Family Facilitators of, Barriers to and Strategies for Healthy Eating among Chinese Adolescents: Qualitative Interviews with Parent–Adolescent Dyads

Abstract

Healthy eating is vital in preventing obesity and long-term non-communicable diseases. This study explores potential family facilitators of, barriers to and strategies for healthy eating among adolescents in Chinese families to guide the development of effective interventions in the future. Parent–adolescent dyads were purposively sampled by age, gender, fruit and vegetable intake and household income. Key family factors were identified by thematic analysis. Fourteen themes under five domains were identified: family health with (1) illness experienced in the family; parental knowledge of (2) dietary recommendations, (3) the preparation of healthy food and (4) healthy food choice; parental attitudes towards (5) the importance of healthy eating and (6) the priority of family health; socioeconomic factors of (7) time concerns and (8) cost concerns; and food parenting practices in (9) nutritional education, (10) role modeling, (11) food provision, (12) child involvement, (13) parental supervision and (14) the cultivation of food preference. Useful strategies included incorporating healthy ingredients in adolescents’ favorite recipes and providing a variety of fruit and vegetables at home. There is a need to empower parents with practical nutrition knowledge, to be more authoritative in food parenting practices, to discuss healthy eating with children and to acquire practical skills related to time- and cost-saving healthy cooking.

The Knowledge, Attitudes, and Practices of Healthy Eating Questionnaire: a pilot validation study in Chinese families

“…Many items of the KAP-HEQ are specific to the local Chinese culture and guided by the results of our earlier qualitative study ( 25 , 26 ). For instance, the items on the definition of one serving of FV (item Q2) and the examples of vegetables (item Q8) were included to address these knowledge gaps found in the qualitative study.…”

“…The dimensions and potential items on KAP of healthy eating were identified from published KAP and health literacy questionnaires specific to Asian populations ( 10 , 21 , 23 , 24 ) and supplemented by the findings from our previous qualitative studies ( 25 , 26 ).…”

“…We evaluated the item importance in addition to relevance, clarity (i.e., comprehensibility in the COSMIN), and comprehensiveness of the questionnaires. Due to the limitation of time and resources in this pilot study, we could only recruit a total of 8 parent–adolescent dyads ( N = 16) from families who participated in an earlier qualitative study on adolescent KAP of healthy eating and the associated family factors ( 25 , 26 ). There is no standard guideline on the analytical approach ( 19 ), and we used the same methods as for expert-reviewed content evaluation.…”

“…There were 390 families in the cohort study with adolescents aged 12–19 years, whose parents were the primary caregivers as of 1 September 2022. A total of 21 families who participated in our previous qualitative study ( 25 , 26 ) were excluded. A sample size of 100 is generally considered sufficient for a pilot test on the psychometrics of a questionnaire using item analysis ( 18 ), and we targeted 120 persons of 60 parent–adolescent dyads.…”

Relationship between Diet Quality and Socioeconomic and Health-Related Factors in Adolescents by Gender

“…CSE, PCSE, and ILTC interventions should also provide families with information to facilitate habit changes and raise awareness regarding the importance of maintaining a healthy diet. Conducting family sessions or workshops to empower parents with practical knowledge of nutrition and healthy cooking (information on dietary recommendations or how to include healthy ingredients in teens’ favorite recipes, for example) can be key facilitators in promoting healthy eating at home along with involving adolescents in meal preparation and encouraging family discussion about food at mealtimes [ 62 ].…”