Abstract
Background: The increase in the Indian and South Asian population in New Zealand creates demand for culturally appropriate hospital food services. As these peoples have rich food cultures, traditions, and strong religious beliefs and practices, it is important to explore these factors when identifying the food preferences appropriate for NZ hospital menu standards. Health Partnership NZ’s national nutritional standards for adult inpatients are currently under revision; as part of this process, the District Health Board (DHB) Dietitians Leader Group need information on Asian groups’ experiences and expectations of NZ hospital food services. This study investigates Indian and South Asian separately as the Indian population group dominates the South Asian population in New Zealand.
Objective: To determine and understand Indian and South Asian adults’ food preferences when they are in hospital and their experiences of New Zealand hospital food service, to enable Food Services to better meet the food preferences of this ethnic group and thereby their nutritional needs.
Design: This exploratory mixed method study using focus groups, a questionnaire and semi-structured interviews, was undertaken with Indian and South Asian people living in Auckland. Three sequential phases were necessary to develop and administer a tool suitable for exploring Indian and South Asian patients’ experiences, expectations and food preferences. A literature review and complementary online survey (Phase 1) with a small convenience sample (n=2), informed the development of topic areas for subsequent focus groups, questionnaires and interviews. In Phase 2 two focus groups were conducted with Indian and South Asian community groups based on religion; Hindu (n=8) and Muslim (n=7). Each focus group explored food preferences when well and unwell, and expectations of NZ hospital food services. Information gathered from these two phases informed the development of the questionnaire and interviews conducted in Phase 3 to assess the participants’ experiences of hospital food services and their cultural needs. Participants (n=20 tot: Hindu=7, Muslim=10, Sikh=3) completed a questionnaire and undertook a short qualitative interview.
Results: Thematic analysis of focus group transcripts indicated that three main themes captured factors influencing Indian and South Asian food preferences: religion, culture, and temperature and texture of the food. Findings highlighted preference for foods based on rice or roti with curry dishes, mainly dhal and vegetable curries. Similar findings were found in Phase 3 with a preference score of 80% for dhal curry and 70% for rice for foods participants would like to be offered in hospital. Interview results added Khichri, a traditional one pot rice and lentil dish, to this list of foods preferred when unwell. Overall religion emerged as exerting the strongest influence on food preferences. Specifically, Hindus require more variety in hospital vegetarian menu options, and Muslims had concerns regarding the source of food on Halal menu options. Hot temperature, and soft texture are key characteristics of food preferred when unwell.
Conclusion: The main findings of this study demonstrate that food preferences of Indian and South Asian adults when unwell, or in hospital, are influenced by religion and cultural food traditions. Preferred menu items and food service factors identified in this study provide the information required to enhance the national DHB adult menu standards and service specifications. Implementation of these changes will improve Indian and South Asian patients’ hospital food service experience and food intake. To the best of our knowledge, this is the first study to explore food preferences of Indian and South Asian patients in New Zealand.