Navigating changing food environments - Transnational perspectives on dietary behaviours and implications for nutrition counselling

United States (US) migrants are often characterised as experiencing unhealthy nutrition transitions. Looking-back' into dietary behaviours and the processes that affect dietary changes before migration may improve counselling interventions. We conducted a qualitative study of an indigenous Zapotecan transnational community based in Monterey, California, and Oaxaca, Mexico. Four focus groups and 29 interviews were conducted with transnational participants concerning health beliefs around and dietary differences between the US and Oaxaca. Analysis focused on nutrition-related themes. The four major themes were: (1) the paradox between participants' experience growing up with food insecurity and fond memories of a healthier diet; (2) mothers' current kitchen struggles as they contend with changes in food preferences and time demands, and the role care packages' play in alleviating these challenges; (3) positive views about home-grown versus store-bought vegetables; and (4) the role of commercial nutritional supplements and the support they provide. Counselling implications include (1) taking a detailed medical/social history to explore experiences with food insecurity and views on the role of nutrition in maintaining health and (2) exploring patients' struggles with different dietary preferences within their families. Transnational experiences may provide new insights for dietary counselling and patient-centred health communication.