"I always buy the purple ones if I see them" : a qualitative study of the perceived socioecological factors influencing anthocyanin-rich food consumption for cognitive health in older adults

Despite the positive relationship between anthocyanin-rich foods and cognitive health,(1,2,3) there is a dietary deficit of anthocyanins in some older adult populations.(4) Designing effective interventions for achieving dietary changes requires an in-depth understanding of people's behaviours situated in social and cultural contexts. Therefore, the aim of this study was to explore older Australian adults' perceptions about increasing their consumption of anthocyanin-rich foods for cognitive health. Nine focus groups with Australian adults aged 65 years and over (n = 20) explored the barriers and enablers towards eating more anthocyanin-rich foods and brainstormed potential strategies to overcome these. Transcripts were coded for barriers, enablers and strategies and codes were classified according to the socioecological model of health as a theoretical framework consisting of four levels of influence: individual, interpersonal, community, and society levels. Enabling factors associated with consuming anthocyanin-rich foods included a desire to eat healthy foods, taste preference and familiarity of anthocyanin-rich foods (individual), receiving support from social networks (community), and the availability of some anthocyanin-rich foods (society). Predominant barriers towards eating anthocyanin-rich foods for cognitive health included budget, food preferences and motivation (individual), household influences (interpersonal), limited availability and poor access to some anthocyanin-rich foods (community) and the price of foods, seasonal variations and poor promotion of purple foods (society). We highlight older adults' recommendations to support consumption of anthocyanin-rich foods for cognitive health that including increasing individual-level knowledge, skills, and confidence in utilising anthocyanin-rich foods, developing educational initiatives and population health messages about the potential cognitive benefits of purple foods, in addition to advocating to increase the availability of and access to anthocyanin-rich foods in the food supply. This study provides insight into the various levels of influence impacting the adoption of an anthocyanin-rich diet for cognitive health in older adults. More barriers to dietary change were found than enablers. Future interventions should be tailored to the predominant barriers and enablers in addition to providing targeted education about anthocyanin-rich foods through community networks and advocating for changes to the food environment to extend the availability and reduce the cost of familiar and commonly consumed anthocyanin-rich foods.