have to get peanut butter, beans … it’s better to have this accessibility to the healthier food items and someone to show me that “oh, he [son] should be eating this instead of the colorful cereal that he wants.”

(28-year-old female)

Another participant, however, questioned WIC administrators about the legitimacy of some regulations, asking why the program permitted some food items but not others:

I always have a list of questions that I wanna ask about the different things that we eat … “why don’t you have this on the list for the WIC services?” and “why don’t you have that?”

(38-year-old female)

As an act of micro-resistance (Abou-Rizk & Rail, 2014), this mother challenged the health-promoting agenda of the program. However, this, too, was an exception: Participants rarely mentioned the intrusion of governmental and other authoritative or expert sources into their information-seeking practices. Instead, they emphasized lay-based community resources that shaped their knowledge about food practices.

Media Sources: The Influence of Technical Information on Lay Knowledge

Participants reported wide-spread use of a range of media sources including television, the Internet, as well as print media. With few exceptions, study participants used at least one media source to obtain technical information about food preparation and nutrition. Demonstrating Crawford’s (2006) contention that “Health consciousness has become increasingly unavoidable” (p. 415) in the 21st century, participants experienced the ubiquitous nature of health-related information in the mass media: One need not deliberately seek it out. Participants sometimes acquired information in unanticipated but potentially impactful ways:

As far as eating habits, I might not necessarily seek it out, but I will hear it just from reading and TV … I do listen when they talk about things dealing with diet.

(30-year-old male)

Despite some research demonstrating that lower income and minority individuals are less likely to use digital technologies (Miller & West, 2009), almost half of the study participants consulted the Internet. Some referred to favorite sites that had become part of their standard information-seeking repertoire: “I go to bettycrocker.com, recipes.com. I’m just—I’m always looking for something new, something different” (38-year-old female). Others conducted more wide-spread searches: “(I) do a lot of Google … or Bing … no specific site that I go to” (38-year-old male).

Participants had different goals for accessing these media sources. Some participants actively sought information to support their individual efforts to achieve a healthy lifestyle and support an ethos of healthism. They purposively used search engines to gather information about specific nutrients or consulted a television show about how to lose weight. When asked what types of information he looked for on the Internet, one man replied, “Certain things about fat levels, sugar levels, carbs, how to cut back on your cholesterol” (38-year-old male). Another said, “I like Dr. Oz … He tells you what you need to do to get it in order. I’m thinking I’ll get it in order and I’m thinking I’ll lose about 20 some pounds” (57-year-old male). As Lupton (1996) has noted, learning about and becoming expert in the micro-nutritional value of food has become a salient feature of actively achieving a healthy lifestyle. Nonetheless, although many participants actively sought information on the Internet, with the exception of directly consulting health or dietary professionals, none referred to other expert information sources (such as academic journals).

Although none of the participants demonstrated a “consumerist frenzy” (Galvin, cited in Ayo, 2012) with extensive purchases of health-related goods (a behavior associated with the moral imperative to be a good citizen in a capitalist society), they were active in the health-related marketplace. Prior to making a purchase, some participants read reviews about new food or food-related products:

… if someone’s putting out a product I’ll normally go in and look at the reviews on the product …

(48-year-old male)

… if I am watching a TV show and I see something, I will kind of Google it and get more information about it.

(28-year-old female)

Nonetheless, even though some participants purchased products designed to help them achieve a healthy lifestyle, they did not necessarily accede to a healthist perspective or adhere to prescribed health regimes. Instead, they demonstrated their agency (i.e., ability to act independently of constraining social expectations or power) in response to what they saw as untenable practices in the context of their lives:

I buy all those magazines … Women’s Health and all that … they always have “Lose 30 pounds in a week” … and then they give you like a month’s worth of recipes and I’ll follow it for about two weeks [laughs]

(28-year-old female)

Sometimes, participants said they might buy new ingredients “just to see,” but did not actually use them: “I really don’t do it” (26-year-old female). Others explained that they weighed the information they obtained and might consciously decide not to use it:

I just go and see what they [Internet sites] have to say and then I decide whether I wanna use the information or not.

(26-year-old male)

Although some analysts would reasonably consider these responses to be strategies of translation and social accommodation (Kaziunas et al., 2013), others (Armstrong & Murphy, 2012) have assessed similar transformative acts to be resistance. Given the monolithic mandates of healthicization, we consider these deviations to be small, everyday acts of passive resistance against prevailing social expectations to use health-related products or information.

Finally, media celebrities inspired some participants in ways that decentered healthist messages. Although participants did not have an actual relationship with them, they constructed a meta-framework that associated the celebrity with their own identity, citing characteristics that reflected shared subjectivities (e.g., age or geographic affiliation). Furthermore, although many cited television shows such as Dr. Oz and The Chew that largely support a healthist agenda, other participants referred to celebrities who were not known for extolling healthy eating:

Paula Deen—I take to her because she cooks a lot like me … And she reminds me of an older version of myself.

(28-year-old female)

Another participant described how athletes inspired him and showed him how to live his life, not only because of their physical characteristics but because they were “being a whole person”:

Basically the body builders … because [they] just try to get the spirit, soul and body and … being a whole person.

(48-year-old male)

Although this participant chose a body builder as a role-model, his comments suggest that he reinterpreted and modulated the healthist message often conveyed by these celebrity athletes: Being a whole person was a priority.

Physicians and Cognitive Authority: The Influence of Advice on Lay Knowledge

Consistent with some of the literature on health-seeking behaviors (Morey, 2007), participants consulted health professionals with expertise in food and eating habits (physicians, or nutritionists) for specialized information and advice. They accorded these professionals “cognitive authority,” which has been defined as “the influence on one’s thought that one would consciously recognize as proper” (Wilson, 1983, p. 15). Because not all sources are evaluated similarly, people tend to seek information from sources that are viewed as competent and trustworthy, that are more “credible, worthy of belief” and therefore, have cognitive authority (Wilson, 1983, p. 15). In this study, participants tended to attribute cognitive authority to their physicians within the socially proscribed arena of the doctor–patient relationship. As Wilson (1983) has said, “having [cognitive] authority is thus different from being an expert, for one can be an expert even though no one else realizes or recognizes that one is” (p. 14). Although previous research has shown that African Americans tend to be distrustful of physicians (Boulware, Cooper, Ratner, LaVeist, & Powe, 2003), these study participants did consult physicians, citing the comfort that they derived from an expert with whom they had an established relationship:

I usually talk to my doctor or I’ll research it myself … But usually, I talk to my doctor … just because I feel like she knows me better, you know? I’ve been with her for a long time and she’s very informative of that kinda stuff … She makes me feel comfortable.

(27-year-old female)

Nonetheless, participants described a complex and nuanced approach to healthist messages proffered by health professionals. Participants occasionally mentioned instances in which they pursued a health-related body practice (e.g., working with a personal trainer), and “had a conscience” about dietary choices, but they simultaneously described their resistance and intentions to pursue their own choices about what to eat:

I have a personal trainer … he gets on me but I still do what the hell I want to do … every now and then I do have a conscience about what I eat so, and I will just kind of get his opinion.

(28-year-old female)

Another physician, who was “cool” and did not press the issue, told a participant to lose weight, but that woman did not comply:

Me and my doctor are cool. So him telling me, “you are fat. You weigh 180 pounds. You’re obese.” I was just like, “OK.” … It’s like me telling him, “Don’t eat meat.” … He’s a different breed of a doctor. [Laughs]

(26-year-old female)

Instead, she personalized her quiet resistance to his healthist dictates. She criticized him for eating meat, knowing that he also would not change. Others similarly questioned the legitimacy of their physician’s advice when the physician themselves had an overweight body that appeared to belie their own healthist advice:

I talk to him sometimes but he—I don’t like some of what he tells because he always had a big plan for your life. But he’s heavier than me, so it’s like if it’s that easy, why are you so heavy? You know? But I mean I talk to him. But I look up anything that I want to know, I usually look it up online. I don’t really ask …

(32-year-old female)

As a result, this participant minimized interactions with her physician. She preferred to seek information elsewhere rather than be subjected to a gaze that extended beyond medical jurisdiction and included “big plan(s) for your life.” In these accounts, participants questioned the trustworthiness of advice not followed by the advisor. As Wilson (1983) has observed, “On some questions, one may speak with authority; on other sorts of questions one might speak with none at all” (p. 14). In these ways, despite the recognized cognitive authority of health professionals in the medical arena, some participants resisted their social expectations by not incorporating healthist messages into their everyday understandings of food practices and not modifying their eating practices.

Emic Community Leaders and the Influence of Advice on Lay Knowledge

Several participants mentioned that their Tai Chi instructors also provided guidance about food and nutrition. These instructors exemplify emic community resources, reflecting locally contextualized experiences, values, and shared histories. Although the participants did not identify these specific instructors as African American, there are several high-profile African American Tai Chi instructors across the dozen or more Tai Chi societies, associations, and training centers in Louisville. As study participants recounted, the Tai Chi trainers promoted healthist moral imperatives that shifted the onus for living a healthy life on to individuals. For example, several mentioned that their instructor counseled them to follow a diet appropriate to one’s age and health condition:

My tai chi instructor … tells us about different food items that we should be eating … and drinking at our age. So he gives us tips ….

(54-year-old female)

Another instructor advised a participant to follow a specific diet low in acid and high in alkaline and emphasized the consumption of fruits and vegetables to balance the body’s ph levels:

And giving us—just general information otherwise we might not have known. Like the importance of the ph balance. I would have never thought about that.

(26-year-old male)

This message, although healthist in nature, is unorthodox. The professional literature has been skeptical of claims that the diet counters the effects of cancer, diabetes, heart disease, and osteoporosis (Huebner et al., 2014). Nonetheless, some traditional and alternative practitioners, such as this Tai Chi instructor, do recommend the diet, illustrating both the complexity of healthist discourse and the need to situate quasi-hegemonic messages within local contexts.

Familial Sources and the Influence of Inspiration on Lay Knowledge

As in previous studies focusing on Black populations (Brown, Thornton, Smith, Surkan, & Levine, 2014; Doldren & Webb, 2013; Morey, 2007) and aggregate population-based studies (Delormier et al., 2009; Falk, Sobal, Bisogni, Connors, & Devine, 2001), our participants noted that family members also served as an important source of information for both healthy and more traditional food preparation. Women, in particular, encouraged the preparation of customary dishes and ways of eating learned from their mothers and grandmothers, even though, in certain instances, the method (frying) is not considered healthy today:

I learned how to cook from my mother and my grandmother, both grandmothers’ actually … I’m repeating the cycle of frying pork chops and using the flour to make the gravy so yeah it is the same, definitely the same.

(32-year-old female)

Similar to the findings of other studies (Smith, Kromm, Brown, & Klassen, 2012), family-based traditions continued to influence the eating practices of these study participants. Other participants, however, limited their consumption of traditional foods, such as chitlins, and used “rhetorical strategies of resistance” (Murphy, 2003) to reinterpret these foods as part of a healthy lifestyle. In doing so, these participants resisted complete accommodation to a healthy diet:

I got most of it from my mother when I was growing up because she didn’t fix a lot of greasy foods or whatever. Occasionally, once a year we might have chitlins, once a year you might have a pig foot. That’s the same thing I do now.

(54-year-old female)

Familial members reminded participants about their shared cultural repertoire of food, rather than exhorting them to engage in new or different eating practices.

In these communities, individuals often, but not always, had constrained budgets. One participant described how his sister-in-law (a butcher) shared strategies to stretch meals:

she [said] … you can fix the egg noodles like this and then you can have it with … chicken … So I started baking chicken and then pouring the noodles … that kind of stretched it and gave me a couple more meals.

(57-year-old male)

Although families might do “little things” to alter recipes to be healthier, in deciding between eating healthy or affordably, the choice often was “you got to get what you can get.” Therefore, participants expanded their conceptualization of healthy lifestyles/eating to incorporate broader cultural and social forces such as marginalization and disadvantage (Ochieng, 2013). They also used interpretive strategies to translate prescriptive information into meaningful and actionable ways that were amenable to their particular social contexts (Kaziunas et al., 2013):

… my mom had a story where she will use turkey instead of pork in her greens and there’s other little things … that we have changed … but … it’s easier to eat what you can get affordable and sometimes not the healthiest but you got to get what you can get.

(28-year-old female)

Participants’ economic situations required that they translate epicurean dictates into more manageable practices even if that meant transgressing dominant healthist dictates.

Participants also sought advice from family members with whom they had shared experiences, who could directly assess participants’ eating practices and, in some cases, persuade them to eat in different and/or healthier ways. Consistent with the literature on gendered roles in food selection and preparation across a variety of cultural backgrounds (Szabo, 2011), most of those who sought advice in this study consulted female family members which underscored the importance of mothering traditions in these African American communities (Thomas & King, 2007). Participants accorded many of these family members moral authority for becoming adherents to “healthy living” and the advice these women gave supported conscious individual efforts to “eat healthier”:

My mom. And because she’s into this healthy living and she’s been trying to get me to eat healthier for many years—before I picked up so much weight …

(32-year-old female)

Although other female family members offered advice that partially reflected their cognitive authority (e.g., from being a healthcare provider), their moral authority as a highly healthy person predominated:

My aunt … She’s a registered nurse … And if I have problems I have to call her because she’s the most healthiest person I know …

(38-year-old female)

Most significantly, however, family members not only provided advice, but they were the most common sources of inspiration. In contrast to celebrities and other food-related media sources, these real life role-models often shared the experiences of the participants and provided emic sources of inspiration. Some described how family members’ health conditions inspired the entire family to eat healthy foods:

I guess my family … We have a family dinner over at my Auntie’s house every Sunday [laughs]. So, we always have different foods and stuff [pauses] ‘cause my cousin, she’s the one got us eating this yogurt, and the multigrain cereals … she has MS and she’s trying to keep her weight down.

(44-year-old female)

Although examples such as this support previous research (Falk et al., 2001) that identified the pivotal influence of health crises in changing food consumption, they also challenge the individualist framing of healthicization. Participants spoke about individual responsibility for healthy eating, but those healthist messages were incorporated into communal eating practices within their families. Healthy eating became a familial- or community-based practice that reflected both a “logic of choice” (with constrained and socially sanctioned choices) and a “logic of care” (Henwood et al., 2011). The participants’ accounts reframed the moral responsibility for healthy eating as a communal one, thus repositioning the eating practices outside the domain of healthicization.

Summary and Conclusion

Our findings are consistent with previous research on healthism (Falk et al., 2001) documenting the public’s use of a wide variety of information sources about health and nutrition. Although the size and composition of our sample pose limitations, our article also supports research that critiques the wide-spread cultural belief that socially perceived “problem populations” (McPhail, 2013) do not understand the concept of healthy eating and demonstrates that African Americans are aware of food-related health issues (Doldren & Webb, 2013). Although our participants reported that their eating practices were affected by economic disadvantage, unlike other studies (Ochieng, 2013), we did not ask these participants about, and they made no overt mention of, racism or social exclusion as factors that framed their dietary choices. Furthermore, African Americans in this study were savvy users of health-related media, technology, and consumer goods. These findings confirm current research (Smith, 2011) showing African Americans adopting digital technologies.

Typologies of Lay Knowledge

Unlike previous studies on lay knowledge, we implicitly conceptualized “information-seeking” as a multi-dimensional activity in which lay participants prioritized and used sources in specific social contexts. We asked participants about where they got information, advice, and inspiration about food and dietary practices in the course of their everyday lives. Participants used various information sources in different ways. They sought out health professionals for medical advice that often incorporated exhortations about eating (although that advice might not be heeded). Study participants almost universally used media sources (television, the Internet, and print) to acquire substantive information about food and eating practices. Family members also provided both substantive information and inspiration that participants used to support, reinterpret, and resist healthist eating practices. In these accounts, our participants described how they used everyday information sources to inform different types of lay knowledge.

Habermas (1971) identified three types of knowledge (technical, practical, and emancipatory) that align with our participants’ accounts. According to Habermas, technical knowledge is related to instrumental action whereby people access “how-to information” to learn how to control and manipulate their environment. This type of knowledge is primarily rational (concerned with cause and effect) and is task-specific (Mezirow, 1981):

As a strategic type of knowledge, its goal is to create efficiency, or to successfully complete a task without deviating from activities contributing to the task’s successful completion. It produces incremental capacities for social and economic action or an increase in the ability of “how to do it.”

(Stehr, 2001, p. 498)

Examples include seeking information about how to prepare certain meals or purchase foods at a lower cost. In contrast, the other two types of knowledge, practical and emancipatory knowledge, are both more deeply embedded in social relationships. Practical knowledge relies upon “ … reciprocal understanding, shared knowledge, mutual trust, and accord with one another” (Habermas, 1979, p. 3). Interpersonal advice exhibits these characteristics and is one practical way to use information: People ask others to advise them about what they should do to change their food practices. Finally, emancipatory knowledge offers freedom from “libidinal, institutional or environmental forces which limit our options and (from) rational control over our lives … insights gained through critical self-awareness are emancipatory …” (Mezirow, 1981, p. 5). When people are inspired by others’ lives to act in new ways, such as increasing the range or quality of their diet, they are empowered and experience emancipatory knowledge.

Existing research tends to focus on lay knowledge that is technical and overlooks socially contextualized ways in which people are advised or inspired to eat. Although all participants in this study consulted at least one source to obtain technical information about food and eating, almost two thirds sought advice about food. Most of those who did not seek advice admitted that they were already cognizant of healthist dictates: “It’s basically commonsense … everybody pretty much knows … what we shouldn’t be doing” (44-year-old female). Others, however, elected to remain outside the purview of healthicization and made their choices about food based on other preferences: “I’m comfortable. I just eat what I want” (38-year-old male). Similarly, although most of the participants described how others had inspired their eating habits, almost one third said others had not inspired them. Most of those who did not seek inspiration described themselves as unhealthy eaters (who also did not seek advice about food, a further indication that they did not feel morally compelled to accede to healthist discourse). Although it was beyond the scope of this formative study to explore patterns across the types of knowledge, our results suggest that if we refine the ways in which we conceptualize information-seeking to build knowledge and apply Habermas’ tripartite typology of knowledge, we might be better equipped to understand the influence of social contexts, including those that resist, as well as support, healthicization.

Rather than conceptualizing the use of information-seeking as a singular activity, we suggest that future researchers use typologies, such as Habermas’ tripartite typology, that delineate information-seeking behaviors as multi-dimensional social processes. In doing so, research on eating practices could redefine types of knowledge to encompass different types of lay knowledge (technical, practical advice, and inspiration). We especially encourage additional research on the lived experiences of those who access technical information, but do not seek advice or inspiration about healthy eating, and thus remain outside the bounds of healthist influences.

Healthicization, Lay Knowledge, and Diet-Related Research in Black Communities

Results from this article have additional implications for the ongoing study of healthicization in Black communities. First, unlike much of the previous healthicization research in which individual choice is constrained by social expectations to engage in explicit and conscious regimens of health-promoting behaviors, this article supports emergent research showing that marginalized communities exercise agency (Abou-Rizk & Rail, 2014; McPhail, 2013). In this article, we drew upon Armstrong and Murphy’s work (2012) that formulated resistance as a multi-dimensional and nuanced concept, including not only overt contestation or non-acceptance of healthist messages but also more subtle acts of resistance. Sometimes, participants did accept culturally shaped messages about diet, nutrition, and eating practices they encountered in their lives and incorporated them as lay knowledge. Other times, however, they created counter-hegemonic conceptual frameworks or “rhetorical strategies of resistance” (Murphy, 2003). Some participants decentered healthist messages in media accounts of food celebrities to focus on broader (non-health) understandings of the self. Furthermore, similar to results in studies on obesity discourse in racially marginalized groups (Abou-Rizk & Rail, 2014; McPhail, 2013), these African American Kentuckians created “micro-resistances” to the dominant neoliberal discourse about health. Participants questioned the authority of government food programs, obtained but did not use health-promoting information from media accounts and physicians, and reinterpreted the consumption of traditional foods as “healthy” when consumed occasionally. Although it was beyond the scope of this article, future research could assess how community members themselves assess their actions which deviate from the dominant healthist agenda: Are they acts of translation or acts of resistance?

Finally, as in other community-based studies on racial and ethnic minority groups (McPhail, 2013; Ristovski-Slijepcevic et al., 2008), emic sources (family members, Tai Chi instructors) informed the eating practices of community members. Participants often identified family members, particularly females, as sources of inspiration—findings that support other research on the role of females in (a) creating and maintaining family-based relationships through food practices (DeVault, 1991) and (b) imparting knowledge about food by engaging in food choice practices (Delormier et al., 2009), as well as research on (c) the centrality of the African American family (Brown et al., 2014; Morey, 2007) and (d) the legacy of mothering traditions in the African American community (Thomas & King, 2007). These family members not only emphasized individual-level skill-building and confidence to encourage better eating behaviors but also served as a communal resource, providing information and encouragement to the study participants. Emic resources, however, vary across communities. Tai Chi instructors may not exert influence on other African American communities with a more limited history of the practice than in Louisville. Further research could investigate the degree to which Afro-centric Tai Chi centers support healthist (including unorthodox healthist) discourse in other communities and whether other counter-hegemonies exist in those local contexts.

To our knowledge, this study is the first community-based study to focus on eating practices of African Americans that documents, from the participants’ perspective, the specific sources of information they used to variously reify or resist healthist notions about eating practices. Future research can build on this work as scholars and policymakers continue to listen to community members recount how they use multiple information sources to shape their collective understandings and knowledge about eating practices.

Author Biographies

Deborah A. Potter, PhD is an associate professor in Sociology at the University of Louisville, Kentucky, USA.

Lisa B. Markowitz, PhD is an associate professor in Anthropology at the University of Louisville, Kentucky, USA.

Siobhan E. Smith, PhD is an assistant professor in Communication at the University of Louisville, Kentucky, USA.

Theresa A. Rajack-Talley, PhD, is an associate dean of International, Diversity and Community Engagement Programs in the College of Arts & Sciences and an associate professor and director of graduate programs in Pan African Studies at the University of Louisville, Kentucky, USA.

Margaret U. D’Silva, PhD, is a professor in Communication and director of the Institute for Intercultural Communication at the University of Louisville, Kentucky, USA.

Lindsay J. Della, PhD, is an associate professor in Communication at the University of Louisville, Kentucky, USA.

Latrica E. Best, PhD, is an assistant professor in both the Pan African Studies and Sociology departments at the University of Louisville, Kentucky, USA.

Quaniqua Carthan, MSW, MA, was a research assistant in the Department of Communication at the University of Louisville, Kentucky, USA, and now is the program coordinator for the Safe & Healthy Neighborhoods, Office of the Mayor, Louisville, Kentucky, USA.