Healthy eating in preschool children: Perceptions of parents and caregivers in Sri Lanka

Objective: Modifying the unhealthy dietary habits of children in low- and middle-income countries is important to overcome the increasing prevalence of childhood under- and overnutrition. Dietary habit formation is multifactorial, with parental influence fundamental in determining children's food environment and intake. Therefore, understanding parents' perspectives regarding healthy eating in their preschool-aged children in low- and middle-income countries is necessary to tailor programmes and interventions. However, limited research exists. This study therefore explored parents' and caregivers' understanding of healthy eating and perceived barriers and strategies to support their preschool children's healthy eating in a middle-income country, Sri Lanka. Design: Qualitative study employing focus group discussions. Setting: Preschools in an urban area of north-western Sri Lanka. Method: Thirteen focus groups, each comprising 6-10 participants, were conducted with 110 parents/ caregivers of children aged 2-6 years in Kurunegala (an urban area), in north-west Sri Lanka. Group discussions were audio recorded, transcribed verbatim, translated into English, coded and underwent inductive content analysis. Results: Participants' understanding of healthy eating was largely consistent with dietary guidelines. Perceived barriers to healthy eating were predominantly intrapersonal ('pester power' and 'picky eating' of children), and family and peer-related (inadequate family support and peer influence). Suggested strategies included changes in household food availability, preparation and rewards, and creating more supportive environments (family, preschool and community). Conclusion: To optimise nutrition intervention outcomes, strategies targeting the identified intrapersonal, family and peer barriers should be incorporated.