Environmental and Individual Influences on Adolescent Diets in an Urban Informal Settlement in Kenya: Perspectives from Adolescents and Influential Adults

Background Adolescents in low- and middle-income countries face increasing risks for all forms of malnutrition. In Kenya, undernutrition and micronutrient deficiencies persist alongside rising rates of overweight, obesity, and nutrition-related noncommunicable diseases, highlighting the need for contextually grounded, multilevel community-based strategies to improve adolescent diets. Objective To examine multilevel factors that influence dietary behaviors among adolescents living in Kibera, the largest informal settlement in Kenya, to inform the design of future community-based interventions. Methods We conducted qualitative formative research in Kibera using focus group discussions (FGDs) with adolescent girls (8 FGDs, n=63) and boys (7 FGDs, n=46) ages 10–18, parents and guardians (4 FGDs, n=31), and teachers (3 FGDs, n=21), as well as key informant interviews with school administrators (n=5) and health care workers (n=7). All discussions and interviews were audio-recorded, transcribed, translated, and analyzed thematically using Atlas.ti. Results Food insecurity and the high cost of nutritious foods were identified as the primary barriers to healthy eating. Adolescents described constrained physical food environments, including school meals that lacked diversity and nearby vendors selling inexpensive fried and sweet foods with few healthy options. Food safety concerns were raised for both school and vendor foods, though these concerns rarely influenced dietary behaviors. While adolescents demonstrated strong nutrition knowledge and motivation to eat healthfully, economic constraints, limited affordable options, social norms, and taste preferences shaped actual food choices. Conclusions Adolescents in Kibera expressed strong motivation and knowledge related to eating balanced diets but faced substantial barriers at the individual, social, physical, and macroenvironment levels that limited their ability to do so. These findings highlight the importance of addressing constrained food choices when designing community-based interventions tailored to the needs of adolescents in urban informal settlements.