Abstract
OBJECTIVE: To explore perceived factors that impede or facilitate healthful eating within the home environment among overweight/obese adolescents. DESIGN: In the present qualitative photovoice study, participants were instructed to take photographs of things that made it easier or harder to make healthful food choices at home. Digital photographs were reviewed and semi-structured interviews were conducted to promote discussion of the photographs. Data were analysed using constant comparative analysis. SETTING: Vancouver, Canada, in 2012-2013. SUBJECTS: Twenty-two overweight/obese adolescents who completed a family-based lifestyle modification intervention. RESULTS: The mean age of participants was 14 (sd 1.9) years, 77% were female and their mean BMI Z-score was 2.4 (sd 0.6). Adolescents talked about six aspects of the home environment that influenced their eating habits (in order of frequency): home cooking, availability and accessibility of foods/beverages, parenting practices, family modelling, celebrations and screen use/studying. In general, homes with availability of less healthful foods, where family members also liked to eat less healthful foods and where healthier foods were less abundant or inaccessible were described as barriers to healthful eating. Special occasions and time spent studying or in front of the screen were also conducive to less healthful food choices. Home cooked meals supported adolescents in making healthier food choices, while specific parenting strategies such as encouragement and restriction were helpful for some adolescents. CONCLUSIONS: Adolescents struggled to make healthful choices in their home environment, but highlighted parenting strategies that were supportive. Targeting the home food environment is important to enable healthier food choices among overweight/obese adolescents.