Determinants of Fruits and Vegetables Consumption in Children aged 6months to 5years old in the Nuffield Medical Area, Suva, Fiji: A qualitative study

Introduction:
In Fiji, NCDs are labeled as a “crisis” and are threatening the nation’s health and development, in which the government is committing to improve diets of the population. The adult population of 18 years and above in Fiji showed that 75% of women and 59% of men are overweight or obese, with only 15% of adults meeting the recommended F&V intake. In addition, children at an early age fail to meet minimum dietary intake of F&V. Epidemiological studies have shown that diets rich in F&V are linked to promotion of health and decrease risk of chronic diseases such as obesity, cardiovascular disease, stroke, diabetes and some cancers. Promoting the consumption of F&V in children is important because eating habits established in childhood persist into adulthood and may help to lower the risk of developing NCDs in adulthood. In addition, determinants that affect F&V consumption in childhood can suggest ways for caregivers and health workers to improve dietary habits of children and also inform the development of effective policies and programs to increase F&V consumption that can impact a healthy and enjoyable life later in adulthood.
Aim:
To assess the perception of caregivers and health workers regarding the determinants of F&V consumption in children (6 months- 5 years old) in the Nuffield Medical Area, Suva.
Method:
A qualitative study design, through the use of Focus Group discussions (FDGs) for caregivers and in depth interviews for health workers are utilized to address the aim of the study. Study population are firstly caregivers of children aged 6 months to 5 years who attended clinics in the Nuffield Medical Area, Maternal Child Health (MCH) clinic in Tamavua and health workers who provide health services to these children in the Nuffield medical area. The first setting was the caregivers from four (4) zones which were, Tamavua, Colo-I-Suva, Nabua and Wailoku. The second setting was the health care workers in the outpatient clinic and the MCH clinic in the
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Nuffield Medical Area. Four (4) FGDs with 6 participants on average, from four of the six zones, was conducted. Hence, with an average of six (6) participants in each group, a total of 24 participants participated in the 4 FDGs. A total of 24 health care workers were recruited for interview. Names were selected from a box of 27 staff names. A semi-structured questionnaire was used to collect the data from caregivers. Prior to the beginning of FGDs, participants completed a brief demographic questions sheet including, gender, age, education level, area of residency, and age of child (months). Similarly, a semi-structured interview guide was used to collect the data from health workers. Prior to the beginning of the interview, participants completed a brief demographic questions/sheet 4) including gender and designated role at work.
Results:
In the FGDs of caregivers, more than 50% of the participants were between the ages of 20-39 years old and are mothers of the children, while only 3 participants (13%) were between 50-59 years old and grandmothers of the children. More than 50% of the participants had two children while 33% of those participants had only one child. Majority of the participants were married while 5 of the participants (21%) are single parent. The highest level of education reached is tertiary education (79%), while 5 (21%) attained secondary education level. As for interview of health care workers, there were a total of 27 staff in the Nuffield Health Staff Listing in September 2017, however 24 were randomly selected for interview. Of this, 12.5% were medical officers, and IMCI nurses: 25% were zone nurses, 4.2% were SOPD, MCH nurses and a dietician while majority, and (37.5%) were GOPD nurses. Four (4) broad themes, thirteen (13) sub-themes and thirty (30) categories were the determinants perceived by caregivers. In addition, five (5) broad themes, five (5) sub-themes and eleven (11) categories were the determinants perceived by health care workers.
Discussion:
The findings of this study focused on the perceptions of caregivers and health care workers on the determinants of F&V consumption in children aged 6 months to 5 years old in Suva, Fiji. Based on the research questions, as aligned to various Conceptual Frameworks, specifically the Pro Children Project, caregivers and health care workers perceptions were thematically organized and discussed in the following determinants to answer the main research questions of the study which are; personal, socio economic, physical and cultural.
Taste preference was the foremost determinant in the personal theme which included neophobia, picky/fussy eating, self-efficacy and skills, education of caregivers and pre-natal and post-natal influences. Socio-economic determinants included teacher’s role as a facilitator in preschool, peer and sibling influence, role of caregivers as modeling F&V consumption and income level of the family. Physical determinants were identified as affordability and availability of F&V, marketing strategies through media, multi-sectorial approach, use of pesticides in F&V and having baseline information for F& V intervention and policy making. Lastly, under the cultural determinants, the dietary habits of Fijian iTaukei descent was explored, social influence of F&V parenting styles and behavior such as parents-grandparents and maternal-paternal.
Conclusion:
Understanding the determinants of F&V consumption of children aged 6 months to 5 years old in the Nuffield Medical area, Suva, Fiji is crucial in creating any policy for F&V consumption in this age group and for developing intervention programs to increase F&V consumption in early life. Furthermore, future research studies to capture knowledge, attitude of caregivers and whether it is translated to practices is suggested. It would also be ideal to conduct a wider study with more representative samples selected randomly.