Children’s diet quality: a mixed methods study on the role of domestic food environments in influencing food access during the COVID-19 lockdown in Chile

BACKGROUND: Households with lower socioeconomic status often have access to diets of poorer quality. However, even within the same socioeconomic group, intrahousehold dynamics influence food acquisition and influence children's diet quality. This study investigated how these dynamics influenced food access and dietary quality among low- to middle-income Chilean children during the COVID-19 lockdown. METHODS: Using an explanatory sequential mixed methods design, we conducted a survey (n = 999 households) and a qualitative photo-elicitation study in a subsample (n = 14 households). We report the results of the integration phase of the mixed methods study, which consisted of a side-by-side joint display table that juxtaposed the quantitative and qualitative results for each study dimension and a comparison and assessment of the "fit" between these results to generate meta-inferences that convey the insights derived from the integration. RESULTS: Food access was influenced by food-related practices particularly food purchasing and meal preparation. Three meta-inferences emerged: 1. Gender inequality in food responsibilities correlated with worse children's diet, directly and through time scarcity. 2. Time constraints limited the ability to buy and cook healthy foods, also restricting children's culinary education. 3. Households with a sole food gatekeeper often lacked resilience to navigate additional intrahousehold challenges, compromising children's diet quality. CONCLUSIONS: Short-term measures could improve access to nutritious food for time-limited caregivers. Long-term policies could promote cultural shifts toward shared food responsibilities. Additionally, leveraging coping strategies from resilient households may help strengthen community capacity and provide material support.