Visualizing “healthy eating” in rural El Salvador through the eyes of children

Introduction: Developing countries are now undergoing a nutrition transition characterized by shifts in diet and physical activity patterns similar to developed countries, resulting in high occurrences of chronic conditions, like obesity, diabetes and cardiovascular disease (CVD). Poor, rural communities share the bulk of these increased incidences, which places the children who live within these communities at great risk. This study aimed to explore children’s conceptualization of “healthy eating” and identify enablers and barriers to eating healthy within rural communities of northeastern El Salvador. Methods: Seventeen students between the ages of 8 and 12 participated in the month-long project. Students were asked to define main concepts, such as ‘health’ and ‘healthy eating’. They were then paired into groups and took photographs of concepts related to "healthy eating" and existing enablers and barriers. Results: A total of 100 photos were generated for analysis. The following main themes emerged: 1) globalization, 2) access, 3) the juxtaposition of “healthy” and “not-so healthy”, and 4) health properties associated with certain foods. Students identified popular food products readily available within their rural neighborhood stores, juxtaposed with a limited selection of fresh fruits and vegetables. Students attributed both positive and negative health outcomes to different foods, such as limes, carrots, bread and sweets. Discussion: Students’ photos revealed several realities that complicate dietary health choices and outcomes. Identification of barriers and enablers in a manner that recognizes children’s conceptualization and capacities in dietary health merits further investigation, particularly as children remain one of the most vulnerable populations worldwide.