Food Activities and Identity Maintenance Among Community-Living Older Adults: A Grounded Theory Study

Participants

We used convenience sampling and snowballing to recruit community-living older adults at two locations: a community interest group meeting and a community research fair in a shopping mall. Inclusion criteria included being age >60, being retired from full-time employment, and living in the community in West London. We excluded older adults who were living in nursing or residential care or unable to give informed consent to participate. All potential participants received an information leaflet from the first author (Plastow) or another participant, a contact sheet, and an addressed stamped envelope. The first author telephoned all potential participants who returned the contact sheet to answer questions and arrange the interview. We excluded 4 of the 43 participants whom we contacted; 1 did not live within West London, 1 lived in a nursing home, and 2 were unable to provide a convenient interview time.

The age at interview of the 39 participants ranged from 61 to 89 yr (mean age = 74, standard deviation = 7.29). All but 1 of the participants described themselves as White. The overwhelming majority of participants were women (n = 31). More than two-thirds were unmarried, including those who had never married (n = 5), were divorced (n = 9), and had been widowed (n = 14). However, the proportion of participants living alone (n = 20) versus living as a couple (n = 13) or with family (n = 6) was similar. Most participants were classified within the highest socioeconomic classification group (n = 26) on the basis of their preretirement occupation. No significant differences were found in gender, marital status, living arrangements, and socioeconomic status between participants at the two recruitment sites (p > .05). However, the community interest group participants (mean age = 76.7 yr) were significantly older than those recruited at the community research fair (mean age = 70.4 yr; p = .006).

We expected our sample size of 39 participants to be sufficient to achieve theoretical saturation of core categories because it fell within the parameters of the 4 to 40 participants most often included in qualitative studies (Holloway & Wheeler, 2010). This sample size also fell within the midrange of 13 to 92 participants included in other qualitative studies of food and identity (Plastow et al., 2015).

Data Collection

A single semistructured interview was conducted with each participant in the participant’s own home (n = 36), a participant’s sister’s home (n = 1), a local library (n = 1), or the researchers’ university (n = 1). The interview schedule was piloted with 4 other older adults from the first recruitment site and 1 participant who also took part in the main study. The first two interviews in the main study were conducted jointly by the first and second authors (Atwal). The remaining 37 interviews were conducted by the first author. Most interviews were conducted with a single participant (n = 31); four interviews were completed in pairs (n = 8), including 3 couples (n = 6) and 2 widowed sisters who were neighbors. Semistructured interviews allowed participants and interviewers to take the conversation beyond the scheduled questions.

The semistructured interviews included four data collection components. Part 1 included responses to the open question, “Tell me about your everyday food activities.” In Part 2, participants completed two possible-selves Q sorts. Possible selves are future-oriented aspects of identity (Christiansen, 1999). In this card-sorting activity, participants rank-ordered 35 statements each printed on a card. Half of the cards included hoped-for self statements such as “I will be loved” and “I will be able to cook.” The other half included feared self statements such as “I will be lonely” and “I will be useless to others around me.” In the first sort, participants ranked the cards from the selves they hoped for most to those they feared most, and in the second, they ranked the cards from those they expected most to those they expected least. Participants commented on the content of their cards.

In Part 3, participants completed the Occupational Performance Measure of Food Activities (OPMF; Plastow, Spiliotopoulou, Atwal, & Gilhooly, 2014), in which they rated their food activities on a 15-item scale across three subscales: Importance (α = .68), Performance (α = .62), and Satisfaction (α = .60). The participants were shown a prompt sheet with each scale but reported their ratings verbally. Most participants spontaneously explained why they had given themselves a specific score. Participants were also asked, “Is there anything that stops you doing your [food activity] in the way you would like to?” Part 4 collected demographic data. At the end of each interview, participants were thanked and given a £10 (∼$15) voucher as a token of gratitude.

Interviews were audiorecorded and transcribed verbatim for analysis. Recorded interview time was between 34 min and 1 hr 51 min. Mean recorded interview time was 60 min. Postinterview field notes included observations of the home environment, comments participants made before or after the tape-recorded interview, the interviewer’s reflections on the content of the interviews, and any concepts the interviewer thought interesting enough to follow up on in data analysis.

Data Analysis

The textual data for analysis included everything participants said to the interviewers and the interviewers’ field notes. Numerical data (e.g., ranked card position, the numerical value of OPMF scores, and date of birth) were excluded from the analysis in the qualitative component reported in this article. The first author coded all data and met with the second author at multiple points to discuss emerging categories and concepts.

The process of analysis is illustrated in Figure 1. The first part of the analysis focused on identities associated with food activities. Open coding was used to identify concepts and categories evident in the content of participants’ interviews. Axial coding was used to describe the relationships among codes, concepts, and categories (Corbin & Strauss, 2008). This process of data analysis was repeated until each category and concept was fully described in relation to its properties (characteristics and attributes), dimensions (variation of properties along a continuum), and inconsistencies using the data available.

OPEN IN VIEWER

Figure 1.

Graphic representation of data analysis process.

The second part of the analysis focused on the processes associated with identity maintenance evident in the data. The potential for each previously identified concept, category, subcategory, or code to be part of an identity process was considered, and memos were recorded (Corbin & Strauss, 2008). The goal was to identify patterns of responses or patterns of behavior within the coded data. In the final stage of analysis, we used selective coding to raise the analysis to a theoretical level by telling the story of the dynamic relationship between food activities and identity maintenance, grounded in the data. Extensive use of diagrams to graphically represent the emerging process facilitated the data analysis and interpretation.

Research Ethics

This study was approved by the Brunel University research ethics committee. Pseudonyms are used throughout this article to protect the anonymity of participants.

Participation and Maintenance

For this study, we defined food identity as a composite sense of who one is derived from one’s experience of participating in food activities. Within the participation and maintenance process, participation in food activities in a way that was consistent with meaning and identity led to the maintenance of a lifelong food identity as either a food lover (n = 18) or a nonfoodie (n = 10; see Table 1).

Food lovers talked about food and food activities in a positive way. Most used the word love to describe the pleasure food gave them. Sharon described the pleasure and enjoyment she experienced from food and food activities: “I love my food. . . . I enjoy cooking, I enjoy food, and it’s the way I was brought up. . . . No, I’m afraid I’m a bit of a foodie.” Maisy similarly described herself as “a foodie, really; I love food.” Daphne and Gloria used the word enjoy to describe their feelings about food and food activities. Identity-consistent participation for these participants included “spending time and money” on food activities, “cooking together” with and for others, and “resisting temptation” through “choosing well” and making “moral choices” during food activities.

The process of identity maintenance was somewhat different for the nonfoodies. They were uninterested in their food activities. Linda described herself as “disinterested”: “I wouldn’t say I’m a foodie at all.” Instead of “loving” food, these participants talked in neutral terms about their food activities. Food activities were important to these participants only because they had to do them. Otherwise, food and food activities did not play an important role in their lives. The nonfoodies maintained this identity by spending “as little time as possible” on their food activities by “minimizing” cooking and eating out. Rupert most clearly described how the nonfoodies spent as little time as possible on their food activities: “Eating keeps you going, but . . . I’d be quite happy not to eat but enjoy life in other ways. . . . If I had an astronaut-type squeezer tube, I’d be quite happy to do that [laughs].”

Threat and Compensation

Regardless of food identity, almost all participants experienced changes in the way they participated in food activities. “Being alone at the table” was the greatest threat to food activities and identity, especially for the food lovers who gained pleasure from the social aspect of their food activities. Edna, Bettie, Saul, Barbara, Carol, Dorothy, and Martha talked about widowhood. Sarah and Daphne talked about divorce. Sarah, Anne, Judith, and Helen talked about their children moving away from home. Judith and Bettie had moved from different parts of the country to be nearer their children. Marjory and Sally talked about retirement and age changing their experience of mealtimes.

Being alone at the table was “difficult and boring” and meant that food activities became “less routine.” For example, Barbara talked about how her cooking had become precise and controlled after her husband died: “It is quite difficult to cook for one person, getting it reduced down in quantity. . . . In the end, you actually get down to the stage you actually know precisely what you’re going to eat.” As a result, she viewed her meals as “mundane.” Adapting to cooking smaller portions was a challenge for those who were widowed or divorced and living alone. It was also a challenge for younger participants whose children had left home. The way being alone at the table affected Anne’s routines also reflects the difficulty other participants had in keeping their routines without somebody else to cook for:

Changes in food activity participation were also caused by deteriorating health, which led to reduced mobility, a change in food choices, and routines becoming controlled by dietary requirements or medication regimens. The cost of food, expressed in the concept “Cost is one thing,” also led to restrictions in the food items participants bought, less eating out, and difficulty making savings, especially through bulk-buy special offers.

Both food lovers and nonfoodies maintained their food identity by successfully compensating for these changes. Successful compensation meant that the meaning of food activities stayed the same and participation remained consistent with each of the two lifelong identities. Food lovers often compensated for being alone at the table by cooking for others, including their friends, neighbors, and extended families and at volunteer organizations. They also learned to cook well for one person and enjoyed being “selfish” in the food choices they made. Nonfoodies, in contrast, made their food activities even more efficient—for example, by buying microwaveable meals instead of ingredients to prepare.

Both food lovers and nonfoodies compensated for deteriorating health by making food activities quicker and easier. Food lovers were more likely to describe themselves as “being reasonable” in the food choices they made and the timing of their meals. Sally, who had diabetes, noted, “I think a bit slower if I have a bit more sugar one day, and I’ve noticed it’s up, and . . . it’s slower to go down, but it does go down.” “Being reasonable” meant they could continue to gain pleasure from their food activities, but in moderation.

The cost of food was an issue faced by food lovers and nonfoodies alike. Some not-bothered participants talked about “spending less” by “eating out less” and “restricting food choices” by buying food on special offer or not buying food that was too expensive. Only the food lovers talked about growing their own food to compensate for cost.

Changes in Meaning and Identity

An accumulation of threats and increasing difficulty adapting led to changes in the experience of food activities. These changes went further than a change in habits and context. For not-bothered participants (n = 11), the meaning of food activities had changed. Food activities became “less important,” “less pleasurable,” and “too much effort.” All of these participants talked about food activities being less important than they used to be: As Edna expressed it, “There was a time when cooking was very important; now it’s just necessary. . . . You get that you can’t really be bothered.”

Food activities became less important because these participants no longer felt socially connected when they shopped, cooked, and ate. When Sally retired, her eating became less important. Edna, Marjory, Ruth, and Howard talked about how their food activities were less pleasurable because they did not enjoy cooking anymore; for example, Marjory stated, “I used to quite enjoy cooking, but I just can’t be bothered these days [laughs]. And that’s the story of my life at the moment: can’t be bothered.” Many participants also became not bothered because their food activities had become too much effort. Edna described herself as merely “coping” with her shopping.

Some not-bothered participants also found it was too much effort to eat healthily or improve their diet to manage their diabetes and osteoarthritis. It was evident that these health conditions led to an increasing importance in being a healthy eater in later life, but participants remained unmotivated to change their eating behavior. For example, Howard noted,

These participants did not describe themselves as always loving food, like the food lovers. Nor did they talk about a lifelong disinterest in food, like the nonfoodies. Instead, it was consistently evident across all of their interviews that a change in meaning had led to a new identity as not bothered about food activities.