Perceptions of eating practices and physical activity among Malaysian adolescents in secondary schools: a qualitative study with multi-stakeholders

Abstract

Objective: To conduct formative research using qualitative methods among stakeholders of secondary schools to explore their perceptions, barriers and facilitators related to healthy eating and physical activity (PA) among Malaysian adolescents. Design: A qualitative study involving eight focus groups and twelve in-depth interviews. Focus groups and interviews were recorded and transcribed verbatim. An inductive thematic analysis approach was used to analyse the data. Setting: Four secondary schools in Perak and Selangor states (two urban and two rural schools) in Malaysia. Participants: Focus groups were conducted with seventy-six adolescents aged 13–14 years, and in-depth interviews were conducted with four headmasters, four PA education teachers and four food canteen operators. Results: Stakeholders thought that adolescents’ misperceptions, limited availability of healthy options, unhealthy food preferences and affordability were important challenges preventing healthy eating at school. Low-quality physical education (PE) classes, limited adolescent participation and teachers’ commitment during lessons were perceived as barriers to adolescents being active at school. Affordability was the main challenge for adolescents from rural schools. Stakeholders perceived that a future school-based intervention should improve the availability and subsidies for healthy foods, provide health education/training for both adolescents and PE teachers, enhance active adolescent participation in PE and develop social support mechanisms to facilitate engagement with PA. Conclusions: These findings provide important insights into developing school-based lifestyle interventions to improve healthy eating and strengthening PA of Malaysian adolescents.

School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol

“…The intervention was developed based on data obtained from systematic reviews (21,49), reports of the MyHeARTs cohort study (48), and a related qualitative study (50). The findings suggested that a school canteen intervention had merit.…”

“…The findings suggested that a school canteen intervention had merit. The qualitative study was also useful to operationalise the intervention content (50). Focus group discussions with selected adolescents aged 15 years were conducted to understand the available canteen food.…”

“…Focus group discussions with selected adolescents aged 15 years were conducted to understand the available canteen food. The key informants were school headmasters and canteen operators who were interviewed on the dietary habits of students to develop a priority list for intervention (50). All transcripts were analysed and coded.…”

“…All transcripts were analysed and coded. The themes on healthy eating suggestions were availability of healthy options, subsidising healthy foods, and health education and training (50). Stakeholders thought that adolescents' misperceptions, affordability, unhealthy food preferences, and limited availability of healthy options were important barriers preventing healthy eating at school.…”

“…Furthermore, affordability was a major problem for adolescents in rural schools. Stakeholders perceived that a future school-based intervention might improve the availability and subsidies for healthy foods (50). The intervention was developed and its components guided by the Theoretical Domains Framework for use in behaviour change (51).…”