Abstract
ObjectiveThe objective of this study was to identify factors influencing eating behavior of Ecuadorian adolescents - from the perspective of parents, school staff and adolescents - to develop a conceptual framework for adolescents' eating behavior.Study designTwenty focus groups (N = 144 participants) were conducted separately with adolescents aged 11–15 y (n (focus groups) = 12, N (participants) = 80), parents (n = 4, N = 32) and school staff (n = 4, N = 32) in rural and urban Ecuador. A semi-structured questioning route was developed based on the ‘Attitude, Social influences and Self-efficacy’ model and the socio-ecological model to assess the relevance of behavioral and environmental factors in low- and middle-income countries. Two researchers independently analyzed verbatim transcripts for emerging themes, using deductive thematic content analysis. Data were analyzed using NVivo 8.ResultsAll groups recognized the importance of eating healthily and key individual factors in Ecuadorian adolescents' food choices were: financial autonomy, food safety perceptions, lack of self-control, habit strength, taste preferences and perceived peer norms. Environmental factors included the poor nutritional quality of food and its easy access at school. In their home and family environment, time and convenience completed the picture as barriers to eating healthily. Participants acknowledged the impact of the changing socio-cultural environment on adolescents' eating patterns. Availability of healthy food at home and financial constraints differed between settings and socio-economic groups.ConclusionOur findings endorse the importance of investigating behavioral and environmental factors that influence and mediate healthy dietary behavior prior to intervention development. Several culture-specific factors emerged that were incorporated into a conceptual framework for developing health promotion interventions in Ecuador.
Highlights
Obesity and chronic diseases are no longer exclusive to affluent societies, but are the leading cause of morbidity and mortality in low- and middle-income countries (LMICs) [1]
Several culture-specific factors emerged that were incorporated into a conceptual framework for developing health promotion interventions in Ecuador
Evidence is needed from LMICs of the pathways through which school-based interventions mediate physical activity and dietary behavior [12]
Summary
Obesity and chronic diseases are no longer exclusive to affluent societies, but are the leading cause of morbidity and mortality in low- and middle-income countries (LMICs) [1]. A staggering rise in unhealthy body weight has been observed in children in LMICs across all levels of socio-economic status [2,3]. This rise is associated with rapid economic and societal changes [4,5] and has led to obesity prevalence estimates in some LMICs as high as those in high-income countries (HICs) [6]. Evidence is needed from LMICs of the pathways through which school-based interventions mediate physical activity and dietary behavior [12]. Intervention studies incorporating theoretical models to address population-specific behavioral and environmental influences on dietary and physical activity behavior are required [13]. Current models may not be transferable to LMICs because culture-specific influences on these behaviors, such as social values/norms and physical environment may be different from HICs
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