BACKGROUND

Food decision making is a complex and dynamic process that influences diet and ultimately health. Adolescents consider many different food environment-level factors when making decisions about food. These factors may vary by context. Adolescents attending junior high school (JHS) in Ghana frequently interact with their school food environments because they do not have access to a national school meal program.

OBJECTIVES

The objective of this study was to understand the factors that influence adolescent food-related decisions and how adolescents interact with their school food environments from their own perspectives. Secondarily, we sought to elicit adolescent ideas for the future of their school food environment.

METHODS

Forty adolescents were purposively selected equally across 4 JHSs in Cape Coast, Ghana. We used Photovoice to elicit photographs and ideas across 5 workshops with each school. Adolescents were provided with digital cameras and weekly photography prompts followed by semistructured group discussions each week. We thematically analyzed photographs and discussions with input from the adolescents. Adolescents presented their findings to local stakeholders through a photograph exhibition at the end of the study.

RESULTS

Adolescents reported factors influencing their food decisions at the policy, environmental, interpersonal, and individual levels, mirroring the socioecological model. These factors included school policies (30 coded references), food hygiene and safety (374), food availability (83), relationships with vendors (62), peer influence (36), nutritional value (42), taste (41), satiety (25), appearance (30), and affordability (160), with hygiene, safety, and affordability being most frequently mentioned. Adolescents wanted to be involved in decisions around their school food environments.

CONCLUSIONS

Adolescent food decision making in this context is often driven by food hygiene and safety and affordability. Supporting adolescent autonomy for food-related decisions and including them in decision making to change school food environments could empower adolescents in their food decisions and improve school food environments to match with adolescents' needs and desires.