Food choice decisions are complex processes influenced by various factors that affect the family’s diet and, thus, their health and nutrition. In low- and middle-income countries like Ethiopia, these factors are shaped by the ongoing nutrition transition, urbanization, and socio-economic challenges. Despite growing concerns about the double burden of malnutrition, the factors influencing food choices among parents of children under five in Addis Ababa, Ethiopia, remain poorly understood. This study explores these factors.

Five focus groups with fathers and mothers (30 participants total, 5–7 per group) were conducted, along with 11 in-depth interviews with mothers of children under the age of five, for a total of 41 participants. Participants were permanent residents of Addis Ababa, having lived in the city for at least six months. Using health extension workers and community guides, participants were purposively sampled from two districts in Addis Ababa. Data were collected from November 2023 to April 2024, with interviews conducted in Amharic, audio-recorded, transcribed, and translated into English. Thematic analysis, both inductive and deductive, was performed using Bronfenbrenner’s socio-ecological model as a lens.

Factors influencing parental food choice were identified at three levels: individual, community, and environmental. Health concerns, affordability, child food preferences, and convenience were most frequently mentioned at an individual level. At the community level, family norms and social pressure played key roles. Food safety concerns and marketing influences were identified as important influences at the environmental level. Parents reported that while food availability was not typically a concern, changes in the food environment and economic constraints significantly impacted their food choices. They also emphasized that food safety and the reliability of food markets were essential issues.

This study underscores the complex, multi-level factors shaping food choices among parents of children under five in Addis Ababa. Health concerns, affordability, food safety, and market reliability were identified as key influences on food choices. These multi-level factors can guide interventions to improve children’s diets by addressing individual motivations and the broader environmental contexts influencing food choices.

Not applicable.

Many low- and middle-income countries (LMICs) are undergoing a nutrition transition, characterized by significant shifts in their food systems resulting from demographic changes, rapid urbanization, supermarket expansion, and the globalization of agricultural markets and trade [1, 2]. This transition is also associated with malnutrition in all its forms (undernutrition, micronutrient deficiencies, overweight, and obesity) and nutrition-related chronic diseases (NRCDs) that impede global food security and sustainable development [3, 4]. Parents play a crucial role in shaping their children’s diets, and the ongoing changes in food systems during this nutrition transition make their influence even more critical. Understanding the factors influencing parents’ food choices is essential for improving children’s nutrition.

Children’s diets play a crucial role in their overall growth, development, and long-term health outcomes. Ensuring optimal nutrition is particularly important given the challenges of undernutrition, micronutrient deficiencies, and the increasing prevalence of NRCDs [5].

Food choice encompasses the processes by which people consider, acquire, prepare, store, and consume foods and beverages [6]. Research on food environments builds on socio-ecological theory, emphasizing that health-related behaviors are shaped by the interplay of personal and environmental factors [7]. Food environments have been described as the interface through which individuals interact with the broader food system to acquire and consume food [8]. These environments are typically divided into two main domains: the external domain, which includes factors such as food availability, prices, vendor and product characteristics, as well as marketing and regulation, and the personal domain, which focuses on individual-level dimensions like food accessibility, affordability, convenience, and desirability. A deeper understanding of the interactions between these domains is essential for addressing the double burden of malnutrition in LMICs, characterized by persistent undernutrition among children, as well as the increasing prevalence of overweight, obesity, and NRCDs. Studies have also found that food attributes, such as the nutritional value of food and its perceived benefits for the child’s physical and mental development, are essential considerations [9]. Additional factors include whether a food is affordable, easy to prepare, safe, or enjoyable for the child [10, 11].

Food choices for young children, particularly those under five years, are influenced by numerous factors. Parents, particularly mothers of preschoolers, often assume the primary responsibility for purchasing and providing food, effectively acting as gatekeepers for what their children eat [12]. Mothers’ decisions are influenced by their perception of the attributes of food, the associated consequences or benefits of those attributes, and their perception of food values. Moreover, these decisions are further shaped by the food environment, which has been linked to dietary changes [1,2,3]. Although food choices made by mothers are crucial for their children’s growth and development, research findings on the factors influencing these choices often lack clear consensus, with results varying across different social, cultural, and economic contexts. This variation highlights the complexity of numerous interacting factors that influence these decisions. While few studies in sub-Saharan Africa focus on the food choices of parents for children under five, the majority of research has been conducted in European and North American countries, which differ significantly from settings like Ethiopia in terms of socio-economic and cultural factors [4].

This study aims to explore the various factors that influence parents’ food choices for their children under the age of five in Addis Ababa, Ethiopia. As a highly urbanized and rapidly growing city, Addis Ababa presents a unique context in which changing food environments, increased exposure to global food markets, and evolving lifestyles may significantly affect parental decision-making. A study conducted in Ethiopia, found that unhealthy food consumption was significantly associated with urban residence. The study found that mothers living in urban areas were 4.55 times more likely to provide their children with unhealthy food compared to mothers residing in rural areas. Access to markets, exposure to more unhealthy foods, and relative affordability of unhealthy food could explain the variations [13]. Understanding these factors in an urban setting is essential, as they can shape both healthy and unhealthy dietary choices for young children. The findings could enhance our understanding of these dynamics and contribute to the design of tailored nutritional interventions that promote healthy food and beverage consumption while reducing unhealthy options.

The study took place in Addis Ababa, the capital city of Ethiopia, a densely populated area with approximately 4.03 million residents [14]. The city is divided into 11 districts/ sub-cities. The research was conducted in the Lemi Kura and Yeka sub-cities. Addis Ababa is experiencing a nutrition transition, characterized by the coexistence of under- and over-nutrition problems. There is a notable prevalence of overweight/obesity at 11.4% and moderate stunting at 19.6% among preschool (0–59 months) children, and about 40% of households are food insecure [15, 16]. There are notable differences in the diets of children living in urban versus rural areas.

This qualitative study used adapted the Bronfenbrenner’s socio-ecological model to map the factors that influence parental food choice decisions at micro (individual), meso (community), and macro (environmental) levels [15]. This model recognizes not only the personal characteristics of individuals but also the broader range of influences at various levels, helping to identify the multiple factors that operate on different levels of influence. Additionally, we incorporated a conceptual model outlining the key components involved in the food choice process to enrich our analysis further [16].

For this study, both focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted. Directors and administrative staff members of Health Centers located within the selected sub-cities were approached to request the contacts of health extension workers and community guides operating in the respective areas, who were well acquainted with the community members. These health extension workers and community guides were contacted and briefed on the purpose of the study and its eligibility criteria. Based on this, they provided a list of potential participants who met the inclusion criteria: being a city dweller residing in Addis Ababa for at least six months and having at least one child under the age of five. From this list, eligible biological parents were invited to participate in FGDs. In forming the discussion groups, participants were grouped primarily based on similarities in sex and educational background (no formal education, primary or secondary education, and higher education) to encourage open dialogue and reduce potential power dynamics. Additionally, maximum variation was sought within each group in terms of the number of children and the age of the youngest child, to ensure a diversity of parenting experiences and perspectives. Accordingly, group discussions were conducted with three mothers’ and two fathers’ groups.

After completing the FGDs, a separate group of mothers (n = 11), who had not participated in the FGDs, was recruited for IDIs to solicit additional information. Like the FGDs, this selection was made using the list of potential participants presented by the health extension workers and community guides. To ensure diversity, the mothers were purposefully selected to reflect different educational levels and children of varying ages, all under the age of five.

Data was collected between November 2023 and April 2024 using FGDs and IDIs guided by semi-structured interview guides [see supplementary files 1 and 2]. The research team developed interview guides based on literature reviews and their experience examining factors influencing parents’ decisions regarding the feeding of their under-five children. Semi-structured interviews were also used to explore themes that emerged from the FGDs in more depth [17].

The first FGD facilitated the refinement of the interview guide, highlighted gaps, and enhanced the overall data collection process. Although vignettes were initially used, they proved challenging due to varying literacy levels. Consequently, the vignettes were replaced with discussion prompts centered on specific foods (e.g., dark green vegetables, vitamin A-rich fruits, instant meals, and orange-colored packaged drinks), supplemented with probing questions and visual aids with photos of locally available food items and vendors. The selection of these food groups was purposeful and based on our previous research [18]. The population group’s consumption of vitamin A-rich fruits, vegetables, and green leafy vegetables was very low. Based on these findings, we sought to investigate the reasons behind this, and we also noticed that the group’s consumption of packaged foods was higher than anticipated. Therefore, we focused on these specific groups for our additional investigation.

The IDIs used a different method to understand the food choices made by parents and were guided by the themes that surfaced in the FGDs [see supplementary file 1]. First, we asked the mothers about their children’s food and drink intake over the previous 24 h. We then asked them more questions about what, when, and where they had eaten and drunk, as well as how they had decided to give, prepare, or buy that specific food at that time. These interviews provided additional information about how parents feed their children daily and the various considerations they weigh when making feeding decisions. If certain foods (such as dark green vegetables, vitamin A-rich fruits and vegetables, instant meals, and orange-colored packaged drinks) were not mentioned in the initial recall, they were discussed in the later portion of the interview, which was similar to the FGDs, using visual aids and probes on the specific foods.

All interviews were conducted in quiet and private settings to ensure the participants’ comfort and confidentiality. FGDs took place in a private room within health centers, whereas IDIs were held at health centers or in the participants’ homes, based on their convenience. The interviews were conducted by three primary members of the research team, all of whom are medical doctors with advanced degrees in public health. They were well-versed in the research and had extensive experience conducting IDIs and facilitating FGDs. Two team members were present at each session: one served as the interviewer, and the other as a note-taker. All participants were fully informed about the study’s objectives and provided written consent, which was obtained after they had been fully informed and before participating. The moderator outlined the rules at the start of each FGD to ensure a respectful and open environment. This helped participants feel safe and comfortable to share honest responses without fear of judgment or external disclosure. With participants’ permission, all sessions were audio-recorded and supplemented with notes from the interviewer. The FGDs typically lasted between 85 and 95 min, while the duration of the IDIs ranged from 33 to 66 min.

The interviews were tape-recorded, transcribed verbatim in Amharic, and then translated into English for analysis. Analysis was an iterative process that formally began in the field, including fieldwork observations and the daily recording of field notes. A thematic analysis was conducted using Open Code software, version 4.0.2.3, to identify patterns and meanings in the participants’ experiences, views, and opinions. All authors who participated in the interviews, transcription, and translation are native Amharic speakers and proficient in both Amharic and English. Codes were reconciled through team discussions. B.S.M. participated in nearly all interviews, took the lead in verifying all transcription and translation of the transcripts, and conducted the initial coding. The piloted code was then discussed and approved by the wider research team. The results were then presented to local researchers with cultural knowledge to help ensure the findings were interpreted in a way that was meaningful and appropriate within the local context. Illustrative quotations were incorporated into the narrative description of the study’s findings.

The study involved five FGDs with both fathers and mothers, as well as eleven IDIs with mothers of children aged 6 months to 5 years. The FGDs were conducted with groups of the same educational level and gender: two FGDs conducted with fathers (one with no formal education, n = 5; one with primary or secondary education, n = 5) and three FGDs conducted with mothers (no formal education, n = 7; primary or secondary education, n = 7; diploma or higher, n = 6). The eleven mothers who participated in the IDIs represented a range of educational backgrounds. Of these mothers, 7 (63.6%) had primary or secondary education, 2 (18.2%) had no formal education, 1 (9.1%) was able to read and write, and 1 (9.1%) held a diploma.

The mean age of participants across both FGDs and IDIs was 32 years (SD ± 5). The mean age of their children was 2 years and 8 months (SD ± 1 year and 2 months), with ages ranging from 1 year and 2 months to 5 years. The majority of participants were married (n = 35, 85.4%), whereas a smaller proportion reported being single (n = 1, 2.4%), separated (n = 2, 4.9%), divorced (n = 2, 4.9%), or widowed (n = 1, 2.4%). Family size ranged from 3 to 7 members, and most participants (n = 34, 82.9%) had one child between the ages of 6 months and 5 years, while the remaining reported having two children within this age range.

The factors influencing parents’ decisions about what to feed their preschool-aged children are complex. Our analysis identified three main themes: individual, community, and environmental. Subthemes at the individual level included health concerns, affordability, child food preferences, and convenience. At the community level, family norms and social pressure emerged as key subthemes. Food safety concerns and marketing influences were identified as important subthemes at the environmental level.

Participants also mentioned other factors, such as availability, physical access, traditional beliefs, and religious values, although these were mentioned less frequently. Overall, Participants expressed that various factors influence what they provide for their children, leading some parents to feel they were not entirely in control. In discussions with both mothers and fathers, the values they emphasized were similar. Most participants noted that various types of food were available in their neighborhood or nearby, consistently indicating that availability was not an issue.

Health concerns

In discussions with parents, health considerations frequently arose as a key factor influencing their decisions about what to feed their children. Many parents firmly commit to providing a healthy diet to help prevent illness, support proper growth, and ensure their children receive a balanced diet that reduces the risk of various health issues. Both mothers and fathers highlighted the health benefits of specific foods for children, especially the importance of milk, fruits, and vegetables in promoting growth and preventing illness: “Milk, eggs, and balanced foods are good for the child. I think that it makes a difference in their growth.” [Mother with formal education].

The level of nutritional awareness varied among the groups based on their educational backgrounds. Parents with formal education were generally more confident about the benefits of balanced diets and understood the nutrients their children would receive from different foods: “I know that porridge prepared with multi-grains, black ‘teff,’ oats, and corn is a nutritious meal. Corn porridge is also possible, but if you can prepare it from a combination of 7 or 8 types of foods, it will be nutritious.” [Mother with no formal education] They actively sought to include nutritious options and recognized how these foods contribute to overall health.

In contrast, while parents with no formal education also had some information and intentions to provide a balanced diet and its benefits, they held misconceptions that hindered their ability to offer the types of foods they intended, such as the idea packed soft drinks were nutritious: “…“Mirinda” is believed to help replenish blood, and “juice” is also beneficial that is what educated people have told us; that it is great.” [Father with no formal education].

Meanwhile, parents with formal education understood what they were giving and its benefits, as one mother explained: “Because they contain protein, they are useful for children. They energize, strengthen, and help them grow [animal-sourced foods].” [Mother with formal education].

Parents considered not only the nutritional content of foods but also the age of their children to determine whether the food was appropriate for them. They paid close attention to how well their children could tolerate certain foods, any allergies, and potential health risks. During discussions, it became clear that some parents were unsure about using packaged foods, expressing concerns about their children’s ability to digest them and the potential health issues they might cause. Additionally, some foods were withheld from younger children because the parents worried about their health. For instance, one father expressed concern that even though packaged foods are widely available, he was unsure if his children could tolerate or digest them adequately: “These days, there are a lot of packaged foods sold. However, there are some things that children’s stomachs cannot tolerate.” [Father with no formal education].

Another mom shared her concerns about using packaged meals and the possible long-term effects of restricting children’s diets to packaged foods: “Indomie [Ramen], it was said that consuming only that could cause loss of bone density. I do not use it often.” [Mother with formal education].

Parents also considered the potential health benefits and drawbacks of certain fruits and vegetables. For instance, one mother noted that some fruits should be consumed in moderation due to their effects on digestion: “If you consume a lot of figs, it causes constipation. You should give your child a little bit of that, not often. It causes constipation.” [Mother with formal education].

Parents frequently mentioned cost as a major factor influencing their food choices, explaining that financial constraints often limit their ability to provide a varied and balanced diet. As one mother explained, “I feed my children what is available in the household; what we are capable of buying, but we know that many things are not balanced. We cannot afford to provide a balanced diet” [Mother with no formal education]. This perspective was common among mothers, many of whom stay at home and depend on their partners’ financial support, making affordability a central consideration in daily food decisions.

Fathers also focus on economic limitations, but often frame their responses in terms of adapting to what they can afford. They mention providing simple and less expensive foods, such as Shiro and potatoes, instead of more balanced or expensive options: “If we eat Shiro [traditional stew made of chickpea flour], rice, or bread with tea, we allow them to become accustomed to those foods. If we let him get used to different foods that we cannot consistently provide, that will not work.” [Father with no formal education].

Another father reiterates the importance of prioritizing what is affordable over what his children might prefer. He discusses the necessity of providing what is financially feasible rather than simply catering to their children’s desires: “I decided what he should eat […] It doesn’t matter if he likes it or not; life will compel him to like it. If he sees someone else pack “Arosto” [roasted meat] for lunch and asks for it, how will I afford it?” [Father with formal education].

Mothers emphasize the importance of making food appealing and suggest enhancing traditional preparations by incorporating additional ingredients. For example, adding meat to steamed vegetables can make the dish more appealing to children. Food taste and a child’s preferences were important factors when preparing and purchasing food. Many parents mentioned that they specifically buy foods their children enjoy, ensuring their happiness and minimizing waste. Children are more likely to eat when given foods they like: “If we compare ‘Enjera’ and pasta, ‘Enjera’ can be harder for children to eat. On the other hand, rice and macaroni are easier for them to consume. Considering their preference and ease of eating, I support their desire to have pasta. Moreover, their happiness is evident when they see pasta being served. Their smiles brighten up, and as a parent, it brings me great joy to see them happy.” [Father with formal education].

The participants noted that certain foods, such as sugar-sweetened beverages, packaged meals, and savory snacks, should not be consumed regularly. However, they acknowledged that these are often the foods children crave or plead for. As a result, the participants mentioned providing these foods to their children under some circumstances, such as when a child is hungry and needs an immediate snack. Sometimes, packaged foods were also used as rewards or positive reinforcement for certain behaviors. Additionally, some parents mentioned they offer these foods as a gesture of affection by occasionally saying “yes” to their children’s desires: “I don’t see the benefits, but the kids love it. He gets excited when we pack biscuits and bomboloni [fried donuts] for school. He would like it if we did this every day, but since that’s not healthy, we treat him to it occasionally.“[Father with formal education].

Convenience also played a part in food choice. Participants said that they opt for easy-to-cook options when they are busy with work and other social activities. For some parents, these easy-to-cook options are not necessarily unhealthy, as they prepare traditional foods with natural ingredients: “This depends on how much time you have. If you want a light snack, you can make Beso [a traditional dish made of roasted barley flour]. If there are fruits in the house, you can make juice. You can make an egg sandwich. For example, if we are busy cleaning the house, we make something simple, such as sautéed tomatoes.” [Mother with formal education].

Still, for others, they opt for ready-to-eat packaged foods: “Since cooking Shiro [stew made of chickpeas] takes a long time, she won’t wait if hungry, she cries, the only thing that is fast is the Indomie [ramen]” [Mother with no formal education].

Mothers also indicated that sometimes time limitations were not the only factor, but rather that some foods require space, equipment, or access to electricity for preparation and storage, which was not feasible due to their living conditions in the city. As one mother explained, “Since I do not have a refrigerator, I cannot keep any leftovers in the fridge. Therefore, I prepare small portions and make sure they finish them.” [Mother with formal education].

Family norms/traditions

Family traditions influence children’s diet. Parents’ attitudes towards certain foods directly influence what is offered to their children. Some parents acknowledge that the foods they consume limit their children’s dietary habits. For instance, a mother reflects that her children have not tried certain foods, such as figs and pumpkins, because these items are not part of their family meals or, at times, because family members, particularly the parents, do not like them: “Since I am not fond of collard greens, I did not introduce them to her. Consequently, she does not consume them” [Mother who has attended formal education].

Conversely, families that regularly incorporate fruits and vegetables into their meals often see their children adopting these preferences. A mother mentions that her family frequently eats cabbage and lettuce, and all her children enjoy these vegetables.

“We eat cabbage a lot. My husband and I usually eat fruit and vegetables for dinner. There is always cabbage and lettuce in our house […] all the kids, including my youngest, eat vegetables.” [Mother who has attended formal education].

From both fathers’ and mothers’ perspectives, parents’ food choices for their children under five years of age were also influenced by social pressure. Children are influenced by the snacks and treats they see their peers enjoying, such as chips, cakes, and juices, leading them to request these items from their parents. This social pressure often results in persistent requests, like crying or disruptive behavior, when the desired foods are not provided. To avoid conflict and ensure their children don’t feel left out, parents comply with these requests, reflecting the substantial impact of social dynamics on food decisions: “They see other children and their friends having it, so they ask me, ‘What about us?‘” [Mother with formal education].

Peer influence was also observed within communal living environments, where social interactions shaped the household food environment. Parents noted that guests often brought snacks such as chips and fried biscuits, which contributed to the regular presence of these foods at home. As one father with formal education explained, “There is a social life because it is a compound. Guests to the household sometimes bring chips, fried biscuits, and other things.” Such exposure influenced children’s food preferences, as they observed and became interested in the foods consumed by others.

Food safety

Food safety concerns were highlighted as a crucial factor influencing food choices. This applies not only to decisions about what to feed their children and the selection of food types but also to the choice of purchase locations. Parents avoided certain vendors/outlets due to safety concerns. They also stressed the significance of freshness and the safety of food ingredients. The safety of food stores and food handlers was also taken into consideration. Above all, the highest priority was on the quality and safety of food for their children.

Concerns were especially pronounced regarding easily spoiled fruits. As one father noted, “Fruits like papaya can be harmful if they rot inside. Oranges, mangoes, and figs spoil quickly and may carry viruses.” [Father with no formal education].

Distrust of packaged foods also emerged, particularly due to concerns about chemical additives and the sale of expired products. One mother explained, “I don’t think packaged foods are good. First, I think they contain many chemicals. Secondly, regarding the expiration date, people with some education may read and understand, but others unknowingly purchase things that could cause problems for their children.” [Mother who attended formal education].

Parents are aware of the impact of marketing and media on their children’s dietary preferences and choices. Numerous parents observed that advertisements generate intense cravings for specific foods, prompting children to demand the snacks and treats they have seen on television. For example, children might request products featured in commercials despite their parents’ refusal. Additionally, parents note that their children tend to opt for less healthy food options when presented with a choice: “There’s a snack called ‘QQ’ made from peanuts. The kids always demand it at the shop and refuse to leave without it. I usually buy one for both, sometimes on credit/loan.” [Mother with formal education].

Parents frequently encounter conflicting and confusing health messages from both mainstream and social media, which are viewed as sources of information by mothers and fathers alike. This creates uncertainty regarding the best nutrition and child-rearing practices. Official guidelines may suggest one approach, while the media offer differing advice on topics like breastfeeding, introducing solid foods, and food-related risks.

Additionally, parents expressed concern about the health risks associated with commonly consumed street foods, especially when purchasing them for their children. A major issue raised was the practice of reusing cooking oil for frying, which degrades food quality and poses health risks. These concerns complicate parents’ ability to make informed decisions for their Children: “Fried street foods such as Pasty [fried dough], chips, and other fried items are everywhere. When the kids see them, walking past without wanting to stop them is impossible. They actively seek out these treats and often insist on trying them. However, it’s common practice to reuse the oil for frying these foods multiple times, which is bad for the children’s health.” [Mother with formal education].

The study found that parents in Addis Ababa consider multiple factors when deciding what to feed their young children. Health concerns are a top priority, with many parents aiming to provide nutritious meals that support growth and prevent illness. Financial limitations and limited nutrition awareness among some parents often restrict their ability to offer a balanced diet, leading them to rely on inexpensive, easy-to-prepare foods. If time and resources permit, parents consider their child’s food preferences, sensory appeal, and convenience. Furthermore, family norms, social pressure, and broader food environment factors, such as concerns about food safety and marketing, shape their decisions.

The findings of this study were consistent with those of other studies, which reveal a complex interplay of individual, community, and environmental factors shaping food choices [19, 20]. While some of these studies focus broadly on household or adult food decision-making, others specifically examine parental food choices [1, 21], making comparisons relevant. Although many individual-level factors, such as health concerns, affordability, and convenience, are similar across different groups, parental decision-making is distinct in that it involves considerations specific to child health, preferences, and eating behavior. In this study, health concerns, affordability, child preferences, and convenience were the most frequently reported factors influencing parental food choices, which were also identified in other studies [4, 22,23,24]. Many parents reported that their food choices for their children were primarily influenced by the desire to promote good health and to avoid foods that may negatively affect their children’s health. However, they also considered whether their child was likely to eat the food, particularly given the time constraints they faced, which made convenient foods more appealing. These foods are often highly processed and ready-to-eat, as identified in other studies [25, 26]. Several factors need to be considered when analyzing how parents choose foods, as they weigh these factors in relation to what will benefit their child and the family as a whole, taking into account what the family can afford to buy and when and if the child would consume it. They want to balance living within their means, creating a happy family dynamic, and ensuring their children’s happiness. Understanding this interplay could be beneficial and applicable when developing nutrition education materials for parents to improve feeding behaviors.

Beyond individual factors, our findings emphasize the significant role of family norms, social pressure, and community expectations in shaping food choices. Parents reported that extended family members and social networks, including neighbors, often shaped their decisions. Some mothers mentioned pressure from in-laws or relatives regarding suitable foods for their children. This is consistent with studies showing that in many cultures, food choices are strongly shaped by familial expectations, and parents may feel pressure to adhere to traditional or socially acceptable feeding practices [11, 22, 27]. Social pressure, driven by the desire to conform to community norms, led some parents to adopt ultra-processed food items into their children’s diets, particularly those associated with global food trends or heavily marketed through advertising [28]. The increasing availability of processed and convenient foods, often promoted through social media, has been noted as a growing influence on food choices. Although some parents were aware of the negative health implications of these foods, the desire to fit in socially often took precedence. These findings underscore the importance of public health interventions that target individual behaviors and address broader community norms. Culturally appropriate strategies that engage local leaders and influencers while respecting family dynamics could help overcome these challenges.

Food safety and marketing were key environmental factors influencing food choices in this study. Parents expressed concerns about food contamination and the reliability of food suppliers, reflecting broader public health challenges in the country. Inadequate regulation, inconsistent quality control, and frequent food safety scares have created an environment in which parents are often unsure about food products’ safety and nutritional value [22, 29].

Moreover, food marketing, particularly that of unhealthy, processed foods and snacks, significantly influences parental decisions. Media advertisements promoting branded, sugary foods highly influence children’s preferences, especially the younger ones [28, 30]. Given children’s overwhelming exposure to media advertisements, particularly in urban settings like Addis Ababa, regulatory policies aimed at restricting the marketing of unhealthy foods to children are critical.

A key strength of this study lies in its inclusion of both fathers and mothers, providing a more holistic view of family dynamics in children’s food choice decision-making in the context of urban low-income settings. FGDs were completed as an initial step because this method can provide rich information on people’s perceptions and feelings [19]. Additionally, group dynamics during these discussions can uncover essential thoughts and opinions [20]. Follow-up interviews were conducted with mothers, as they are the main actors in food purchase and preparation. Despite efforts to mitigate social desirability bias through rapport-building, biased self-reported behaviors that show an inclination towards providing children with healthy foods and avoiding unhealthy ones cannot be ruled out.

B.S.M.:

Bethlehem Shawel Moreda

FGDs:

Focus Group Discussions

IDIs:

In–depth Interviews

LMICs:

Low–and Middle–Income Countries

NRCDs:

Nutrition–Related Chronic Diseases

SD:

Standard Deviation

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The project was funded by the Swedish Research Council grant 2022–02907.

Open-access funding is provided by Lund University.

The authors’ responsibilities were as follows: B.S.M. identified the manuscript topic, participated in data collection, conducted the analysis and interpretation of the results, and wrote the manuscript. H.Y.B. and F.F.M. participated in data collection and analysis. E.-C.E., Y.B., M.J., H.Y.B., and A.W. supervised and guided study tool development and conceptualization. E.-C.E., Y.B., M.J., A.W., H.Y.B., and F.F.M. reviewed the manuscript. All authors have read and approved the final version of the manuscript.

Correspondence to Bethlehem Shawel Moreda.

Ethical approval for this study was obtained from the Institutional Review Board of Addis Continental Institute of Public Health with reference number ACIPH/IRERC/010/2024. Before approaching individuals, permission was obtained from the Lemi Kura and Yeka sub-cities and all district (Woreda) health offices. Per the Declaration of Helsinki, all participants provided written informed consent (or a thumbprint for those unable to write) before data collection. The informed consent included an explanation of the study, its potential risks and benefits, the participants’ voluntary participation, permission to use audio recorders, and confidentiality.

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The authors declare no competing interests.

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