A Mixed Methods Analysis of Factors That Influence the Diet Quality and Decision‐Making of Adolescent Girls in an Urban Informal Settlement in Kenya

Due to the nutrition transition, adolescent diets globally appear to be shifting to increased consumption of fast foods and snacks high in sodium, added sugar, and saturated fat. In urban informal settlements in Kenya, limited evidence suggests adolescents consume 1-2 meals per day, have low dietary diversity, and consume foods from roadside stalls. We characterized the diets of adolescent girls in an urban informal settlement in Kenya and assessed the factors associated with diet quality and decision-making. We used a convergent mixed methods design to simultaneously analyze survey, dietary intake, structured interview, and focus group discussion data. Participants were recruited via a community-based participatory-development organization. We assessed diet quality from 24-h recall using the Global Diet Quality Project's Global Dietary Recommendations score-combining dietary risk factors for non-communicable disease (NCD-risk) with dietary factors protective of non-communicable disease (NCD-protect). We tested associations between diet quality, household hunger, sociodemographic variables, and food behaviors. Focus group discussion (FGD) and interview data were transcribed, translated, and analyzed thematically according to the factors that influenced diet. Adolescent girls predominately consumed food from grains, dark leafy greens, sweet tea or coffee, and deep-fried foods (predominately samosas, mandazi [doughnuts], and fries). Adolescent girls with moderate or severe household hunger had higher diet quality scores-driven by a lower consumption of dietary risk factors for non-communicable disease (NCD risk)-compared to girls with little to no household hunger. This relationship was driven by the consumption of red meat, by girls with less household hunger. In qualitative data, finances were the main decision-making factor with skipping meals as a common coping strategy. Adolescent girls were aware of what foods constitute a healthy diet, but their diet quality and decision-making were driven by household hunger, finances, and food safety.