Informing health-related behaviour change in Saudi Arabia : a social marketing approach

Abstract

Many Arab countries, such as Qatar, Kuwait and Saudi Arabia have a high prevalence of non-communicable diseases (such as Type 2 diabetes) where obesity is a risk factor. In Saudi Arabia, 30% of men and 40-50% of women are classified as obese (Alquout and Reynolds, 2013). This has led researchers to question the factors that have led to the high incidence of obesity, and in particular, the food choices motives and food-related behaviors made by Saudi citizens. Understanding these underlying factors influencing food and lifestyle choice will help to underpin social marketing support recommendations to change food-related behaviours targeted at Saudi women. This research adopted a mixed method research design consisting of three components. The first, determined the food choice motives of Saudi Arabian adults aged 15-65 (n=377) using the Food Choice Questionnaire (Steptoe et al, (1995). The second phase examined the barriers and facilitators to healthy eating using focus group methodology (n=25) and thematic analysis. Focusing on Saudi Arabian females, the third component explored the opinions of health experts via semi-structured in-depth interviews (n=13) using findings from phase two as elicitation prompts, in order to identify potential solutions to improve eating habits and increase exercise in order to reduce health problems of Saudi women. Insights gained from the results of each study were used to develop social marketing recommendations aimed at encouraging and facilitating healthy eating behaviors and exercise among women in the Kingdom of Saudi Arabia. Despite Saudi Arabian women being the target market for the recommendations provided by this thesis, both genders were included all stages of the data collection in order to allow comparative analysis. The results from the questionnaire identified 6 of factors as an important factors affecting food choice of Saudi Arabian adults. Significant factors included; taste, health and wellbeing, and convenience; while price, mood and sensory appeal were found to be less important to this cohort. The factors found to be motivating food choices of Saudi Arabian adults helped to inform the design, content and the participants’ requirement for the second phase, which was to gain a deeper insight into the questionnaire using focus group methodology. The results of the focus group identified a number of barriers to healthy eating which were similar for both males and females, particularly in relation to taste, individuals’ time constraints, will-power, culture and tradition and price. Although price and will-power were seen as major barriers for males, specific barriers for females included time constraints and customs and traditions, particularly at social events which hindered their ability to maintain healthy eating habits. Conversely, the predominant facilitator that encouraged both males and females to opt for healthier foods was the support from others, availability of healthy food, reasonably priced healthy foods and education/awareness of health and wellbeing. In addition, Saudi Arabian females viewed changes to diet and exercise and an investment in public transport to be vital facilitating factors. Health professionals interviewed highlighted additional psychological factors such as depression as a significant barrier to healthy eating. Structural solutions such as health centers with an educational focus and Governmental policies to support healthy behaviors were also identified. The results of the data collection culminated in the development of social marketing recommendations to encourage women to maintain healthier behaviours. Recommendations included both short-term and long-terms initiatives such as, improved health facilities including the provision of gyms, educational classes, dietitian support, subsidised transportation and smart phone applications, and an associated decision support tool to inform future implementation options.