Objective: To: (i) understand facilitators and barriers to healthy eating practices and physical activity in younger and older urban adolescent South African boys and girls; and (ii) understand how the views of caregivers interact with, and influence, adolescent behaviours. Design: Semi-structured focus group discussions (FGD) were conducted in July 2018. Data were analysed using thematic analysis. Setting: Soweto, Johannesburg, South Africa. Participants: Seventy-five participants were stratified into eight FGD as follows: two for young boys and girls (10–12 years); two for older boys and girls (15–17 years); two for caregivers of young adolescents (boys and girls); and two for caregivers of older adolescents (boys and girls). Results: Unlike their caregivers, adolescents were not motivated to eat healthily and failed to appreciate the need to develop consistent patterns of both healthy eating and physical activity for their long-term health. Although adolescents gained independence with age, they commonly attributed unhealthy food choices to a lack of autonomy and, thereby, to the influence of their caregivers. Adolescents and caregivers perceived their engagement in physical activity according to distinct siloes of recreational and routine activity, respectively. Both similarities and differences in the drivers of healthy eating and physical activity exist in adolescents and caregivers, and should be targeted in future interventions. Conclusions: Our study identified a complex paradigm of eating practices and physical activity in South African adolescents and their caregivers. We also highlighted the need for a new narrative in addressing the multifaceted and interrelated determinants of adolescent health within urban poor settings.

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The Bukhali trial is being implemented with young women (18-28 years) in Soweto, South Africa. A qualitative longitudinal study was conducted to explore Bukhali trial participants’ perceptions of health and their health behaviours over time and in the context of their life circumstances. This article reports an interpretation of interview data from a sub-sample of 11 of 35 participants who participated in four interviews conducted over 12 months. A longitudinal case analysis approach was applied, and four themes were developed: life circumstances, perceptions of health, health behaviours and changes, and experiences of the trial. Participants experienced largely challenging life circumstances characterised by instability and lack of security in terms of employment and education. Their health and health behaviour trajectories also lacked stability and were fragile within the Soweto context. Data were also interpreted through the lens of a concept previously explored in Soweto and introduced in the final interview: ukuphumelela (‘flourishing’). This concept provided a useful framework for understanding the dominance of external or structural (versus internal or personal) factors and social dynamics influencing the health behaviour and life trajectories of participants, particularly in terms of success in the face of difficulty. Participants’ experiences of the trial highlighted the critical role of support provided by and trust established with trial staff. This longitudinal qualitative approach provides unique perspectives about the Bukhali trial over time, the importance of contextualising health behaviour change, and the variable instability impacting the participants, outcomes and implementation of Bukhali in Soweto, a vulnerable setting.