3.1 Introduction
When developing behaviour change interventions, participatory approaches are recommended (van Gemert-Pijnen et al., 2011; Yardley et al., 2016), which involve end users in intervention development (Eyles et al., 2016). This is thought to better tailor the intervention to users’ needs and preferences, and therefore improve its feasibility and effectiveness. Qualitative methods (such as focus groups) and quantitative methods (such as surveys) can each be used to engage users (Yardley et al., 2016). This chapter describes a focus-group study aiming to generate a better understanding of Chinese adolescent snacking, as well as their needs and preferences in relation to snacking interventions. As preparation for intervention development, the findings of this study will help us understand key features of a feasible snacking intervention for Chinese adolescents.
Snack choices among Chinese adolescents
Ouyang et al. (2016) reported the most frequently consumed snacks of Chinese children and adolescents using the data of CHNS collected in 2011. For adolescents aged 11 to 17 years in urban areas of China, the top five snacks were fruit products, dairy products, beverages, fast foods, and snack foods and pastries. Four types of snacking food patterns were identified, with 82.6% of the adolescents showing a healthy snacking food pattern that mainly consisted of fruit products and dairy products. However, around 15% of the adolescents mainly snacked on beverages and fast foods which could lead to excessive calorie intake.
Two studies investigated snack food choices among Chinese adolescents aged 12 to 13 years (Chan, Tse, Tam, & Huang, 2016) and 16 to 20 years (Veeck, Yu, Yu, Veeck, & Gentry, 2014) using focus groups . Both studies found taste was a key determinant of choice. In addition, older adolescents reported that food safety, nutrition, price, body image, convenience and sharing with peers as influential (Veeck et al., 2014). Younger adolescents appeared to be less concerned about the healthiness of their snack as they thought unhealthy foods were not only more tasty, but also more fun and trendy (Chan et al., 2016). Although older adolescents cited nutrition as being an
important factor to consider (Veeck et al., 2014), young adolescents tended to choose unhealthy foods. It is possible that Chinese adolescents become more health conscious as they get older.
To date, only a few studies have provided detailed information on Chinese adolescents’ views and practices around snacking (Chan, Tse, Tam, & Huang, 2016; Veeck et al., 2014; Ouyang et al., 2016), and there is no information on their attitudes towards, and needs, in regard to a snacking intervention. To develop a snacking intervention for Chinese adolescents, it is essential to understand the context and drivers for their snacking behaviour, and what would make a feasible intervention for them.
3.2 Current study
The present study constituted a form of user engagement and aimed to gain a better understanding of Chinese adolescents’ snacking behaviour and attitudes towards a snacking intervention.
Focus groups were used as they are effective ways to explore lifestyle behaviours including dietary habits and the complexity surrounding food choice (Rabiee, 2004). Specifically, the following research questions were addressed:
1. Why do Chinese adolescents snack and what do they eat as snacks?
2. How do Chinese adolescents perceive healthy and unhealthy snacking, and what would influence their snack choice?
3. What are the motives and barriers for Chinese adolescents to snack more healthily? 4. What are Chinese adolescents’ attitudes towards, and preferences for, a snacking
intervention?
3.3 Methods
Ethics
The study was approved by the University of Leeds Research Ethics Committee (Faculty of Medicine and Health). Reference number: 17-0169; date of approval: 07/06/2017. Prior to securing signed informed consent, participants were informed of the study aims and protocols including audio recordings and transcriptions. It was also explained that they could withdraw
anytime during the discussion without giving any reasons. Data was anonymised at the point of transcription.
Participants and Recruitment
Psychology teachers (known to QZ) from three public boarding high schools in Beijing assisted recruitment in their schools. Teachers were emailed a school and participant information letter. Permission from all head teachers was obtained. However, as the third-year students (18 to 19 years) were intensively preparing for the National College Entrance Examination (NCEE), schools did not support recruitment of the third-year students. We therefore aimed to recruit four single-sex groups of the first and the second-year students (16 to 18 years), with six participants for each group (Rabiee, 2004). We planned to group the adolescents by school year rather than age, considering students in the same school years had very similar daily routines, which could influence their dietary behaviours. Students were invited to take part in the focus group on school premises, and were told that the purpose of this was to explore their snacking and help develop guidelines for a health intervention. People could take part if they:
(1) were Chinese adolescents aged 16 to 18 years; (2) were self-identified snackers;
(3) did not have a self-reported or diagnosed eating disorder;
(4) were willing and able to take part in a focus group and talk about snacking with their school peers.
Four single-sex groups, comprising a total of 24 participants, with six adolescents per group, were recruited (see in Table 3.1). Most participants were acquainted with one another in the same group.
Table 3.1 Participants’ characters for each group
Group No.
Participants No. of participants Age Recruitment school Group 1 Group 2 Group 3 Group 4 First-year boys First-year girls Second-year boys Second-year girls 6 6 6 6 16 – 17 16 – 17 17 – 18 17 – 18 School A School B School C School C
Focus Group Schedule
A series of questions were designed in line with the study objectives as outlined in Box 3.1.
Box 3.1 Focus Group Questions