Ambiguous dietary behaviors of female school students: a qualitative content analysis via social cognitive theory

Adolescence is a critical period for the development of dietary patterns that significantly impact long-term health. This study explores the perspectives of adolescent girls, their parents, and educational staff regarding the factors shaping dietary behaviors in female school students. A qualitative content analysis was conducted between February and August 2024 in various regions of Khuzestan, Iran. Data were collected through semistructured interviews guided by social cognitive theory (SCT) and analyzed via a directed content analysis approach. The study took place in school and home environments in Khuzestan, Iran. Twenty-eight participants, including 17 female school students (aged 13-17 years), 8 parents, and 3 health educational stakeholders, were interviewed for 28-55 min (average: 40 min). The analysis identified 208 thematic codes categorized into six main categories and 15 subcategories. The key categories include (1) self-efficacy, which addresses challenges in nutrition management during stress and positive eating habits; (2) outcome expectations, which highlight the role of physical consequences and social approval/disapproval in food choices; (3) environmental factors, which reflect the influence of physical and social contexts; (4) self-regulation, which emphasizes goal-setting and self-monitoring; (5) knowledge, which reveals gaps in general and specialized nutritional understanding; and (6) attitudes, which highlight various perceptions of local foods. The dietary behaviors of female school students are shaped by a dynamic interplay of individual, social, and environmental factors. Promoting healthy eating requires a multifaceted approach, incorporating education, environmental adjustments, and social support to create sustainable changes.