The global burden of non-communicable diseases (NCDs) is increasing. This has significant implications for Pacific Island Countries and Territories (PICTs) including Kiribati, whose struggles with food security have led to an increased burden of chronic, metabolic, and lifestyle-related NCDs, particularly diabetes and cardiovascular diseases. While past studies have explored consumption patterns, no studies have examined actual cultural food preferences in Kiribati. Through freelist data collected from 399 fixed-question household surveys, this study aims to explore this gap in cultural food narratives and see if there is an association with NCD prevalence. The study used Smith’s S salience analysis to assess significance, finding food items such as fish, rice, breadfruit, chicken, and coconut as culturally important in Kiribati. Participants were also categorised into sociodemographic regions, finding nuanced differences between urban and rural communities. The analysis revealed focus foods for tailored interventions that align with cultural narratives and ‘healthy’ foods ensuring effective food security interventions that address the escalating prevalence of NCDs. Limitations were identified, such as the temporal aspect of the data collected just before the COVID-19 pandemic, potential social desirability bias, unequal sample sizes between sociodemographic regions, and disparities between reported food consumption and actual consumption patterns. The study also suggests future implications, including a comprehensive dietary investigation of Kiribati, particularly in examining food additives like sugar and salt, and the applicability of similar methodologies in exploring cultural food narratives in other PICTs.
Research Article
Cultural Food Preferences and Non-Communicable Diseases: a case study of cultural values assigned to food in Kiribati
https://doi.org/10.21203/rs.3.rs-5202715/v1
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The nutrition transition outlines that as societies develop, there is a shift in dietary patterns away from traditional diets rich in grains, fibre, and high in polyunsaturated fatty acids towards more ‘Westernised’ diets characterised by elevated levels of fat, cholesterol, sugar, and other refined carbohydrates (Popkin & Ng, 2022). These Westernised diets are typically ultra-processed foods that are affordable, convenient, calorie-dense, and hyper-palatable, contributing to a surge in non-communicable diseases (NCDs) such as diabetes, obesity, and hypertension (Benjamin et al., 2018; Endocrinology, 2017; Goryakin et al., 2017; R. G. Hughes & Lawrence, 2005; Monteiro et al., 2018; Popkin & Ng, 2022; Rodríguez et al., 2016; Ulijaszek, 2005). Kiribati, one of the Pacific Island Countries and Territories (PICTs), is an ideal case study due to challenges pertaining to food security contributing to a rising public health burden of NCDs (Cauchi, Bambrick, Correa-Velez, et al., 2021; Eme et al., 2019; Food and Agriculture Organization, 2012; Government of Kiribati, 2019; United Nations, 2021). High mortality rates attributed to NCDs (Global Burden of Disease Collaborative Network, 2020), disproportionate shares of premature deaths (Global Burden of Disease Collaborative Network, 2020), and significant healthcare expenditure relative to other countries in the region (World Bank, 2024) highlight the need to address the growing NCD burden in Kiribati and other PICTs alike (Global Burden of Disease Collaborative Network, 2020). Understanding the cultural food preferences in Kiribati will allow for targeted interventions that align with community values towards food.
The Republic of Kiribati comprises 32 atolls, the Gilbert, Phoenix, and Line Island groups, along with the isolated limestone island of Banaba, spanning three time zones across the Central Pacific Ocean (Gerhardt et al., 2023). The eastern Line Islands and the central Phoenix Islands are sparsely populated, contrasting sharply with the western Gilbert Islands. Particularly, in the capital of South Tarawa, the atoll infrastructure is strained due to high population densities rivalling global metropolises like Tokyo and Hong Kong (Gerhardt et al., 2023; Secretariat of the Pacific Community, 2022; World Population Review, 2024b). Kiribati's population, known as the i-Kiribati, totals 135,083 individuals (World Population Review, 2024a), with 57.8% residing in urban areas (Central Intelligence Agency, 2024). Kiribati has a GDP per capita of $1,702.0, falling under the World Bank classification of a lower middle-income country (LMIC) (World Bank, 2023b). The United Nations also classifies Kiribati as one of the 45 least-developed countries (United Nations Conference on Trade and Development, 2023). The estimated poverty rate in Kiribati varies slightly across various sources. According to the Kiribati National Statistics Office's cost of basic needs approach, 21.9% of i-Kiribati lived below the basic needs poverty line in 2019, with nearly half of this population residing in South Tarawa (Kiribati National Statistics Office, 2022). Using the $3.65 LMIC poverty line, the poverty rate was 19.5% (World Bank, 2023a). These varying estimates reflect the different methodologies used to measure poverty, but they all indicate that a sizeable proportion of the population in Kiribati experiences low income. However, some subsistence communities get by without any cash or use a mixed cash-barter system (Cauchi, Bambrick, Correa-Velez, et al., 2021; Cauchi, Moncada, et al., 2021). With a mean elevation of just two meters above sea level, the nation is highly susceptible to climate change and sea level rise (Gerhardt et al., 2023). The nation's geographical isolation and remoteness are also reflected in its scattered islands, with an area of 811 km2, spread across 3,500,000 km2 of ocean (Figure 1) (Secretariat of the Pacific Community, 2022).
[Figure 1: Map of the Pacific Ocean with Kiribati marked in bold font. Source: Mark Gunning ©]
Current State of Food Culture: “Pandanus People” to “White Foods”
Kiribati underwent dietary globalisation over the 20th century, influenced by colonial history, economic factors, and cultural changes. The i-Kiribati were once described as “Pandanus People”, highlighting the crop’s importance, having a diet of traditional foods consisting of locally grown foods such as roots and tubers, supplemented with fish or coconut (Grimble, 1934). This diet is described to have moderate to high energy, fat and protein levels, high complex carbohydrates and fibre, possibly high antioxidant, potassium and trace minerals, and low simple carbohydrates and salt, reflecting the nutritional diversity in the past (Coyne et al., 2000). However, the introduction of rice (Macdonald, 1982) and other low-nutritional quality imports from the globalisation of international trade has significantly altered their diets (R. G. Hughes & Lawrence, 2005; Troubat & Michael K., 2021). Currently, the i-Kiribati diet is characterised by a high percentage (67%) of average dietary energy attributed to imported foods (Food and Agriculture Organization, 2021), of which more than 30% is rice, followed by 14% sugar and 7% bread (Troubat & Michael K., 2021). These imported foods, alongside salt, were framed from a neocolonial perspective as being “not white people but white foods” by interviewed i-Kiribati in a previous study (Cauchi, Bambrick, Correa-Velez, et al., 2021).
Globalisation also facilitated the introduction of colonial influences, bringing along new social values associated with food: the colonial system of education (McLennan & Ulijaszek, 2015), the cultural status of imported food (R. G. Hughes & Lawrence, 2005; Ulijaszek, 2005), and the introduction of a cash economy, fundamentally changing the relationship of Pacific people with the food they consume (Cassels, 2006; McLennan & Ulijaszek, 2015). These social values emphasised imported food requiring minimal investment of time, money, or effort for consumption, making them implicitly favourable (Cauchi, Bambrick, Correa-Velez, et al., 2021; Kodish et al., 2019; McLennan & Ulijaszek, 2015). These values are reinforced through various mediums such as television, the Internet, and food marketing initiatives, potentially strengthening the shift towards the consumption of imported foods in the Pacific diet (McLennan & Ulijaszek, 2015; Popkin & Ng, 2022). Tastepreferences have also shifted towards the more appealing “white foods” high in fats, sugars, and salt content compared to traditional local food despite understanding the health issues associated with this transition (Cauchi, Bambrick, Correa-Velez, et al., 2021; Rimon, 2011; Santos et al., 2019). This is particularly the case in the younger generations, with some even opting for imported foods despite the availability of local alternatives (Cauchi, Bambrick, Correa-Velez, et al., 2021; Ministry of Environment Lands and Agricultural Development, 2020).
Current State of Food Security
Food security is a major issue for Kiribati, drawing attention from local, national, and international entities (Cauchi, Bambrick, Correa-Velez, et al., 2021; Government of Kiribati, 2019; Savage et al., 2020; The World Bank Group, 2021; United Nations, 2021). The FAO’s “Food Consumption in Kiribati” report highlights that 41% of the population faces moderate to severe levels of food insecurity, corresponding to 36% of households in Kiribati (Troubat & Michael K., 2021). In the face of declining local produce from climate change, population pressures, and economic constraints, importing foods has ensured a degree of food security for the I-Kiribati, even though local foods are perceived as healthier (Cauchi, Bambrick, Correa-Velez, et al., 2021; Kodish et al., 2019; Rimon, 2011).
Environmental and Climate Vulnerability
As a small island state far removed from main shipping thoroughfares and with limited infrastructural and financial capacity, Kiribati is disproportionately affected by environmental and ecological changes. This is further compounded by the multiplier effects of climate change, which increases food insecurity and leads to adverse health outcomes (Savage et al., 2020; Secretariat of the Pacific Community, 2022). The strain these factors place on local food systems is anticipated to increase in the future decades (Cauchi, Bambrick, Correa-Velez, et al., 2021; Duvat et al., 2021). Key climate and environmental factors can be summarised into these three main themes: limited natural resources, environmental impacts, and extreme weather events.
Limited Natural Resources:
Kiribati faces significant challenges due to its limited natural resources, particularly land, agriculture, and coastal fisheries (Cauchi et al., 2019; McIver et al., 2017; Ministry of Environment Lands and Agricultural Development, 2020; Savage et al., 2020), relying heavily on these resources for food security, sustainable livelihoods, and economic growth (Ministry of Environment Lands and Agricultural Development, 2020; Ministry of Finance & Economic Development, Government of Kiribati, 2021). Urban areas have increasingly limited space for producing agriculture (Secretariat of the Pacific Community, 2022), while rural and outer island settlements have better access to land, nearshore resources, and a lower population pressure (Cauchi, Bambrick, Correa-Velez, et al., 2021; Secretariat of the Pacific Community, 2022). However, unfavourable soil conditions and scarce freshwater challenge local agriculture and livestock production (Cauchi, Bambrick, Correa-Velez, et al., 2021; Ministry of Environment Lands and Agricultural Development, 2020; Secretariat of the Pacific Community, 2022). This has placed a greater reliance on the more abundant mariculture, reflected in Kiribati having one of the highest per capita consumption worldwide (Food and Agriculture Organization, 2018). However, overfishing has reduced the supply of coastal fisheries, particularly in urban regions (Food and Agriculture Organization, 2018; Ministry of Finance & Economic Development, Government of Kiribati, 2021).
Environmental Impacts:
While there is ongoing debate regarding the extent of loss of land due to sea level rise and coastal erosion (Aung et al., 2009; McLean & Kench, 2015; Rankey, 2011; Sabūnas et al., 2021; The World Bank Group, 2021), increasing seawater intrusion has devastating effects on water table salinity, worsening the already poor soil quality and reducing water supplies (Aung et al., 2009; Cauchi, Moncada, et al., 2021). Ocean acidification and warming have increased the frequency of coral bleaching and mortality, endangering coastal subsistence communities by reducing food supply and coastal defences (Australian Bureau of Meteorology and CSIRO, 2011; Bell et al., 2013; Duvat et al., 2021; Hoegh-Guldberg et al., 2017; T. P. Hughes et al., 2018).
Extreme Weather Events:
Periods of drought during La Niña events further reduce the water supply, damaging rain-dependent agriculture (e.g. local coconut palms) and affecting deep-rooted agriculture (e.g. local breadfruit) (Australian Bureau of Meteorology and CSIRO, 2011; Cauchi, Bambrick, Correa-Velez, et al., 2021; Government of Kiribati, 2019; McIver et al., 2014). Warmer temperatures are also causing stronger El Niño weather events (Cai et al., 2018; United Nations Office for Disaster Risk Reduction, 2019), leading to more intense and more frequent Perigean ‘king’ tides, storm surges, and rainfall that can result in flooding (Australian Bureau of Meteorology and CSIRO, 2011; Cauchi, Moncada, et al., 2021; Government of Kiribati, 2019; Secretariat of the Pacific Community, 2013; Werner, 2017). As a consequence of these challenges, knowledge and capacity to produce local foods in Kiribati have been declining, encouraging people to turn towards imported food for greater food stability (Cauchi, Bambrick, Correa-Velez, et al., 2021; Cauchi et al., 2019; Food and Agriculture Organization, 2021; R. G. Hughes & Lawrence, 2005; McIver et al., 2014; Ministry of Environment Lands and Agricultural Development, 2020; Morgan et al., 2016; Savage et al., 2020).
Food Access and Availability
Population growth and internal migration from the outer islands are particularly evident in South Tarawa. In 2020, South Tarawa recorded a population density of 3,942/km2 (Secretariat of the Pacific Community, 2022). Betio islet and Nanikai exhibited even higher population densities, surpassing 10,000/km2, with another 11 villages on South Tarawa recording population densities exceeding 5,000/km2 (Secretariat of the Pacific Community, 2022). This rapid urban population growth has resulted in overcrowding, leading to a reduction in the per-capita supply of local food and an increase in their costs (Connell, 2015; Food and Agriculture Organization, 2012; Government of Kiribati, 2019; Ministry of Finance & Economic Development, Government of Kiribati, 2021; Savage et al., 2020; United Nations, 2021). Insufficient infrastructure exacerbates the situation, as households cannot cultivate their food, store fresh local foods, or access local produce more abundant in the outer islands (Cauchi, Bambrick, Correa-Velez, et al., 2021; Food and Agriculture Organization, 2012; Secretariat of the Pacific Community, 2022). On the other hand, rural communities have difficulty obtaining imported foods when local produce is affected by the climate, seasonality, or tide flows (Cauchi, Bambrick, Correa-Velez, et al., 2021; Ministry of Environment Lands and Agricultural Development, 2020; Rimon, 2011). The economic disparity of urbanisation is also noteworthy, with the wealthiest households spending approximately four times more than the least wealthy households to obtain food (Troubat & Michael K., 2021). Consequently, nutritious traditional foods are inaccessible to those with less income, and many have simply substituted them with cheaper, imported foods.
The Paradox and Dangers of Imported Food
Substituting traditional foods with imported foods presents a double-edged sword for Kiribati. Kiribati’s dietary landscape is now predominantly characterised by imported foods consisting of refined grains (rice and flour), oils, fatty and processed meats of poor quality, and confectionery high in sugar, resulting in a decline in consumption of traditional fruits, starchy vegetables, and leafy greens to levels less than half the recommended consumption by the WHO (Eme et al., 2019; Farrand et al., 2017; Food and Agriculture Organization, 2021; R. G. Hughes & Lawrence, 2005; Lewis, 1988; Sahal Estimé et al., 2014; Santos et al., 2019; Troubat & Michael K., 2021). Poor nutrition quality has profoundly impacted Kiribati’s food security and nutrition transition (Troubat & Michael K., 2021). These imported foods are more affordable, energy-dense, and nutrient-poor, shifting Kiribati’s public health burden towards chronic, metabolic, and lifestyle-related NCDs such as diabetes and cardiovascular disease (Global Burden of Disease Collaborative Network, 2020; Hanna & McIver, 2014; R. G. Hughes & Lawrence, 2005; R. Hughes & Marks, 2009; McLennan & Ulijaszek, 2015; Savage et al., 2020). In 2015, for example, non-insulin-dependent diabetes mellitus ranked as the second highest cause of hospitalisation. Similarly, 49.7% of all health facility presentations were attributed to confirmed or suspected diabetes, while 46.9% were due to hypertension (Kiribati Ministry of Health and Medical Services, 2015). Complications from diabetes such as lower limb amputation are also increasing, underscoring concerns regarding the lack of resources for functional multi-disciplinary foot services in Kiribati (Cauchi, Bambrick, Moncada, et al., 2021; Hon et al., 2024; Mansfield, 2023). Additionally, Kiribati ranks fourth highest worldwide for the proportion of diabetes-related deaths under the age of 60, at 30.4% (Magliano et al., 2021). High dependence on imports also puts Kiribati at risk of global shocks (Headey & Fan, 2008; R. G. Hughes & Lawrence, 2005; International Monetary Fund. Asia and Pacific Dept, 2023; McGregor et al., 2015), with the most recent example being COVID-19 affecting access to foods and increasing their prices (Davila et al., 2021; Monaco & Abe, 2024). In light of projections indicating worsening climate change in the Pacific, it is imperative to explore methods to reduce the burden of NCDs (Duvat et al., 2021; United Nations Office for Disaster Risk Reduction, 2023).
Aim and Rationale for Study
As described, Kiribati’s unique geography, socioeconomic factors, and climate significantly impact its food security, contributing to an increased burden of NCDs. Existing research has shed light on numerous household food decision-making factors beyond just knowledge of food healthiness (Cauchi, Bambrick, Correa-Velez, et al., 2021; Cauchi, Bambrick, Moncada, et al., 2021; Kodish et al., 2019). Dietary recalls have also identified patterns of preference in households (Eme et al., 2019; Troubat & Michael K., 2021). However, a notable knowledge gap exists in actual food preferences. Knowing the cultural food preferences of the community will assist in the promotion of healthy food security interventions that align with community values towards food, improving food security and public health outcomes.
This study will attempt to answer the following research question: What are the current cultural values assigned to food in Kiribati and are they associated with the development of NCDs? The specific aims of this study are to: 1) use freelisting methodology to understand the cultural values of food items; 2) examine cultural values of foods in different sociodemographic regions of Kiribati; 3) identify food items for targeted food security interventions; 4) explore the application of this study to other PICTs. To our knowledge, this is the first study that identifies cultural food values in Kiribati using the freelisting methodology.
Study Design
This study is part of a larger cross-sectional study looking at pre-Covid data in Kiribati. Data were collected in 2019, just before Kiribati closed its borders in February 2020 in light of the global pandemic. It uses the freelisting methodology, a qualitative technique used to elicit cultural “salience” of particular notions within groups and variation in individuals’ topical knowledge across groups (Purzycki & Jamieson-Lane, 2017). In other words, freelisting shows the importance of certain ideas to groups of people and how much individuals within those groups know about those ideas. Differences in freelists reveal intracultural variation. This study uses the freelisting methodology to explore cultural narratives surrounding food.
Participants provide two freelists: one of favourite foods, demonstrating cultural preferences, and another of traditional foods, reflecting cultural values towards local foods. The significance of listed items is determined using Smith’s S, a salience analysis method considering both frequency of mention and position in the list, adjusting for the total number of items listed by each respondent. Higher frequency and earlier mention indicate greater salience, with scores ranging from 1 (highest) to 0 (lowest). Additionally, participants list their ‘top three’ consumed foods. Data from the top three consumed foods is also subjected to Smith’s S salience analysis and literature validation, providing insights into cultural consumption patterns. Participant data was also categorised by urban and rural localities to explore variations in food access and availability known to exist between these settings. Based on the consensus that local food is considered ‘healthy’ (DiBello et al., 2009; Hanna et al., 2011; Oliveira et al., 2015), food items that are highly salient for favourite foods, traditional foods, and top three foods consumed fall under the category “Salient Sweet Spot”. Food in this category is key to informing culturally appropriate recommendations to reduce the growing NCD burden seen in Kiribati.
Data Collection
The fixed-question household survey (n = 402) was carried out by a team of trained local research assistants between April 2019 and January 2020, to be answered by the person responsible for food preparation in the household. Ethical consent was obtained by the team from every household and recorded data was anonymised. In total, three islands were surveyed. This included South Tarawa (including the islet of Betio), North Tarawa and Butaritari, all in the Gilbert Islands (Fig. 2).
[Figure 2: Islands and areas sampled for this study. The red box outlines the Tarawa atoll, while the yellow boxes show Butaritari and Betio in greater detail. Source: Google Maps.]
Sampling Technique
An enumeration data map was obtained from the Kiribati National Statistics Office (KNSO) in 2019 with permission for use by both the KNSO and the Secretariat of the Pacific Community (SPC). This map includes the entire land area of Kiribati segmented into Enumeration Areas (EAs), with listed households and people living in each area. In total, the country was subdivided geographically into 391 EAs. EAs were randomly sampled using the Microsoft Excel 2016 RAND function. Power calculations for the household selection process are included in Supplementary Material 1.1 for this manuscript. A novel approach was used to randomise household selection for each EA due to the lack of a local postal address system in Kiribati. Research assistants started in a randomly selected corner of an EA following an ‘s-bend’ pattern, skipping between two households for each participant and repeating until a maximum of 10 households were chosen per EA (Supplementary Material 1.2).
Interviews
Through the help of local research collaborators, Kiribati Health Retreat Association and Kiribati Climate Action Network, five research assistants (two female, three male) were recruited fluent in both English and I-Kiribati. Data collection was carried out in the preferred language of the respondent, in most cases a mix of I-Kiribati and English. The survey itself was written in English and translated into I-Kiribati by people fluent in both languages. The three questions pertaining to this manuscript where freelisting was included for analysis are shown below.
Favourite Food Freelist
Each participant was given one minute to provide their responses, with no additional prompts or suggestions provided. This approach ensured that the data collected reflected the unaided thoughts and preferences of the participants.
Question 20: “What are your favourite foods? Please tell me which ones they are."
This question allowed participants to list their food preferences.
Top Three Foods Question
Following the favourite food freelist question, participants were asked to identify the three foods they consumed most frequently.
Question 21: "What three foods do you eat most often?"
This question aimed to capture participants’ actual consumption patterns with quantitative data.
Traditional Food Freelist
Question 34: "What are your traditional foods? Please tell me which ones they are."
This question was posed after a series of inquiries about local foods. The survey questions are included in Supplementary Material 2 for this manuscript. This provided participants with the necessary frame of reference to recall and name traditional foods.
The selection of these three questions from the fixed-question household survey aimed to identify preferred, consumed, and locally produced food items to better inform policy recommendations. The data was reviewed and manually cleaned to remove typographical errors and translations to produce a homogenous list in English for each participant.
Data analysis
Descriptive Analysis
Urban localities exhibit higher population densities and more developed infrastructure than rural counterparts (Secretariat of the Pacific Community, 2022). Rural localities are characterised by lower population densities, less developed infrastructure, and often a stronger connection to traditional subsistence lifestyles and practices (Secretariat of the Pacific Community, 2022). These two localities formed the subgroups that were analysed.
[Table 1]
| Locality | Villages |
|---|---|
| Urban | Bikenibeu, Eita, Abarao, Betio, Ambo, Ananau, Taborio, Temwaiku, Bairiki, Teaoraereke, and Bonriki |
| Rural | Bikaati, Tabonuea, Buota, Nabeina, Marenanuka, and Buaraiki |
Salience Analysis
RStudio’s package, AnthroTools (version 0.9), was used for the salience analysis (Purzycki & Jamieson-Lane, 2017). Salience was derived using a salience index (Smith’s S) defined as: S = ((L − Rj + 1)/L)/N, where L is the length of each list, Rj is the rank of item J in the list, and N is the number of lists in the sample (Smith & Borgatti, 1997). This study used a previously published approach to determine a breaking point for salient food items. Food items are sorted into a Scree plot in the order of their salience. Natural inflexion points in the curve act as breaking points for saliency, and food items before the inflexion point were retained as salient (Agbalog & Yukawa, 2019; Fares et al., 2019; Fiks et al., 2011; Harper et al., 2021; Keddem, 2021; Quinlan, 2019).
Salience scores were generated for all participants, then for subgroups urban and rural localities based on the enumeration map (Table 1). To understand the degree of similarity among participants' cultural food narratives, we then used consensus analysis to establish the extent to which the subgroups shared an understanding of the particular domain. Consensus analysis is based on the idea that members of a cultural group tend to share similar knowledge about a specific cultural domain. The analysis assesses the extent of agreement within the group, demonstrating a common cultural perspective shared by the group members.
The ‘eigenvalue’ is a key component in this analysis, calculated from the correlation matrix of participants' responses. The eigenvalue of the first factor, which represents the amount of variance explained by the consensus model, is particularly significant. If the ratio of the first eigenvalue to the second eigenvalue is at least 3:1, it indicates a strong consensus, meaning the group is likely to share a single cultural perspective. In this study, we considered a ratio of 3:1 or higher as evidence of consensus. Furthermore, if only one factor was identified, the subgroup was also considered to have a consensus, signifying that the cultural knowledge within that group was uniform (Fiks et al., 2011; Keddem et al., 2021).
Study population and characteristics
A total of 399 of 402 participants had data on the three questions selected for this manuscript. 85.0% of participants were from urban localities, with the remaining 15.0% from rural localities. The majority of participants interviewed were ages 31–50 (54%), and female (68%). Education, percentage of income spent on food, and household number are also described in Table 2. Rural freelists averaged 5.6 and 5.8 foods for favourite food and traditional foods respectively, while urban freelists were longer and averaged 6.5 and 6.4 foods.
| Locality | |||
|---|---|---|---|
| Characteristic | Overall N = 399 | Rural N = 60 | Urban N = 339 |
| Age | |||
| 18–20 | 5 (1.3%) | 0 (0%) | 5 (1.5%) |
| 21–30 | 80 (20%) | 22 (37%) | 58 (17%) |
| 31–40 | 105 (26%) | 20 (33%) | 85 (25%) |
| 41–50 | 110 (28%) | 12 (20%) | 98 (29%) |
| 51–60 | 60 (15%) | 5 (8.3%) | 55 (16%) |
| 61–70 | 32 (8.0%) | 1 (1.7%) | 31 (9.1%) |
| 71–80 | 7 (1.8%) | 0 (0%) | 7 (2.1%) |
| Education | |||
| None | 14 (3.6%) | 4 (7.8%) | 10 (3.0%) |
| Primary | 57 (14%) | 6 (10%) | 51 (15%) |
| Secondary | 112 (28%) | 17 (28%) | 95 (28%) |
| High School | 132 (33%) | 19 (32%) | 113 (33%) |
| Technical College | 18 (4.5%) | 3 (5.0%) | 15 (4.4%) |
| University | 59 (15%) | 6 (10%) | 53 (16%) |
| Unknown | 7 (1.8%) | 5 (8.3%) | 2 (0.6%) |
| Sex | |||
| F | 270 (68%) | 35 (58%) | 235 (69%) |
| M | 129 (32%) | 25 (42%) | 104 (31%) |
| Food expendituret | |||
| <25% | 8 (2.0%) | 2 (3.3%) | 6 (1.8%) |
| 25% − 50% | 98 (25%) | 28 (47%) | 70 (21%) |
| 51% − 75% | 173 (43%) | 29 (48%) | 144 (42%) |
| >75% | 115 (29%) | 0 (0%) | 115 (34%) |
| Unknown | 5 (1.3%) | 1 (1.7%) | 4 (1.2%) |
| Median number of people in household* | 7.0 (5.0, 9.0) | 6.0 (5.0, 8.0) | 7.0 (5.0, 9.0) |
| t Food Expenditure as a percentage of total income * n (%); Median (Q1, Q3) | |||
[Table 2]
Comparing salient terms for the general population
Favourite Food Freelist
Participants identified 133 food items, with salience scores ranging from 0.204 to 0.0000477 (see Supplementary Material 3.1). Among these, Fish was mentioned by 356 participants (89.2%), Rice by 277 (69.4%), Breadfruit by 208 (52.1%), Chicken by 159 (39.8%), Babai (Swamp taro) by 84 (21.1%), and Coconut by 97 (24.3%) (Fig. 4).
[Figure 3: Scree plot test. The breakpoint for which the curve flattens significantly is after Coconut, indicating that six food items are salient. This graph only includes food items with salience above 0.005 to improve visual quality.]
[Figure 4: Bar graph showing the cultural preferences identified by participants in the Favourite Food Freelist. Six items were salient, including Fish, Rice, Breadfruit, Chicken, Babai (Swamp taro), and Coconut.]
Traditional Food Freelist
Participants identified 84 food items, with salience scores ranging from 0.174 to 0.0000477 (see Supplementary Material 3.2). Among these, Breadfruit was mentioned by 328 participants (82.2%), Fish by 307 (76.9%), Coconut by 235 (58.9%), Babai (Swamp taro) by 211 (52.9%), Pumpkin by 183 (45.9%), Pandanus by 143 (35.8%), and Banana by 130 (32.6%) (Fig. 6).
[Figure 5: Scree plot test. The breakpoint for which the curve flattens significantly is after Banana, indicating that seven food items are salient. This graph only includes food items with salience above 0.005 to improve visual quality.]
[Figure 6: Bar graph showing the cultural traditional foods identified by participants in the Traditional Food Freelist. Seven items were salient including Breadfruit, Fish, Coconut, Babai (Swamp taro), Pumpkin, Pandanus, and Banana.]
Top Three Foods
Participants identified 54 food items with saliency scores ranging from 0.363 to 0.000418 (see Supplementary Material 3.3). Among these, Fish was mentioned by 385 participants (96.5%), Rice by 365 (91.5%), Breadfruit by 107 (26.8%), and Chicken by 109 (27.3%) (Fig. 8).
[Figure 7: Scree plot test. The breakpoint for which the curve flattens significantly is after Coconut, indicating that five food items are salient. This graph only includes food items with salience above 0.001 to improve visual quality.]
[Figure 8: Bar graph showing the cultural consumption patterns identified by participants in response to the Top Three Foods Question. Five items were salient, including Fish, Rice, Breadfruit, Chicken, and Coconut.]
Analysis of the Kiribati Food System as a Whole
The data highlights a cultural preference for fish, rice, breadfruit, chicken, babai, and coconut in Kiribati (Fig. 4). Fish and rice emerge as predominant food choices in Kiribati, with Fish being the most preferred and rice the most consumed. Despite fish being more frequently mentioned and preferred, rice takes precedence for consumption. This suggests that while fish holds cultural significance as a favourite food, rice may have greater overall importance, reflecting the cultural dependence on imported foods as suggested in other studies (Cauchi, Bambrick, Correa-Velez, et al., 2021; Eme et al., 2019; Kodish et al., 2019; Troubat & Michael K., 2021). This is also the case with chicken, albeit less culturally important than rice. Locally produced breadfruit ranks third for preference and consumption, followed by chicken. Fish and breadfruit are also salient in traditional foods (Fig. 6), suggesting that there still is a cultural preference for locally produced items that align with consumption patterns. Babai and coconut are two other locally produced items that are preferred.
A scatter plot and Venn diagram was generated to show the intersections of the three questions, highlighting information of value that pertains to cultural food narratives. The scatter plot shows that few food items dominate the importance for the i-Kiribati, namely fish, rice, breadfruit, and chicken (Fig. 9). Despite breadfruit, babai, coconut, and pumpkin being traditional and locally produced, rice has become a common staple. Interestingly, rice is mentioned by 15 participants as a traditional food, indicating its cultural integration into the local diet despite being an import. The Venn diagram highlights the importance of fish, breadfruit, and coconut (Fig. 10). These items can be described as a “Salient Sweet Spot”, as they are likely to be effective targets for policy recommendations. Rice and chicken were salient preferred and consumed items. Babai (swamp taro) was a salient preferred and traditional food item. Pumpkin, pandanus, and banana, on the other hand, were only salient for traditional foods.
[Figure 9: Graph showing the scatter plot of food items. Food items with salience between 0.1 and 0.02 were included to represent the data thoroughly. The remaining food items below a salience of 0.02 were removed to avoid cluttering. Full range of salience was kept for Top Three Foods Question and shown in the colour coded gradient.]
[Figure 10: Venn diagram comparing salient food items in each category: FF = Favourite Food Freelist, T3 = Top Three Foods Question, TF = Traditional Food Freelist.]
Overall, the cultural narratives for Rice and Fish align with the current literature as they are considered staple foods in Kiribati. As aforementioned, fish are an integral part of the traditional diet (Food and Agriculture Organization, 2018; Grimble, 1934) and provide a major source of income (Food and Agriculture Organization, 2018; Ministry of Finance & Economic Development, Government of Kiribati, 2021). However, the literature suggests that Chicken is not as widely consumed in comparison with Coconut as this study would suggest (Troubat & Michael K., 2021). This disparity in consumption patterns is even greater with foods like Bread and Flour which do not attain salience in this study. Bread and Flour are more commonly consumed and in greater quantities than Coconut and Chicken (Eme et al., 2019; Troubat & Michael K., 2021). Similarly, sugar is less frequently mentioned in the study than suggested by existing literature, thus failing to attain saliency (Troubat & Michael K., 2021). A common practice in Kiribati was to add sugar to nearly all meals (Eme et al., 2019), even going so far as to add it to water to enhance its taste (Cauchi, Bambrick, Correa-Velez, et al., 2021). The low salience for these food items raises questions about the perception of some foods in the freelist, which are perhaps thought of more as condiments rather than foods.
Subgroup Analysis
A subgroup analysis comparing urban and rural communities was also carried out, given the different foods accessed by the different population categories. Venn diagrams were also generated for each of the three questions to show the relationship between cultural food narratives from both subgroups. This analysis would be useful for policymakers given different infrastructural capacities available.
Favourite Food Freelist
Urban participants mentioned 128 food items, with saliency scores spanning from 0.205 to 0.0000562 (see Supplementary Material 4.1). Fish was mentioned by 300 participants (88.5%), Rice by 224 (66.1%), Breadfruit by 165 (48.7%), Chicken by 144 (42.5%), Coconut by 78 (23.0%), Egg by 68 (20.0%), Sausage by 69 (20.4%), and Babai by 60 (17.7%) (Fig. 12).
Rural participants mentioned 52 food items, with saliency scores ranging from 0.206 to 0.000463 (see Supplementary Material 4.2). Rice was mentioned by 53 participants (88.3%), Fish by 56 (93.3%), Breadfruit by 43 (71.7%), Babai (Swamp taro) by 24 (40.0%), Coconut by 19 (31.7%), Pumpkin by 14 (23.3%), and Chicken by 15 (25.0%) (Fig. 14).
[Figure 11: Scree plot test. The breakpoint for which the curve flattens significantly is after Babai, indicating that eight food items are salient. This graph only includes food items with salience above 0.005 to improve visual quality.]
[Figure 12: Sociodemographic categorisation of Urban Favourite Food Freelist. Eight items were salient, including Fish, Rice, Breadfruit, Chicken, Egg, Coconut, Egg, Sausage, and Babai.]
[Figure 13: Scree plot test. The breakpoint for which the curve flattens significantly is after Chicken, indicating that seven food items are salient. This graph only includes food items with salience above 0.005 to improve visual quality.]
[Figure 14: Sociodemographic categorisation of Rural Favourite Food Freelist. Seven items were salient, including Rice, Fish, Breadfruit, Babai (Swamp taro), Coconut, Pumpkin, and Chicken.]
Traditional Food Freelist
Urban participants mentioned 80 food items, with saliency scores spanning from 0.171 to 0.0000562 (see Supplementary Material 5.3). Breadfruit was mentioned by 279 participants (82.3%), Fish by 275 (81.1%), Coconut by 207 (61.1%), Babai (Swamp taro) 171 (50.4%), Pumpkin by 153 (45.1%), Pandanus by 126 (37.2%), and Banana by 99 (29.2%) (Fig. 16).
Rural participants mentioned 40 food items, with saliency scores ranging from 0.188 to 0.000463 (see Supplementary Material 5.4). Fish was mentioned by 32 (53.3%), Breadfruit by 49 (81.7%), Coconut by 28 (46.7%), Babai (Swamp taro) by 40 (66.7%), Pumpkin by 30 (50.0%), Pandanus by 17 (28.3%), Banana by 31 (51.7%), Papaya by 15 (25.0%), Bero fig by 17 (28.3%), Pawpaw by 15 (25.0%), and Sweet potato (Koumara) by 12 (20.0%) (Fig. 18).
[Figure 15: Scree plot test. The breakpoint for which the curve flattens significantly is after Banana, indicating that seven food items are salient. This graph only includes food items with salience above 0.001 to improve visual quality.]
[Figure 16: Sociodemographic categorisation of Urban Traditional Food Freelist. Seven items were salient, including Breadfruit, Fish, Coconut, Babai (Swamp taro), Pumpkin, Pandanus, and Banana.]
[Figure 17: Scree plot test. The breakpoint for which the curve flattens significantly is after Rice, indicating that twelve food items are salient. This graph only includes food items with salience above 0.001 to improve visual quality.]
[Figure 18]
Top Three Food Question
Urban participants mentioned 52 food items, with saliency scores spanning from 0.366 to 0.000492 (see Supplementary Material 5.5). Fish was mentioned by 329 (97.1%), Rice by 309 (91.2%), Chicken by 108 (31.9%), Breadfruit by 82 (24.2%), and Coconut by 50 (14.7%) (Fig. 20).
Rural participants mentioned 19 food items, with saliency scores ranging from 0.366 to 0.00278 (see Supplementary Material 5.6). Rice was mentioned by 56 (93.3%), Fish by 56 (93.3%), Breadfruit by 25 (41.7%), Babai (Swamp taro) by 11 (18.3%) (Fig. 22).
[Figure 19: Scree plot test. The breakpoint for which the curve flattens significantly is after Coconut, indicating that five food items are salient. This graph only includes food items with salience above 0.001 to improve visual quality.]
[Figure 20: Sociodemographic categorisation of Urban Top Three Food Question. Five items were salient, including Fish, Rice, Chicken, Breadfruit, and Coconut.]
[Figure 21: Scree plot test. The breakpoint for which the curve flattens significantly is after Babai, indicating that four food items are salient. This graph only includes food items for salience above 0.001 to improve visual quality.]
[Figure 22: Sociodemographic categorisation of Rural Top Three Food Question. Four items were salient, including Rice, Fish, Breadfruit, and Babai (Swamp Taro).]
[Figure 23: Venn diagram comparing salient items in the Favourite Food Freelist by urban participants (UFF) and rural participants (RFF).]
[Figure 24: Venn diagram comparing salient items in the Top Three Foods Question by urban participants (UT3) and rural participants (RT3).]
[Figure 25: Venn diagram comparing salient items in Traditional Food Freelist by urban participants (UTT) and rural participants (RTT).]
Overall, the data on food preferences across urban and rural localities shows mostly homogeneity, albeit with some nuance among highly salient food items that contrast with existing literature on food security. Conversely, less salient food preferences have patterns indicative of a nutrition transition, shaped by the forces of urbanisation and globalisation.
Rice, fish, breadfruit, chicken, coconut, and babai maintained their salience across both settings (Fig. 23), with distinctions in less salient items whereby urban communities prefer imported sausage and rural communities prefer pumpkin. This preference is similar for consumption, with fish, rice, and breadfruit maintaining salience across both localities but rural communities preferring babai over chicken (Fig. 23). Regional variation within food preferences reflects the understanding of the relationship between the environment and food availability, with urban food security maintained by imports and rural food security maintained by traditional foods (Cauchi, Bambrick, Correa-Velez, et al., 2021; Kodish et al., 2019). This is also reflected by a greater variation of salient traditional foods in rural Kiribati (Fig. 24). However, the preference for fish, breadfruit, coconut, and babai in urban communities highlights their cultural significance and dietary importance even with limited access and availability. Eggs are locally produced yet only preferred in urban localities. This may be attributed to the high cost of eggs in urban areas making it a “luxury” item, whereas in rural areas people often obtain eggs through subsistence farming (Food and Agriculture Organization, 2021). Interestingly, consumption of coconut is salient in urban localities but not in rural localities possibly for the same reason that coconuts are more abundantly found in rural areas.
Contradicting the literature, rural localities demonstrate a higher preference and consumption of rice than urban localities. This shows that despite rural communities having a greater diversity of local foods, they exhibit a stronger cultural preference and reliance on rice, which is imported. This is also seen with rice being mentioned as a traditional food by a greater proportion of rural participants (8.3%) than urban participants (3.0%). This finding may stem from deeper cultural assimilation of rice into traditional diets, as observed in a previous study, wherein elderly rural i-Kiribati individuals were observed mixing rice with traditional foods (Cauchi, Bambrick, Correa-Velez, et al., 2021). Another potential reason for the high salience of rice in rural communities could be because of a lower diversity of imported foods. Conversely, urban preference and consumption of fish is more salient. This contradicts the understanding of food security regarding fish, given that rural areas typically have greater access and availability of marine resources (Food and Agriculture Organization, 2018). This interesting finding may be attributed to seasonal variations in tides affecting fish availability (Cauchi, Bambrick, Correa-Velez, et al., 2021). However, further research is required to understand the underlying reasons for these discrepancies.
Consensus Analysis
[Table 3]
| Question | Urban | Rural |
|---|---|---|
| FF | 7.69 | 5.65 |
| TF | 6.78 | 3.60 |
| T3 | 6.57 | 3.68 |
The existence of a group consensus was determined for each question in urban and rural localities (Table 3). A consensus was indicated by an eigenvalue ratio greater than 3, suggesting that individuals within a group had a common understanding of the cultural food narratives within that domain. Both subgroups for all three questions displayed cultural consensus of the cultural food narratives. However, the urban subgroup had larger eigenvalue ratios compared to the rural subgroup for all three questions, showing a stronger consensus. This suggests a more uniform cultural food narrative in urban localities, which may indicate a more restricted range of food.
This study used the freelisting methodology to understand Kiribait’s cultural narratives around food preferences and traditional foods. Smith’s S salience analysis was applied to calculate the significance of food items based on their frequency of mention and position in the freelist. Salience analysis was also used for food consumption. Overall, the study revealed that fish, rice, breadfruit, chicken, and coconut are culturally preferred and commonly consumed items in Kiribati, with fish, breadfruit, and coconut falling into the category “Salient Sweet Spot”. There are distinctions in food preferences and consumption between urban and rural localities, with rural communities preferring traditional foods and urban communities preferring imported foods. By combining all aspects of the results, focus foods can be identified for policy recommendations aimed at improving food security of culturally important food items and reducing the growing prevalence of NCDs in Kiribati.
Dietary Dichotomy: What Foods Are Healthy?
The literature on Kiribati’s dietary landscape shows a divergence between imported and traditional foods. However, it does not necessarily indicate a strong cultural preference for unhealthy, imported foods that are commonly associated with NCDs (Hanna et al., 2011; Hawley & McGarvey, 2015; R. G. Hughes & Lawrence, 2005; Jane Parry, 2010; Ulijaszek, 2005). Focus foods for targeted policy recommendations are shown in Table 3. Salient imported foods include rice, chicken, and sausage (Cauchi, Bambrick, Correa-Velez, et al., 2021; Cauchi, Bambrick, Moncada, et al., 2021; Troubat & Michael K., 2021). High rice consumption is associated with an increased risk of type 2 diabetes (Yu et al., 2022). Similarly, processed meats like sausage are associated with elevated NCD risks, although poultry consumption is not (Anand et al., 2015). Eggs are recognised for their nutritional value in Kiribati (Troubat & Michael K., 2021).
Conversely, traditional foods are high in essential nutrients and are associated with a decreased risk of NCDs (DiBello et al., 2009; Hanna et al., 2011; Oliveira et al., 2015). Salient traditional foods include breadfruit, fish, coconut, babai, pumpkin, pandanus, banana, papaya, bero fig, pawpaw, and sweet potato. Fish is rich in protein and many essential micronutrients and its consumption displaces the consumption of other processed meats or tinned foods options (Seto et al., 2024; Troubat & Michael K., 2021). Breadfruit has a low-glycaemic index, high fibre content, and high antioxidant properties (Mehta et al., 2023), presenting a viable alternative to rice and can potentially mitigate diabetes and obesity (Daley et al., 2019; Turi et al., 2015). Similarly, coconuts, whether young or mature, offer a spectrum of nutrients and antioxidants from their water and meat (Phonphoem et al., 2022; Tuyekar et al., 2021). Babai (swamp taro) serves as an important cultural food, with a moderate-glycaemic index, and is high in fibre, essential micronutrients, and antioxidants (Englberger et al., 2008; Santonia et al., 2022).
[Table 4]
Table 4. Focus foods for policy recommendations. Green = Beneficial foods, White = Neutral foods, Yellow = Probably detrimental foods, Red = Detrimental foods.
Policy Interventions for Nutritional Reform
This study offers valuable insights into Kiribati's cultural preferences, consumption patterns, and locally produced food items. By highlighting these salient items, culturally appropriate policy recommendations can be made to address the challenges of food security and NCD prevalence. The following policy recommendations expand on policies recommended from a previous study in Kiribati (Cauchi, Bambrick, Correa-Velez, et al., 2021):
1. Sustainable Ecological Management of Foods that are in the “Salient Sweet Spot”
Maintenance of “Salient Sweet Spot” foods is key to the long-term viability of food security in Kiribati. These food items include fish, breadfruit, and coconut. Emphasis should be placed on sustainable fishing and farming practices of these food items.
2. Infrastructure Improvement
Enhancing transportation networks and storage facilities can ensure a steady supply of preferred, traditional foods, particularly breadfruit, babai, and coconut, to urban communities to reduce reliance on imports. This aims to increase the consumption of healthier, traditional alternatives.
3. Subsidisation and Processing
To combat the dominance of cheap, convenient imported foods such as rice, a subsidisation and processing strategy for salient traditional foods is recommended. This allows traditional foods like breadfruit and babai to be more economically viable. Processing techniques, such as milling breadfruit or babai into low-moderate glycaemic index flour, can enhance their shelf life and nutritional value, thereby promoting their consumption and dietary diversification: these are currently not readily available in Kiribati except on a household level (Liu et al., 2020; Mehta et al., 2023; Santonia et al., 2022; Turi et al., 2015).
4. Removing Subsidies from Imported Food and Promoting Traditional Alternatives
Subsidies on imported staples, such as rice, sugar, and flour are promoting unhealthy dietary preferences (Cauchi, Bambrick, Correa-Velez, et al., 2021; Rimon, 2011). Gradually reducing subsidies on imported staples and concurrently promoting traditional foods like breadfruit and babai aims to shift preferences towards healthier alternatives. This also reduces the impact of shocks to imported foods. However, careful planning and mitigation strategies are necessary to ensure food security for vulnerable populations, as the removal of subsidies may disproportionately affect low-income households that rely on cheaper foods for food security (Troubat & Michael K., 2021).
5. Targeted Health Education, Food Awareness, and Food Promotion Initiatives
Targeted health education can include programs such as curriculum development in schools, farmer field schools, village workshops, and media promotion. This policy aims to enhance the cultural importance of non-salient traditional foods in Kiribati but can also apply to all salient traditional foods. However, certain non-salient leafy vegetables are highly nutritious options, adaptable to Kiribati's climate, and are more environmentally friendly than current salient traditional foods like babai (Lyons et al., 2020). The babai Food Garden policy, which aimed to introduce low-tech pathways for growing other vegetables, exemplifies a tailored approach to promoting non-salient traditional foods (Lyons et al., 2020). Further research is needed to understand the factors influencing the adoption and sustainability of such initiatives across different geographic characteristics and communities (Lin et al., 2022). Additional workshops could include cooking tutorials from outer islands to showcase the integration of traditional and imported foods, highlighting their complementary roles in the traditional diet (Cauchi, Bambrick, Correa-Velez, et al., 2021).
6. Education on Sugar and Salt Consumption
The prevalence of these foods in daily consumption of the i-Kiribati is higher than the recommended values (National Health Service UK, 2022; Troubat & Michael K., 2021; World Health Organisation, 2015), yet it was not reflected in the preference or consumption salience analysis in the study. Education on the impacts of dietary sugar and salt consumption can allow the i-Kiribati to be more self-aware of their unhealthy consumption patterns.
These policy interventions offer actionable strategies to improve food security, promote healthier dietary choices, and mitigate the burden of NCDs in Kiribati by targeting specific food items that are culturally important. They also highlight non-salient items that can benefit from better understanding and awareness.
Strengths
The study benefits from a robust sample size of 399 participants, exceeding the minimum requirement of 20 for cultural salience analysis (Keddem et al., 2021), and this is reflected in the high congruence of responses. This suggests a strong and consistent cultural profile which increases the reliability of the findings. Including participants from diverse locations across three islands ensures a representative sample across urban and rural communities, allowing for more reliable and applicable policy recommendations. Cross-referencing consumption freelist data with dietary recall studies collected during similar periods helps validate the accuracy of responses. This contextualisation proved to be integral in finding a limitation of this study which will be explained later.
Limitations
The data collected and cross-referenced were from 2019, just before the Covid-19 pandemic. Food preferences may have changed due to possible strains in food supplies during the pandemic, but this is unlikely due to limitations in infrastructure to allow large deviations. However, this temporal limitation highlights the need for periodic updates to capture evolving dietary trends. While the findings offer valuable anthropological insights, they do not fully represent actual food consumption patterns. This could be seen when cross-referencing consumption freelist data with dietary studies. Discrepancies observed in the consumption of certain food items like coconut, bread, sugar, and flour highlight potential limitations of relying solely on participant-reported top three foods most often consumed.
An explanation for the discrepancy between food preference and consumption could be due to the nature of the questioning, predisposing participants to social desirability bias to avoid choosing sugar. A refinement in methodology, such as querying about the community’s food preferences rather than the individual’s preferences, could mitigate this bias.
Lastly, the unequal sample sizes between urban (n = 339) and rural (n = 60) participants affect the generalisability of the findings. The larger urban sample size could potentially skew the results towards urban preferences and consumption patterns, while the smaller rural sample size may not adequately capture the diversity of rural food preferences. This, however, highlights the logistical difficulty in accessing rural communities in Kiribati, which often are poorly connected through limited air or boat travel.
Implications for Future Studies
Within the context of Kiribati, a comprehensive dietary study including the consumption of food additives like sugar and salt emerges as a critical area for future research. A thorough examination of these additives between urban and rural communities in Kiribati would provide invaluable insights into the country’s dietary habits and health implications. The implication of this research also extends beyond Kiribati's borders, holding relevance for other PICTs facing similar challenges related to food security and nutrition transition. Researchers are encouraged to extrapolate and apply similar methodologies to explore cultural food narratives in other PICTs to enrich the understanding of regional food systems further. By identifying and leveraging "Salient Sweet Spot" foods and other salient beneficial foods, targeted interventions aligned with cultural narratives will be more effective at addressing the growing concern of NCD prevalence in the region.
This study shows the cultural significance of food in Kiribati, highlighting staples like fish, rice, breadfruit, chicken, and coconut, and recognises the nuanced differences between these staples that prove to be areas for future research. Urban communities preferred imported foods like sausage, reflecting broader trends towards modernisation and globalisation. In contrast, rural communities often maintained stronger connections to ‘traditional’, home-grown foods such as pumpkin. These urban-rural disparities show the complex interplay between cultural dynamics, socioeconomic factors, and dietary behaviours. Although the impact of cultural food preferences on NCDs was unclear, recommendations on strategies to mitigate their burden are relevant for focus foods, emphasising food that falls under the group “Salient Sweet Spot”. This included fish and breadfruit, and coconut, highlighting the relevance of local, traditional foods that could prove key to successful food security interventions. By developing targeted interventions like those mentioned in the discussion section above, efforts can be made towards a healthier future for Kiribati and other PICTs alike, addressing cultural values towards foods, food security, and public health challenges.
Acknowledgments
The authors of this paper would like to acknowledge the work of Loleina Auraria, Bungea Kanuete, Aata, Tanugea and Kinaua from Kiribati for attending training sessions and collecting the data. We are also grateful to the staff of the Kiribat health Retreat Association (KHRA) and KiriCAN (Kiribati Climate Action Network) for their support in making this study possible. We would also like to thank Mark Gunning for creating the map of Kiribati used in this manuscript.
Ethics approval
This study was conducted according to the guidelines laid down in the Australian National Statement on Ethical Conduct in Human Research and all procedures involving study participants were assessed and approved as Low Risk by the Queensland University of Technology Human Research Ethics Committee (UHREC) with Application No 1700000904. Data were subsequently transferred to Queen Mary University of London, Malta Campus (QMUL Malta) through a Data sharing agreement signed in 2024. Written informed consent was obtained from all participants.
Conflict of Interest Statement
The authors declared that they have no conflict of interest.
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Supplementary Material 5 is not available with this version.
The authors declare no competing interests.