Despite showing promise of restoring nutrition status of people living with HIV (PLHIV), acceptance for ready-to-use therapeutic foods (RUTF) has remained low.
Therefore, a study was conducted by the World Food Programme to find out how psychosocial factors impact the acceptance and consumption among such products among PLHIV in Bangkok.
With the support of the Thai Red Cross AIDS Research Centre, five products were given to participating PLHIV and peer counsellors (PCs) to investigate perceptions toward potential therapeutic foods and supplements.
These were cream filled chocolate cereals, fruit bars, Krayasat (local snack made with peanuts, sesame seeds and honey, soft sticky texture, slight crunchy), medium spicy instant noodles, and a local yoghurt drink of slightly sweet and sour orange flavour.
Researchers wrote that the energy and nutrient densities of these products could then potentially be adjusted and fortified to meet the requirements for supplements treating malnutrition.
Five themes unveiled
Using in-depth interviews (IDIs) with triangulation of data from different participants, five themes emerged from the study:
1) Local food culture is an important motive: Participants perceived the cream-filled chocolate cereals as ‘western’ food for example, not something that Thais, who eat meals with ‘natural colours’ would found appetising. But while Krayasat is local and acceptable, it was found too sweet and chewy for daily consumption. The medium spicy noodles have the right flavour and is convenient to prepare, but participants associated the product with emergency rations (during floods) and eaten only by people low in funds.
2) The health benefits should be easily understood: Participants indicated that food is important to maintain health and strength, thus, they choose foods like fruits and vegetables because they are healthy options. The local yogurt drink was accepted, as it has proteins needed for body building.
3) A soft and easy to swallow texture, and softer scents and flavours are popular: Preference for foods of soft texture and thick-liquid drinks emerged as a commonality among all PLHIV, independent of the health challenges that affected them. Fatigue and lack of appetite, both attributed to anti-retroviral therapy (ART), HIV infection and the presence of episodic diseases, were the main drivers to search for foods of soft or liquid consistencies.
4) Food packaging affects preference: Participants consistently indicated that a packet should be portable enough to carry in errands, and should be small enough not to call attention. Food from small packets that can be consumed in secrecy if necessary – preventing possible stigma relating to consuming a nutritional supplement linked to having HIV.
5) PCs may support therapeutic food consumption: Participants said PCs are the best people to distribute the product and give advice on its use because they are considered peers that overcame critical phases of AIDS and can teach with their own life experience how health can be improved by taking the meds, eating healthy, avoiding alcohol, and doing exercise.
The researchers concluded: “We found that PLHIV choose their food based on food social values, sensory attributes, perception of self-efficacy and perceptions of the potential impact that foods can have on their health status. Moreover, all participants voiced concern about being stigmatised and discriminated if they were found to eat a ‘strange food,’ or food packaged in ‘big containers’ on a regular basis. Unfamiliar foods were widely rejected because its consumption was perceived to be a behaviour that could not be integrated into their daily lives and because they were disliked.”
“Psychosocial factors influencing preferences for food and nutritional supplements among people living with HIV in Bangkok, Thailand”
Authors: Santiago Rodas-Moya, Supabhorn Pengnonyang, et al.