Understanding children’s perspectives of the influences on their dietary behaviours

Abstract

Objective This study aimed to examine the intrapersonal, interpersonal, environmental and macrosystem influences on dietary behaviours among primary school children in Singapore. Design A qualitative interpretive approach was used in this study. Focus group discussions guided by the socio-ecological model (SEM), of which transcripts were analysed deductively using the SEM and inductively using thematic analysis to identify themes at each SEM level. Setting Two co-educational public primary schools in Singapore. Participants A total of 48 children (n=26 girls) took part in the semi-structured FGDs. Their mean age was 10.8 years (SD = 0.9, range 9-12 years) and the majority of the children were Chinese (n=36), along with some Indians (n=8) and Malays (n=4). Results Children’s knowledge of healthy eating did not necessarily translate into healthy dietary practices and concern for health was a low priority. Instead, food and taste preferences were pivotal influences in their food choices. Parents had a large influence on children with regards to their accessibility to food, their attitudes and values towards food. Parental food restriction led to some children eating in secrecy. Peer influence was not frequently reported by children. Competitions in school incentivised children to consume fruits and vegetables, but reinforcements from teachers were inconsistent. The proximity of fast-food chains in the neighbourhood provided children easy access to less healthy foods. Health advertisements on social media rather than posters worked better in drawing children’s attention. Conclusions Findings highlighted important factors that should be considered in future nutrition interventions targeting children.

Development and Evaluation of a Diet Quality Index for Preschool-Aged Children in an Asian population: The Growing Up in Singapore Towards Healthy Outcomes cohort

“…Besides the aforementioned factors, other possible factors not examined in this study may also explain why children are not meeting dietary recommendations. In a recent study exploring barriers to healthy dietary behaviours amongst children aged 9-12 years of age in Singapore 37 , it was found that barriers to children consuming a healthy diet included them valuing tasty foods over nutrition, modelling after parents’ unhealthy dietary behaviours, peer influence on fast food consumption, having easy access to fast food chains and convenience stores selling unhealthy snacks 37 .…”

Sociocultural environmental factors and childhood stunting: qualitative studies – a protocol for the Shared Values theme of the UKRI GCRF Action Against Stunting Hub

“… 11 Research has recently widened to qualitative and mixed-method studies to explore the influences on specific nutrition-related determinants of sociocultural practices and religion, 11–13 school systems, health communication campaigns, food chains. 13 However, it has been reported that even with high coverage (90%) of the ‘top 10’ recommended ‘nutrition-specific’ interventions, the stunting burden in LMICs will likely only reduce by 20%. 14 15 …”

“…For example, in certain settings, moderate undernutrition is perceived not as a health problem, but rather a ‘seasonal weight loss’. 13 15 A lack of understanding of such locally situated perceptions 16 can cause ‘the creation of solutions that are neither meaningful nor beneficial to those in need’, (Harder et al , p509) 17 whereas an understanding of underlying shared values of groups associated with children’s food and education might reveal grounded information on linkages between them and direct determinants of stunting.…”

Local contextual factors of child stunting found via shared values of stakeholder groups: an exploratory case study in Kaffrine, Senegal

“…To improve knowledge on these, recent research has turned to qualitative and mixed-method studies to explore several indirect influences of nutrition-related determinants such as gender ( 21 , 22 ) , socio-cultural practices and religion ( 9 , 23 , 24 ) , socio-economic ( 25 ) , structural and environmental factors such as school systems, health communication campaigns, food chains ( 24 ) , as well as local lived experiences shaping the design, uptake, implementation and efficacy of interventions ( 26 ) . The social context and cultural meanings within a community shape the perceptions of what is considered a child’s healthy growth ( 27 , 28 ) and influence the engagement in nutrition interventions, such as family relations and gendered household roles ( 24 , 26 ) , for example, where women have little control over family finances ( 29 ) .…”

“…Upon these are constructed local perceptions and experiences which carry rich socio-cultural information. For example, in certain settings, moderate undernutrition is perceived not as a health problem but rather a ‘seasonal weight loss’ ( 24 , 30 ) ; the impact of time- and socio-economic costs of participating in interventions reduces their effectiveness ( 31 ) and lack of understanding of locally situated perceptions ( 32 ) can cause ‘the creation of solutions that are neither meaningful nor beneficial to those in need’ ( 33 ) (pp. 509) .…”