Abstract
Background. Time insufficiency is frequently cited as a reason for poor dietary habits. This does not adequately explain the variations in how time is perceived as a factor in healthy eating. Aims. This study placed the eating behaviors of rural Australian women within the contexts of their stories to understand the factors that influenced healthy eating and how rural communities could enhance their health and well-being. Method. A three-phase sequential multimode narrative inquiry was used within four communities in rural Queensland, Australia. Each phase used a different mode of data collection: photo elicitation focus groups, narrative interviews, participatory workshops. Data were thematically analyzed iteratively to inform subsequent phases. Results. Nine final themes were identified. This article explored the theme of time and two contrasting perceptions of time sufficiency regarding healthy eating within a rural context during a drought. Discussion. Exploration of “time as a commodity” and “time as a duty” allowed a deeper understanding of time as a social and environmental determinant of health. Conclusion. Time’s influence on healthy eating is much more than the minutes it takes to prepare a meal. To fully appreciate its impact, time should be considered as a social and environmental determinant of health.
Amid busy lives, full of work and family responsibilities, many of us dream of having sufficient time to live healthier lives. In Western cultures, time is conceived in a way that encourages us to focus on its finite nature and thus we “run out of time” when trying to balance our work and family responsibilities and undertake healthy behaviors. This article examines the concept of time sufficiency and healthy eating identified in a narrative inquiry research project conducted with rural Australian women participating in the Country Kitchens program facilitated by the Queensland Country Women’s Association (QCWA). Time was identified as a key theme. In this article, we review literature related to time as a barrier to healthy eating and present findings related to time from the research project. We argue for a broader conceptualization of time beyond the finite and consider time as a social and environmental determinant of health.
Perceived time insufficiency has been identified as a barrier to healthy eating for at least 20 years. In a large European cross-sectional survey undertaken in the mid-1990s, Lappalainen, Saba, Mykkanen, and Gibney (1997) identified “lack of time” as the most frequently mentioned inhibitor to following nutritional advice. Since then, numerous international studies have confirmed this barrier. Welch, McNaughton, Hunter, Hume, and Crawford (2008) in an extensive cross-sectional survey of Australian women identified time pressure as a barrier to healthy eating related to long or unpredictable working hours, family and friend commitments. In a Canadian qualitative study, parents of preschool-aged children indicated a lack of time influenced the timing, duration, and types of family meals with healthy meals taking longer to make, or more effort to make when tired, and it was often easier to give children convenience food that they liked (Dwyer, Needham, Randall Simpson, & Saver Heeney, 2008). The issues around food preparation and healthy eating were also examined in a time allocation study of American midlife women that found time spent making meals was not always associated with adhering to nutrition guidelines, although those who spent less than 20 minutes making lunch or dinner tended to eat fewer vegetables (Chu, Addo, Perry, Sudo, & Reicks, 2012). In contrast, a cross-sectional study of American adults found more food preparation time was associated with healthier diets. This study also found working adults spent the least amount of time on food preparation (Monsivais, Aggarwal, & Drewnowski 2014). A Scottish health survey showed that women who reported a lack of cooking skills were less likely to meet fruit and vegetable intake recommendations, although taste, preparation time, and willpower were also barriers to healthy eating (Morrow, Ludbrook, Macdiarmid, & Olajide, 2016). Finally, a recent extensive cross-sectional survey of European adults identified time constraints as a barrier to healthy eating, along with a lack of willpower and taste (Pinho et al., 2018). This study found women were more likely to report decreased fruit and vegetable intakes when they had irregular working hours and busy lifestyles.
Venn and Strazdins (2017) have noted most of the previous research related to time insufficiency and healthy eating have been cross-sectional studies, and there has been an assumption of causality between time scarcity and health behaviors that do not account for how health or behaviors may affect time sufficiency. In their longitudinal study using Australian Household and Labour Dynamics data, Venn and Strazdins identified a lack of time could lead to a decreased intake of fruit and vegetables, eating more food overall, and eating more discretionary foods. They also started to unpack the notion of time itself, recognizing time scarcity was socially contextualized and relative; that is “how people’s time is valued as well as the capacity to control time varies by social status” (p. 99). Thus, they argued for time to be considered a social determinant of health. In this article, we use this idea of time as a social determinant of health as we examine the healthy eating behaviors of rural women. As the communities were experiencing drought at the time of the study, we extend the idea to examine how drought affects time and food production and is also an environmental determinant of health.
Method
Setting
Four rural communities in Queensland, Australia, were included in this study: One was in the north of the state, the other three were in the south. One site was a mining community, while three sites were traditionally farming and pastoral communities that had been experiencing drought conditions for some years. As the research was in partnership with the QCWA’s Country Kitchen’s program, the sites were determined by this program’s schedule. Attendees of the Country Kitchen’s program were recruited through the QCWA’s local networks and word-of-mouth. The program consists of a series of three education sessions related to healthy eating and practical cooking skills. These sessions are held monthly and are approximately 4 hours in duration. The research was explained in the first session. Data from phase one was gathered at the second session, and the results were presented back to participants in the third session.
Ethical approval was obtained through Central Queensland University (HREC20957).
Study Design
The research used a sequential multimode narrative inquiry design. Narrative inquiry is an emancipatory methodology that incorporates several approaches influenced by various disciplines and can be applied in individual and collective contexts (Chase, 2008). The study design consisted of three phases of data collection and analysis using different modes that built on each other. Each mode falls within the narrative inquiry methodological family and provided avenues to privilege the voices and experiences of participants, examine the contexts in which these experiences occur, and empower participants to develop their own strategies to address issues within their particular contexts, in association with external researchers and practitioners (Chase, 2008; Reissman, 2008). Specifically, the three modes were (1) photo elicitation focus groups, (2) narrative interviews, (3) participatory workshops.
Data Collection and Analysis
Meyrick’s (2006) quality framework for qualitative research guided the description of data collection and analysis processes and described how the findings were grounded in the data in reporting the research. These are based on transparency and systematicity of relevant processes.
Photo Elicitation
While primarily used in one-to-one interviews, photo elicitation has been used successfully in focus groups (Leonard & McKnight, 2015; Pettinger et al., 2017). Participants were offered the choice of providing a photograph or to use one of 20 photographs taken by Country Kitchens staff on previous travels around rural and regional Queensland. The photographs contained a selection of landscape and food-related scenes the staff thought would be of interest to participants. Once a photograph was selected, participants were given a printed blank template using the SHOWED framework, based on Freire’s empowerment model (Wallerstein & Bernstein, 1987 cited in Wang, Kun Yi, Wen Tao, & Carovano, 1998): What do you see? What is happening in the picture? How does this relate to our lives? Why does this happen? How could this image educate others? What can we do about it? Participants spent a few minutes writing down their thoughts about the photograph. Once everyone had completed writing, participants formed small groups of between four and eight to discuss their photographs and ideas. We digitally recorded these group discussions and thematically analysed the data focusing on concept coding and categorization (Saldana, 2016) to develop interim themes in preparation for the next phase.
Narrative Interviews
Narrative interviews are individual interviews that privilege the experiences of the participant, including ways the participant may choose to represent or interpret their experiences (Jovchelovitch & Bauer, 2000). These experiences are always embedded in the sociohistorical and thus, are useful in hearing the voices of those missing from the social and historical records and provide insights into the contexts in which those voices are located (Chase, 2008). Six open-ended questions were developed from the interim themes that guided the interview, but participants were also encouraged to express their stories (Liamputtong, 2013). Thirteen interviews were conducted with participants who volunteered from the second Country Kitchens sessions. These telephone interviews were digitally recorded, transcribed verbatim, and thematically analyzed, again focusing on concept coding and categorization (Saldana, 2016), to revise and further develop the interim themes in preparation for the final phase.
Participatory Workshop
For purposes of transparency (Meyrick, 2006), this phase of the research design presented the findings of the previous two phases back to participants to allow them to interpret the results as applied to their contexts and to develop strategies for their lives, individually and collectively. Participants formed small groups and brainstormed ideas around two questions: What strengths and assets are available in the community to support healthy behaviors? What are the priorities for healthy behaviors in this community? This group work was digitally recorded, and notes from each of the groups were also collected and included in the final analysis.
Participants
All those attending the Country Kitchens workshops were invited to participate in the research. While the attendees were mostly the same across the three workshops, there was some variation in participants in the different phases. Except for a couple of men coming to the occasional session in one of the communities, all participants were women, ranging in age from 20 to 80 years. Approximately half of the women lived on farming properties while the others lived in rural townships. Attendance of the workshops varied: one township only had 4 participants; one had around 20 come to most workshops; the other two ranged in numbers from 8 to 10.
Results
Nine final themes were identified: physical environment, access to food, social environment, the impact of Country Kitchens, othering, time, weather, food, health, and well-being. This article focuses on the time theme as it was a pivotal theme and played a role in aspects of other themes.
Time-related issues were regularly identified as participants reflected on the photographs. For example, participants spoke of time in relation to the seasons and the impact of drought: “It is a cycle of the seasons” and “Drought is part of our rhythm of existence in Australia, and the world.” They also noted the importance of time spent with others: “Time out and time together.” Time was understood in terms of being filled: “Work needs to be done and time on a farm needs a lot of work done in each season.” As time was frequently being mentioned in this phase, participants were asked to describe how time influenced their eating patterns and types of meals during their narrative interviews.
Two contrasting perceptions of time were evident from the interviews: those who felt they had time to focus on food and its preparation and those who did not. Those who perceived they had sufficient time were generally retired or at home tending to young children. For example, “I spend a lot of time at home, so I got plenty of time to cook our meals,” “I have lots of time . . . I’m retired,” and, “I suppose I’ve just got so much more time because I’m not going to the farm so often, so I’m enjoying putting more effort into what we need.”
Those who perceived time insufficiency were often living and working on farms. The level of labor required on these farms had increased significantly as a result of drought conditions. For example: Yeah, hard work, especially the last few years with this drought. It’s been sort of feeding and . . . it’s really, really tough, and time-consuming, and that affects your diet and everything . . . I feed the cows, I feed the horses, I feed the chicks, feed the dogs. I come last, sort of thing. I’m just getting to the stage, my kids are getting a bit older, and I’m realising that I haven’t taken hardly any time out for myself in the last 10 years. My husband’s been away working to pay for the farm, so I’ve been juggling kids, running the cattle property myself, doing things that I never thought I would do.
Another woman’s voluntary work affected her perception of time insufficiency: I used to do a lot of preserving when I lived down south, but I don’t so much up here. I just don’t have the time. We’ve got a lot of animals. I’ve got involved with the local animal rescue group, so it leaves very little time for doing stuff at home.
This woman felt that if she were more organized, she would better manage her meal planning. Another woman, while very busy running a farm and family, placed a high priority on eating healthy meals as a family: “I’m a big believer in everyone sitting down at the table and food being family time and everyone just sticking to their mealtimes and eating the right food and having good food.”
One way many of these rural women used to help manage their time was through extensive use of the freezer, a necessity for those who lived some distance from the nearest town. One woman reported, “Yesterday we had a busy day, but I had some leftovers in the freezer, so I just pulled them out, and then I put a few extra vegetables on.”
As such, those who perceived sufficient time for healthy eating had fewer out-of-home commitments were organized or prioritized healthy eating over other activities. Those who perceived insufficient time for healthy eating had extensive outdoor and indoor responsibilities that affected their energy levels and abilities to prepare healthy meals.
Revised interim themes at the end of the narrative interview phase included access to foods, preparation, and a range of physical, social, and personal environmental factors. Figure 1 summarizes these themes. This figure was used to provide feedback to the community groups in phase three. Time was conceptualized as a central link. Interestingly, the actions identified in phase three did not address time specifically. Instead they focused on cooperation and the use of existing community facilities.
Summary of themes.
Discussion
At a surface level, the theme of time from this study aligns with previous studies that equate a perceived lack of time with poorer eating behaviors. However, this does not provide us with a deep understanding of the relationship between time and healthy eating behaviors. Taken from a Western conceptualization of time, we contend that rural women place value and meaning on time-related issues and seek to balance their activities and behaviors through compensatory mechanisms. While these values and meanings are socially derived, environmental conditions also affect them. Thus, we agree with Venn and Strazdens’s (2017) conception of time as a social determinant of health but urge extending this also to consider time as an environmental determinant of health.
First, we need to articulate the Western concept of time because how time is perceived is culturally bound (Birth, 2004). Western readers will assume many of these concepts, but it is necessary to recognize this understanding of time is not universal. From this perspective, time is a finite construct, consisting of 24 hours a day, 7 days a week (what constitutes an “hour” and a “week” is socially constructed, but we assume a conventional understanding of these here). Time can thus be measured and is considered to be linear (there is a “before” and “after”; Birth, 2004; Klein, 2009). There is also a very strong use of time as a commodity within Western language: time can be “spent,” “wasted,” “saved” (Birth, 2004). Venn and Strazdins (2017) point to Marx’s understanding of time as a commodity—that is, traded as labor for wages—in their argument for time as a social determinant of health. In placing this emphasis on time as a commodity, there is a strong valuing of external, paid work. Unfortunately, there are not similar metaphors in the English language to describe the domestic and caregiving responsibilities that are still largely undertaken by women (Venn & Strazdins, 2017). In this article, we describe these as “time as a duty,” and they incorporate activities such as childcare and other caring responsibilities, housework, food preparation, and clean-up. Birth (2004) warns that there is a tendency in Western thought to assume that measures of time equate to the meaning placed on time and the value of that activity. An activity that takes a “long time” is more important than one that takes a shorter measure of time, but this is only sometimes the case.
Based on this conceptualization of time, much of the extant research suggests that we can maintain healthy eating behaviors when we can balance our work (time as a commodity) with our care/domestic responsibilities (time as a duty)—often phrased as achieving a “life–work” balance. We can maintain healthy eating when one of these responsibilities is heavy if we can “buy-out” pressure from the other. For example, when we have a lot of work responsibilities, we may be able to “buy-out” some domestic duties such as getting in a house cleaner or a nanny. Alternatively, healthy eating may be maintained when one has heavy domestic responsibilities and can be supported by the wages of a partner or welfare payments. Those women in our study who indicated they were retired are examples of this explanation. However, maintaining healthy eating behaviors becomes problematic when we have heavy work and domestic responsibilities simultaneously. Those women in our study who indicated they were time-poor are examples of this situation. They were not able to balance their work and domestic responsibilities and as a result their eating behaviors were adversely affected.
The rural women in this research who lived on farms affected by drought were spending enormous amounts of time feeding animals, time which would usually be exchanged for financial income. (Not only did they not have an income, but they also needed to spend money buying fodder for the animals.) They tried to compensate for this through convenience food (especially frozen meals), which were perceived as an attempt to “buy” more time and reduce domestic responsibilities, or they did not prepare food for themselves at all: “I’ve been trying to make sure I have breakfast of a morning, but sometimes it doesn’t happen.” Unfortunately, many cheap frozen meals are higher in fat and indicative of unhealthy eating. The research that identifies insufficient time as a barrier to healthy eating (Lappalainen et al., 1997; Monsivais et al., 2014; Morrow et al., 2016; Pinho et al., 2018; Welch et al., 2008) implies an “out-of-balance” situation. This inability to “buy” more time as a commodity or as a duty is likely to have greater health implications beyond healthy eating, including feelings of dissonance between what they would like to do and what they can do, leading to potential mental health issues (Indregard, Knardahl, & Nielsen, 2018).
Exploring time sufficiency and its impact on healthy eating in this way helps highlight time’s social construction: the social expectations around maintaining livestock in drought conditions regarding what should be done and by whom; the gender expectations around domestic responsibilities; and how, as a society, we could better support the health and well-being of those farmers who provide our food. Consideration of drought conditions also encourages us to examine the environmental impacts on time and its consequences for healthy eating, especially given droughts are predicted to be more frequent and more severe as a result of climate change (Ingram et al., 2016). Climate change has significant implications for farming families being able to eat healthy diets. Farmers will experience higher demands on their time to keep animals and crops alive under adverse conditions. They will see profit margins eroded over time, as more funds are more frequently needed to support stock with bought feed or replace failed crops, and there are fewer “good” seasons to recover financially. This will have an impact on farmers’ abilities to provide healthy meals for themselves and their families and increase the cost and insecurity of food supplies more broadly (Barosh, Friel, Engelhardt, & Chan, 2014; Ingram et al., 2016). Thus, drought and other natural disasters have financial costs and short- and longer-term time costs associated with farmers and rural communities attempting to compensate for the additional work involved in food production. In this way, time is an environmental determinant of health as food security will demand more time from resource-poor farmers.
Conclusion
When we think about time and healthy eating, we may think about the minutes and hours it takes to buy fresh food to prepare healthy meals. We may think about exchanging some of the money we gain from time spent working to “buy out” other responsibilities to free us up to make healthy meals. We may look to buy convenience foods as ways of reducing food preparation time. These are examples of time as a social determinant of health that reflect our social ways of thinking about healthy eating. Time can also be thought of from the perspective of the environment, and the slow-moving impact of climate change whereby droughts are more likely in the future. For the farmers dealing directly with drought and extreme weather conditions associated with climate change, their ability to compensate for heavy work and domestic responsibilities is reduced, and unhealthy eating behaviors are more likely. However, as the suppliers of food for the rest of us, the health and well-being of those farmers impacts on the broader society through food insecurity and cost causing a ripple effect on everyone’s ability to balance their time as a commodity and time as a duty to maintain healthy eating behaviors. In this way, time is also an environmental determinant of health, reflecting the interdependence between food security and climate change.
Footnotes
Acknowledgements
The authors wish to acknowledge the invaluable contribution of the Country Kitchen’s nutritionists—Chloe Dyce, Alice Cameron, and Connie Conyard—for engaging with the communities and helping facilitate this research. The Queensland Country Women’s Association Country Kitchen’s Program is funded by the Queensland Government. The views expressed in this publication do not necessarily reflect those held by the Queensland Government or the Queensland Department of Health. The funder was not involved in the design of the study, collection, analysis and interpretation of data, or writing the article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: CQUniversity Interdisciplinary Grant.
