Study design and setting

A qualitative study was conducted as part of the ARISE-NUTRINT initiative (Africa Research, Implementation Science, and Education – Reducing nutrition-related NCDs in adolescence and youth: Interventions and policies to boost nutrition fluency and diet quality in Africa) [34,35]. The ARISE-NUTRINT study seeks to enhance understanding of dietary and physical activity-related risks for NCDs among AYAs in seven SSA countries of Uganda, Tanzania, Burkina Faso, South Africa, Ethiopia, Nigeria, and Ghana, with partners from Europe and North America [34,35].

This paper focuses exclusively on the Uganda site of the initiative, conducted within the Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) [36]. This HDSS is predominantly rural, spanning Iganga, Mayuge, and Bugweri districts, with approximately 18,634 households and a population of about 120,000 residents, 27% being adolescents [36]. Mayuge District, where data for the current study were collected, depend on subsistence farming and small-scale trade as the main sources of livelihood [36] and a 2025 study in this area documented poor dietary behaviours among AYAs [19].

Study population and sampling

The study population comprised AYAs, their parents or guardians, teachers, basket food vendors (community members who carry baskets containing ready-to-eat foods such as fried cassava, roasted groundnuts, fruits, etc., and sell them to students around schools), and key district- and community-level stakeholders in Mayuge district. Purposive sampling was used to obtain diverse perspectives on AYAs’ dietary behaviors. For AYAs, maximum variation was ensured by sex (male or female), age group (10–14, 15–19, 20–24 years), schooling status (in-school or out-of-school), and residence within the Iganga–Mayuge HDSS catchment informed the selection of AYAs. Out-of-school AYAs were approached directly at households, while in-school AYAs were approached at schools, with local leaders (LC1) facilitating mobilization but not influencing participation.

Parents or guardians of these AYAs, their teachers, and basket food vendors at the respective schools were also purposively recruited. Additional stakeholders included the district education officer, district nutrition focal person, and representatives of civil society organizations (CSOs) involved in adolescent health and nutrition programming. No purposively selected participants declined or dropped out.

A total of twelve FGDs and six KIIs were conducted. Eight FGDs were held with AYAs, stratified by sex (male or female), age group (10–14, 15–19, and 20–24 years), and schooling status (in-school or out-of-school) to capture diverse perspectives. Two FGDs were conducted with parents or guardians (separate for male and female), and two with teachers (primary and secondary school levels). The six KIIs involved the Mayuge District Education Officer, the District Nutrition Focal Person, two CSO staff, and two basket food vendors. The final sample size was guided by data saturation, which was reached when subsequent discussions or interviews yielded no new insights.

Conceptual framework

This study was underpinned by the social-ecological model (SEM), which posits that health behaviors, such as diet, result from the interaction of factors across individual, interpersonal, organizational, community, and societal levels [37]. At the individual level, the study examined how gender, nutrition knowledge, skills, attitudes, and personal preferences shape dietary behavior. The interpersonal level considered the role of parents, peers, social networks, household income, and food security. Community and organizational-level factors included resources, socioeconomic status, cultural norms, and local food environment. At the societal and environmental level, broader structural, cultural, and contextual elements that shape behavior at a macro level were explored. These included environmental conditions (like food availability and seasonality), local infrastructure and access, media and marketing factors, and entrenched cultural belief systems or taboos not necessarily enforced by immediate social ties.

By applying the SEM, this study adopted a multi-layered perspective to explore the diverse and interconnected factors influencing dietary behaviours among AYAs in rural Eastern Uganda, as illustrated in the hypothesized conceptual framework (S1 File).

Data collection

Guides for FGD and KII informed by literature review were used to collect data from participants, recruited from 17th June 2024–30^th August 2024. The guides were pretested among non-participants in Bugweri district, a setting with socio-demographic characteristics similar to Mayuge District, to assess clarity, cultural appropriateness, and question flow. Feedback from the pretest informed minor revisions to wording and sequencing to enhance contextual relevance and comprehensibility. The finalized guides, translated into Lusoga, the primary local language; contained open-ended questions tailored to each participant group. Examples included: “What factors influence your food and drink choices?” (FGDs with AYAs); “What is your opinion about the eating habits of young people in this community?” (KII with food vendors); and “What factors shape the dietary choices of AYAs in the district?” (KII with CSO and district staff). The complete guides are provided in S2 File. Prior to each KII and FGD sessions, basic socio-demographic information (e.g., age, education level, area of residence, and school status for the AYAs) was collected from each participant.

All KIIs were conducted by three male research team members (TB, JKit, and JKiw), each fluent in English and Lusoga, holding Master of Public Health degrees, and with prior experience in qualitative data collection. At the time of the study, they were serving as Research Associates at the School of Public Health, Makerere University. This team was complemented by a female Research Assistant (JW), with Bachelors of Counselling and Guidance, with extensive experience in nutrition and qualitative data collection, and fluent in both Lusoga and English. KIIs with basket food vendors were conducted in Lusoga while interviews with CSO representatives and district staff were conducted in English. All interviews were conducted face-to-face in private and convenient locations; primarily participants’ workplaces or community venues, to ensure confidentiality and limit access by non-participants. Each KII lasted 45–60 minutes. To strengthen interpretation of societal-level factors influencing dietary behaviours, three repeat KIIs (two with district staff and one with a CSO representative) were conducted to clarify selected sub-themes.

All FGDs were conducted face-to-face in Lusoga, moderated by two male members of the research team (TB and JKit) alongside the female Research Assistant (JW). Each FGD involved an average of eight participants and was held in private, neutral venues such as schools or health centres, identified with support from local community health workers and local council one chairpersons. One researcher moderated the discussion, while another managed audio recording and took field notes. Both FGDs and KIIs were audio-recorded using digital voice recorders, with detailed field notes taken to capture non-verbal cues and contextual observations. Each FGD lasted 60–90 minutes.

Although the researchers were not members of the study communities, they were familiar with rural Eastern Ugandan contexts and AYAs’ nutrition issues, which facilitated meaningful engagement with participants. To maintain neutrality, no prior personal relationships existed between researchers and participants. Recruitment occurred in multiple settings, with guidance from community leaders: out-of-school AYAs and parents were approached through household visits; in-school AYAs, basket food vendors, and teachers during school visits; and district staff and CSO officials at their workplace offices. At the start of each interaction, researchers introduced themselves as public health professionals conducting a study on factors influencing dietary behaviors among AYAs, with the aim of informing future nutrition improvement programs. The study objectives, confidentiality procedures, and voluntary nature of participation were clearly explained prior to obtaining consent.

Regular debriefing meetings were held between the data collectors and another member of the research team (JB), a senior faculty at the School of Public Health, Makerere University, to review field experiences. The senior member provided close supervision and ongoing support, offering feedback on interview techniques and guidance on addressing emerging challenges. These efforts helped ensure consistency and enhance the overall quality of data collection.

Data management and analysis

Audio recordings from the FGDs and KIIs were transcribed verbatim and simultaneously translated into English by three research team members (TB, JKit, and GS). To ensure accuracy and fidelity to participants’ responses, another team member (MM) reviewed each transcript while cross-checking with the original audio recordings. All personal identifiers were removed during transcription to maintain confidentiality. To gain a deep understanding of the data, four of the team members (TB, JKit, GS, and JKiw) read the transcripts at least three times and independently documented initial impressions. These insights informed the development of a codebook, which was collaboratively discussed, refined, and harmonized to ensure consistency during coding.

Transcripts were imported into ATLAS.ti version 9, and coding was conducted using a combination of inductive and deductive approaches. Inductively, the team identified key concepts, ideas, and patterns expressed directly by participants, particularly those related to factors influencing AYA dietary behaviours. Recurring codes were organized into sub-themes, guided by the phases of thematic analysis as outlined by Braun and Clarke [38]. The research team reviewed the sub-themes to ensure coherence and relevance, merging, splitting, or excluding them as appropriate. Final codes and sub-themes were summarized in a data master sheet and deductively mapped onto the pre-determined themes: the levels of the SEM (individual, interpersonal, community, organizational, and societal).

The analysis is presented as a narrative synthesis, supported by typical quotations by participants, codes, and sub-themes, to describe the socio-ecological factors influencing dietary behaviours among the AYAs. The study methods and findings are reported in accordance with the COnsolidated criteria for REporting Qualitative Research (COREQ) guidelines [39], and the completed COREQ checklist is provided in S3 File.

Ethical consideration

Ethical clearance for ARISE-NUTRINT project was obtained from the Research and Ethics Committee of the School of Public Health, Makerere University (Ref: SPH-2023–460), and the study was registered with Uganda National Council for Science and Technology (Ref: HS3481ES). Written informed consent was obtained from parents or guardians of adolescents aged 10–17 years, followed by assent from the younger adolescents themselves. Participants aged 18 years and above provided their own written informed consent. Collected data contained no personally identifiable information and was stored securely on password-protected devices and servers, with access limited to authorized research personnel only.

Socio-ecological factors influencing dietary behaviours among AYAs

This section describes the findings of the study in terms of sub-themes, supported by participants’ quotes. We present the sub-themes, organized based on the pre-determined themes of the SEM, as shown in the empirical framework (S5 File).

Satisfying hunger and providing energy

Adolescents and young adults commonly associated certain foods with the ability to satisfy hunger and provide energy, reflecting a strong belief in the functional benefits of eating. However, rather than referencing specific nutrients or nutritional knowledge, participants described these choices in terms of the extent to which food made them feel strong, satisfied, and fueled them to complete daily tasks.

Both male and female AYAs identified foods like posho (stiff maize meal) and beans as “energy-giving,” particularly useful for physically demanding work such as digging, riding boda-bodas (motorcycle taxi) or household chores:

“What motivates us as boys is the food that gives us strength and energy in our bodies. For me, when I eat like posho and beans, I can get energy to dig very well.” (FGD, boys, 16 years, in school)

“For me as a girl, what motivates me to eat a particular type of food is the desire to eat what helps my body to have energy to do my daily work and to also grow very well.” (FGD, girls, 18 years, out of school)

“Now that I ride a boda-boda, I eat foods that fill me fast so I can continue without feeling hungry.” (FGD, boys, 23 years, out of school)

Gendered contrasts were also observed: girls often described restrictions linked to taboos, while boys still framed food around strength and masculinity:

“As girls we are instructed not to eat emamba [lungfish]; elders say it can cause misfortune or even affect our ability to have children. Because of this, I don’t eat it, even though I know it gives energy.” (FGD, girls, 17 years, in school)

Sensory affection: taste, aroma, and appearance

Taste, aroma, and visual appeal acted as powerful, interrelated motivators of food choice among AYAs, influencing not only what they ate but also how they emotionally and socially related to food. Across group discussions, AYAs consistently highlighted the importance of taste, particularly a preference for sweet, oily, and strongly flavored foods that are readily accessible within their communities. For many, taste was a primary criterion in deciding what to eat:

“I always first consider the kind of food that is tasty and sweet but not harmful.” (FGD, boys, 12 years, in school).

“Some of those healthy foods smell badly for me, like greens (i.e., amaranth leaves, cabbage..). That’s why I fail to eat them.” (FGD, girls, 14 years, in-school)

Adolescents and young adults were drawn to street foods and quick snacks that delivered both sensory satisfaction and ease of access. Parents corroborated these views, frequently observing their children’s inclination toward street foods such as rolex (a popular snack made of fried eggs rolled with chapati), plain chapati, sodas, and energy drinks, foods known for their rich flavor profiles and availability:

“Most young people prefer eating rolex, plain chapati, sodas, and energy drinks.” (FGD with parents, female, 38 years)

Teachers also noted that adolescents’ food preferences are highly influenced by preparation methods that enhance taste. Foods perceived as bland or less flavorful, such as unfried vegetables, were often rejected in favor of tastier options:

“Whenever we cook unfried green vegetables, they [AYAs] refuse to eat food because they want it fried. They say that unfried food is not tasty.” (FGD with teachers, secondary school)

Beyond taste, aroma played a similarly influential role in food decisions. For many AYAs, the smell of food acted as a trigger for cravings, prompting impulsive food-seeking behaviors. The scent of familiar street foods, particularly chapatis, was frequently cited as an irresistible sensory cue:

“For instance, you can be walking by the roadside and you smell the nice chapati aroma. You are then forced to look for the money to buy it.” (FGD, boys, 13 years, in school)

Visual appeal further deepened this sensory connection. In particular, adolescent girls emphasized the importance of food presentation and appearance in stimulating their interest and willingness to eat. For some, visual appeal could override even concerns about how the food was prepared:

“What motivates me is the food that appeals to my eyes, whether well prepared or not.” (FGD, girls,18 years, out of school)

Nutrition knowledge

Nutrition knowledge was an important factor shaping AYAs’ dietary behaviours, with stronger knowledge observed among in-school adolescents compared to their out-of-school peers.

Among in-school AYAs, school-based nutrition education was frequently cited as the main source of information about healthy eating practices:

“The teacher at school taught us that we have to eat a balanced diet so that we are healthy, so for me, I always try to eat a balanced diet.” (FGD, boys, 17 years, in school)

By contrast, those who were out-of-school demonstrated limited awareness of balanced diets, underscoring disparities linked to educational access:

“I just eat what is there… mostly cassava and dry tea [black tea]. I don’t know much about which foods are healthy.” (FGD, boys, 20 years, out of school)

Key informants reinforced these subgroup patterns, emphasizing that low nutrition knowledge remains a barrier to healthy eating especially among out-of-school AYAs in Mayuge district:

“So, low level of knowledge about a balanced diet and nutritious foods to eat negatively affects the food choices of most of the out-of-school AYAs here in Mayuge district.” (KII, CSO staff)

Perceived role of food in enhancing physical and sexual appeal

Across discussions with AYAs, teachers, and district stakeholders, distinct subgroup patterns were identified, describing how AYAs perceived the role of food in shaping physical attractiveness and sexual appeal. Girls, especially younger (10–14 years) and in-school ‒ framed food choices around body image and sexual appeal, while boys, particularly out-of-school youth, linked food to energy and work productivity.

Among younger adolescent girls aged 10–14 years, eating sweet foods was described as a way to enhance body image and appear attractive to peers:

“I also want my body to look nice and sexually appealing, so I have to eat sweet things, which helps me gain weight and improve skin colour to look good.” (FGD, girls, 13 years, in school)

Older adolescent girls aged 15–19 years who were out of school expressed similar views, linking fatty foods with beauty and social acceptance:

“For us girls, when you eat foods that make you grow fat, people admire you and say you are beautiful, so I also try to eat such foods when I can.” (FGD, girls, 19 years, out of school)

By contrast, young boys aged 20–24 years who were out of school linked food choices with productivity and strength needed for physical work, to earn income:

“For us boys, when we eat posho and beans, we get the energy for do heavy work like making bricks or loading sugar canes. It is about having energy to keep working to make money.” (FGD, boys, 20 years, out of school)

Teachers confirmed that these beliefs were widespread among in-school adolescents, particularly older adolescents (15–19 years), who frequently equated sweet or “good” foods with attractiveness and desirability:

“They [AYAs] prefer eating good and sweet things. Like at my school, they say that if you eat sweet things, you also become sexually appealing… that is their reason, and that is how they understand it. During that adolescent stage, when they eat sweet things, they believe they will also become sexually appealing to their partners.” (FGD with teachers, primary school)

Key informants emphasized that these pressures were gendered and disproportionately influenced girls. A district health official highlighted a locally held myth:

“For example, there is a myth among girls here in Mayuge District that if they eat a lot of fatty foods and grow fat, they will be loved by boys because of their enhanced beauty.” (KII, district health staff, Mayuge)

Eating to belong: Peer and social pressures

Across interviews and group discussions, participants consistently highlighted how AYAs’ dietary behaviours were shaped by a web of peer and social pressures. These pressures reflected a quest for social belonging, identity, and status. Both boys and girls framed food in relation to acceptance within friendship groups. However, boys also make certain food choices to gain status or favour in peer and romantic relationships (reported by food vendors).

In-school adolescents described conforming to the eating patterns of their peers as a way of blending into social groups and avoiding exclusion:

“The motivation comes from the rest of the people they are with because they are also eating, so that they can fit in the group.” (FGD, boys, 18 years, in school)

Adolescent girls emphasized the pressure of pocket money and the social expectation to consume certain foods or drinks alongside friends:

“When my friends have pocket money, they buy fried cassava and pancakes. If I don’t also buy, they laugh at me.” (FGD, girls, 13 years, in school)

District education officials reinforced this point, noting that peer influence was particularly pronounced in school settings, where adolescents adopted their friends’ preferences for trendy or “fast” foods:

“The food choices of some adolescents to eat fast food stuff like chapatis, chips, etc. influence the food choices of their peers as well.” (KII, district education staff, Mayuge)

A basked food vendor cited that adolescents, particularly those with access to money, sometimes use food as a tool to gain social favor or impress peers and lovers. The food vendors also highlighted that AYAs prioritize eating out, often buying more expensive or locally trendy foods to signal status or affection.

“Whenever these young people get some money, they prefer eating out of home. Some of them have started getting girlfriends who ask for chicken, and the boy has to excite her by buying the roasted chicken.” (KII, basket food vendor at secondary school).

Parents decide, AYAs eat

Across adolescents, parents, and key informants (CSOs), there was a shared recognition that food choices within households were largely dictated by parents or caregivers, with AYAs having limited input. The AYAs described a lack of autonomy, often consuming whatever food was available or prepared, especially by mothers:

“Usually, we eat what our parents prepare, what is available at home. Sometimes during the sweet potato harvest season, you find that we eat sweet potatoes because it’s what our mother always prepares.” (FGD. boys, 14 years, in school)

This dynamic was reinforced by key informants, who pointed to structural and cultural norms that assign decision-making around food to adults rather than children:

“In most cases, children and adolescents have limited power to select the food they would like to eat. They eat whatever is available in the household, as decided by parents.” (KII, CSO staff)

Parents themselves openly acknowledged this authority. They emphasized that food preparation was primarily guided by seasonal availability and household economic constraints, and that children were expected to accept what they [parents] affords to provide:

“As parents, we usually prepare food based on what we have harvested or can afford to buy; and I always tell my children to learn to eat what is available.” (FGD with parents, male, 41 years)

Keeping up with the neighbours’ plate

Neighbours’ choices were frequently cited as shaping AYAs’ dietary preferences. Adolescents described how observation and emulation influenced their food aspirations, often leading them to desire meals similar to those consumed by peers and surrounding households:

“I can look at the neighbors and then desire food they have eaten, then we also go back home and decide to eat what they have eaten.” (FGD, boys, 18 years, in school).

This form of social mirroring extended beyond adolescents themselves, creating pressure within households. Parents explained that their children’s requests were often directly linked to what they saw others preparing in the neighbourhood:

“Whenever my children see my neighbors cooking vegetables, they come back and ask me to buy for them too.” (FGD with parents, female, 49 years,)

For many parents, meeting such demands became a way of maintaining harmony at home and avoiding disappointment, even when these requests added to household expenses:

“I buy vegetables so that I don’t disappoint them.” (FGD with parents, female, 49 years,)

Gendered cultural food taboos and norms

At the community level, gendered cultural norms influenced AYAs’ dietary choices. Traditional taboos, particularly those targeting girls and women ‒ restricted the consumption of specific foods such as emamba (lungfish) and chicken. These norms were widely upheld by community actors, including parents, elders and food vendors.

Adolescent girls emphasized early socialization into these restrictions, often describing them as rules they had to follow from childhood:

“As a girl, since I was young, my grandmother told me never to eat emamba. Even now at my age, I can’t try it because people will say I disobeyed our culture.” (FGD, girls, 16 years, out-of-school)

By contrast, boys highlighted their freedom to consume emamba and pointed out that the restriction was gender-specific:

“We boys can eat emamba freely, but girls are not allowed. For us, it makes us strong, but for them it is a taboo.” (FGD, boys, 18 years, out of school)

Food vendors reinforced these cultural norms, reflecting how deeply embedded they were in community practices:

“From childhood, girls in this community are taught not to eat emamba (lungfish); it is considered taboo for me or any other girl or woman. As a result, girls avoid it; even if they might want to try it.” (KII, basket food vendor at a secondary school)

Reception of health workers’ advice

Adolescents and young adults positioned healthcare providers as authoritative voices in shaping their dietary practices. Participants reported that guidance from health workers strongly influenced their food choices, especially in the context of maintaining health and preventing disease. The legitimacy of this guidance was rarely questioned, with many youths acknowledging the value of medical advice in navigating food decisions:

“Doctors advise that we eat food that will soften our digestive system, and that’s what influences me when making food choices.” (FGD, boys 12 years, in school).

Health concerns, particularly chronic or acute illnesses, were also reported as major triggers for dietary modifications. Some adolescents described avoiding certain foods based on diagnoses or health risks identified by health professionals:

“Then diseases or sickness, like you can want to take some sugar, but when you are sick with diabetes, that cannot allow you to eat.” (FGD, boys, 16 years, in school).

In addition to direct interaction with health professionals, adolescents frequently applied nutrition knowledge conveyed through caregivers and community health promotion efforts. This mediated form of health education appeared to enhance their perceived ability to make informed food choices, especially in contexts where formal education or access to health services was limited:

“Whenever I get the opportunity, I cook greens because I was told by a community health worker it helps to prevent diseases.” (FGD, girls, 14 years, in school).

Cultural identity and ancestral food taboos

At the societal level, deep-rooted cultural identities and ancestral food taboos shaped dietary behaviors across ethnic and clan lines. Among AYAs, these taboos were described as inherited prohibitions tied to clan beliefs and symbolic meanings of certain foods. For some, foods considered totems were completely avoided, regardless of their nutritional value. These restrictions were perceived not as personal choices but as obligatory observances tied to cultural heritage:

“As a Musoga (a member of the Basoga ethnic group in eastern Uganda), I come from a clan that prohibits eating certain foods, especially those considered to be totems. We also eat a lot of sweet potatoes; it’s part of our culture.” (FGD, boys, 19 years, in-school)

From the perspective of district-level stakeholders, such dietary patterns reflected distinct ethnic affiliations within the region. Specific staples were associated with different groups; Banyole, Basoga, and Baganda ‒ highlighting how ethnic food traditions continued to shape AYAs’ food preferences at a population level:

“Among the ethnic groups in this area, the Banyole mostly eat millet bread; the Basoga prefer cassava and sweet potatoes; while the few Baganda living here tend to eat matooke [steamed green bananas]. Young people in Mayuge generally follow these culturally rooted food preferences.” (KII, district staff, Mayuge)

Media and celebrity endorsements

Media exposure such as watching television (TV) and celebrity endorsements were identified as modern, trans-local forces that shaped AYAs’ aspirations around food and lifestyle. These influences were described as aspirational and identity-driven, often clashing with locally available foods and varied across gender, age, and schooling status.

Adolescent boys aged 15–19 years, reported being especially drawn to foods they saw in movies or advertisements, associating them with desirability and social status:

“I love eating the kind of food I see in movies; it always looks so delicious.” (FGD, boys, 16 years, in school).

Female AYAs expressed similar sentiments, with many saying they were motivated to try new foods after seeing celebrities endorse them:

“When I see my favorite artist eating something, I feel like I want to try it too.” (FGD, girls, 12 years, in school).

Among out-of-school young adults, media influence often reached them indirectly through peers rather than direct access. Males described relying on friends with smartphones to share what they saw online. Relatedly, females echoed similar aspirations, particularly around foods linked to beauty and celebrity status:

“I don’t watch TV much, but when my friends in town who have smartphones tell me about foods they see on Facebook or TikTok, I also feel like trying them.” (FGD, boys, 22 years, out of school).

“Sometimes my friends talk about the foods celebrities eat, like fried chicken or pizza. Even if I haven’t seen a pizza myself, but wish to taste it one day.” (FGD, girls, 20 years, out of school).

These pressures were also acknowledged by parents, who described difficulties in managing their children’s exposure to food advertising:

“My child often asks for foods they’ve seen on television. It’s hard to say no when they insist.” (FGD with parents, male, 35 years).

Teachers highlighted the pervasiveness of media influences, noting that they often shaped classroom discussions or snack preferences among students:

“Students often talk about foods they’ve seen on TV or their favorite celebrities eating. It definitely affects their choices.” (FGD with teachers, secondary school).

Food seasonality based on rainfall patterns

Food seasonality was an overarching factor shaping dietary behaviours, with AYAs, parents, and teachers alike recognizing that seasonal shifts determined what foods were grown, available, and ultimately consumed. For AYAs in rural communities, dietary behaviours fluctuated with what was locally produced during specific seasons, often limiting dietary diversity:

“During dry seasons, we mostly have cassava bread and sweet potatoes. Those are the easiest foods to get, and that is what they [AYAs] eat” (FGD for parents, female, 45 years).

Teachers also echoed this view, indicating that even school environments are affected by seasonal dynamics, which influence what learners bring from home and what schools provide. District staff corroborated these patterns, emphasizing the constrained choices that seasonality imposes on AYAs:

“When it’s sweet potato season, that’s what they eat; when it’s maize season, the same applies. Even greens depend on availability.” (FGD, teacher, secondary school).

“The availability of food in a given season largely determines what adolescents eat. Their diet changes with the season.” (KII, district staff, Mayuge).

Furthermore, institutional settings such as schools often had limited flexibility to respond to seasonal variations. School feeding programs tended to rely on staples like posho and beans; foods that are logistically practical but nutritionally monotonous:

“Most schools provide posho and beans; some fry them, some don’t; but it’s what is consistently available.” (FGD for teachers, secondary school).

Local availability and physical access

Adolescents and young adults’ food choices were strongly influenced by their geographic location and the physical proximity of food outlets. Participants emphasized that regional agricultural production shaped what foods were both culturally consumed and practically accessible. For instance, adolescents highlighted how staple foods varied across areas:

“People in Mbarara have bananas because they grow a lot of them. In Busoga, it’s mostly sweet potatoes; it depends on where you come from.” (FGD, boys, 15 years, in school).

Physical distance from food outlets further restricted access, particularly for in-school boys, who reported challenges in obtaining purchased foods such as beverages due to mobility constraints:

“Even when you have money, it’s hard to get juice if the shop is too far from where you are.” (FGD, boys, 18 years, in school).

District officials reinforced these perspectives, noting that AYAs largely consumed what was grown locally within their immediate surroundings:

“Adolescents in Mayuge mostly eat what is grown locally. They rarely have the option to choose from a wide variety of foods.” (KII, district staff, Mayuge).

Study limitations and strengths

A primary limitation of this study was the reliance on self-reported data, which may have been influenced by participants’ perceptions or social desirability, potentially leading to misreporting of factors influencing dietary behaviors. However, this limitation was mitigated through methodological triangulation. The study engaged a diverse group of participants, including AYAs, parents, food vendors, teachers, the district nutrition focal person, and representatives from civil society organizations involved in adolescent health and nutrition. Additionally, responses were cross-validated through a combination of FGDs and KIIs. Probing techniques were used during data collection to enhance clarity, encourage honesty, and reduce social desirability bias, thereby improving the credibility and reliability of the findings.