Factors perceived to influence healthy eating: a systematic review and meta-ethnographic synthesis of the literature

Context: Dietary risks are leading contributors to global morbidity and mortality and disproportionately burden individuals of lower socioeconomic positions. Objective: The aim of this review is to understand, holistically, what factors are perceived to influence healthy eating and to determine whether perceived factors differ when comparing the general population with lower socioeconomic subgroups. Data Sources: Four academic databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library) and 3 gray literature databases were searched systematically, along with reference lists. Study Selection: Studies were included if they were qualitative and were conducted with community-dwelling adults in high-income countries and if they focused specifically on healthy eating. Eligibility was determined through author consensus. Data Extraction: Thirty-nine eligible studies (of 11 641 records screened) were identified. Study characteristics were extracted using a standard template, and quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted using meta-ethnography, with themes categorized according to the socioecological model. Results: Factors across the individual, social, lived, and food environments were perceived to influence healthy eating. Meta-ethnography revealed that multiple environmental and social factors were frequently reported as barriers to healthy eating. While factors were largely generalizable, diet affordability and the lower availability of stores offering healthy food appeared to be more salient barriers for lower socioeconomic groups. Conclusions: Actions to improve population diets should mitigate the barriers to healthy eating to create environments that support healthy eating across the socioeconomic gradient. Systematic Review Registration: PROSPERO registration number CRD42017065243.