Perceived barriers and facilitators of healthy eating and physical activity: focus groups with children, parents and teachers in Mumbai, India

Abstract

Background: Childhood offers a critical opportunity to inculcate healthy eating habits and promote adequate activity levels. Prior studies have assessed the factors that influence food choices and activity among children, however, these perspectives may vary considerably across communities, cultures and social environments. Knowledge regarding determinants of diet and activity related behaviors among children in India is lacking; understanding these influences will help to develop appropriate interventions. This qualitative study employed the tenets of the health belief model to identify barriers and facilitators of healthy eating and physical activity levels in children in Mumbai, India.Methods: Fourteen focus group discussions were conducted with children, parents and teachers, selected from three aided and three private schools in Mumbai. The transcripts were coded and analyzed using the scissor and sort method to derive common themes as per the protocol questions.Results: The discussions revealed four main themes, namely knowledge regarding non communicable diseases and physical activity guidelines, perceived susceptibility and severity of consequences of unhealthy behaviors, socio-environmental factors such as availability and accessibility of foods at school and home, facilities for sports and peer support and individual determinants that shape choices such as time, academic pressure, convenience and will power. Variety in canteen menus, ‘fun’ outdoor activities, daily screen time monitoring and parent role modeling emerged as key facilitators.Conclusions: The results reiterated a need to improve parents’ nutrition knowledge, enforce strict school food sale policies and generate interest and motivation among children through targeted behavior change communication strategies.