The theory of planned behaviour in exploring dietary diversity practices among mothers in informal settlements in Kenya

Abstract

One of the leading causes of malnutrition, which contributes to morbidity and mortality in children, is lack of dietary diversity. Despite remarkable improvement in exclusive breastfeeding in Kenya, there are still poor dietary diversity practices among children aged 6-24 months. Limited studies have applied the Theory of Planned Behaviour (TPB) to examine the factors that influence dietary diversity practices in informal settlements in Kenya. The objective of this qualitative study was to explore behavioral, normative, control beliefs, intention, and dietary diversity practices, based on the TPB. The study sites were Kibera in Nairobi, Manyatta A in Kisumu, and Kaptembwo in Nakuru. Participants were 64 mothers of children aged 6-24 months selected using purposive sampling. Nine focus groups, each comprising of 5-10 mothers were conducted and the data analyzed using thematic analysis. Using a focus group guide, based on the TPB, mothers described salient beliefs regarding their attitude, subjective norms and perceived control of dietary diversity. Analysis of the data showed that some mothers had intended to introduce solid foods at six months. However, barriers such as mother not feeding well, baby’s hunger, perceived insufficient breast milk production, and return to work led to earlier introduction of foods. Most mothers indicated their intention to give a variety of foods to their children but were hindered by barriers such as poverty/inadequate money, non-availability of food at home, and inadequate knowledge about complementary feeding. Friends, health professionals, fathers, neighbours and friends were cited as most salient referents that influenced the dietary diversity practices. The most frequently provided starchy foods were chappatis, mandazis, potatoes, rice, weetabix, porridge, and ugali. In conclusion, the results indicate that mothers had positive attitude towards dietary diversity. The ‘significant others’ who mostly influenced dietary diversity practices were health professionals, fathers, and friends. Future interventions need to target mothers' perceived child-feeding responsibilities, influence subjective norms, and increase parents' perceived control over child feeding.