Family Barriers and Facilitators to promote healthy eating among adolescents – a systematic review of qualitative studies

Abstract

Introduction: Promoting eating habits is an important strategy to tackle adolescent obesity. Existing systematic reviews have confirmed family impacts on adolescent eating habits, but it is not entirely clear “how” and why” families are or are not able to support adolescents in adopting healthy eating. This review aimed to consolidate the findings from qualitative studies, and identify the family barriers and facilitators of knowledge, attitudes and practices (KAP) of healthy eating in adolescents. Methods: A literature search of PubMed, Web of Science, PsycINFO and Embase using search terms for adolescents/family, knowledge/attitudes/practices, eating habits and qualitative methods was completed on 31 July 2020. Qualitative studies were included if they explored the family factors influencing the eating habits of adolescents (aged 10 to 19 years); and excluded if they were not reported in English, not original studies, or targeted adolescents with specific health problems. The selected studies were reviewed through data extraction, quality assessment and synthesis of findings following the KAP framework. Results: 48 studies were included with a majority from the Western countries and sampling from single source. Ten themes were synthesized under adolescent dietary KAP: Knowledge – 1) Parental education, 2) Parenting style, and 3) Family illness experience; Attitudes – 4) Family health, 5) Cultivation of preference, and 6) Family motivation; and Practices– 7) Home meals and food availability, 8) Time and cost, 9) Parenting style, and 10) Parental practical knowledge and attitudes. Conclusions: This review highlights authoritative parenting styles, parental dietary knowledge and attitudes as facilitators of adolescent KAP of healthy eating, while time and cost concerns are major barriers. Families of adolescents with working parents and low SES are more vulnerable to unhealthy eating. Cultural differences in family influences on adolescent KAP, especially in the aspects of attitudes and food choices, call for more studies on Asian families.