Barriers and enhancers to dietary behaviour change for Aboriginal people attending a diabetes cooking course

Issue addressed: Aboriginal people access diabetes and nutrition education less than non-Aboriginal people. Culturally appropriate, effective and accessible diabetes and nutrition education for Aboriginal people is urgently needed. Methods: A qualitative approach was used to explore the experiences of Aboriginal people who had attended cooking courses run at the Aboriginal Medical Service Western Sydney between 2002 and 2007. Data from 23 semi-structured interviews were analysed thematically. Results: Despite reported improvements in nutrition knowledge and cooking skills, the ability of participants to implement desired dietary changes varied. A new health diagnosis, such as diabetes, pre-diabetes, heart disease or cancer and the desire of participants to influence their families to lead healthier, diabetes-free lives were strong motivators for dietary change. In contrast, lack of family support for dietary change and a sense of social isolation caused by dietary change strongly impeded some participants' attempts to improve their diets. Other significant barriers were poor oral health and depression, the higher cost of healthier food and generational food preferences. Conclusion: Aboriginal cooking course participants faced multiple barriers to dietary change - social, financial, medical and historical. The family was the most crucial determinant of participant ability to achieve sustained dietary change.