The Home Food Environment for 6–11-Year-Old Children in China

Introduction:
China is experiencing the double burden of malnutrition, with undernutrition persisting in rural areas while childhood overweight and obesity continue to rise. Among children aged 6–11 years, dietary behaviours are shaped predominantly within the home food environment (HFE), which encompasses home food availability and accessibility, parental feeding practices, family food rules, and family meal routines. While extensive evidence on the HFE exists from Western contexts, little is known about the HFE in Chinese families, where unique cultural features, such as multigenerational households, and Chinese dietary culture.

Methods:
This PhD thesis adopted a mixed-methods with three phases. In Phase 1, a structured HFE questionnaire was designed and developed before large-scale administration to 3,148 parents across seven provinces. The survey assessed home food availability and accessibility, parental feeding practices, family food rules, and family meal routines, and examined their associations with demographic characteristics. In Phase 2, qualitative focus groups were conducted separately with parents and children in 2 provinces (Beijing and Dongying), exploring perceptions of the HFE, daily practices, and intergenerational influences. In Phase 3, four home-based “nudge” strategies (Snack Out of Sight, Easy Fruit, Attractive Vegetables, Lead by Example) were designed and developed, then piloted with families in Zhejiang and Shanxi during five weeks. Data were collected via pre- and post-intervention questionnaires, weekly diaries, and follow-up interviews to assess feasibility, acceptability, and preliminary outcomes.

Results:
This thesis developed and validated a culturally adapted questionnaire to assess the home food environment in Chinese families with children aged 6–11 years, drawing on data from 3,148 parents across seven provinces. Home food inventory varied substantially, with fresh fruits, vegetables, obesogenic, and high-salt foods generally increasing with child age, except at 11 years. Higher parental education was unexpectedly linked to greater obesogenic food availability, while three-generation families reported more obesogenic but fewer high-salt foods.

Qualitative data highlighted how children exerted substantial influence on food purchasing and preparation, often negotiating with both parents and grandparents. Parents described tensions between promoting healthy eating and accommodating children’s preferences, while grandparents were reported as both preservers of traditional diets and contributors to indulgent feeding practices.

The pilot intervention tested that the four nudge strategies were feasible and acceptable to families. “Easy Fruit” and “Snack Out of Sight” were most consistently applied, while “Lead by Example” was often adapted into verbal encouragement. Implementation varied by site: families in Zhejiang engaged more frequently than those in Shanxi. Food diary data suggested slight increases in fruit and vegetable consumption. Follow-up interviews revealed that parents valued the practicality of the strategies but noted barriers such as limited time, competing family routines, and differing attitudes between generations.

Conclusion:
This thesis is the comprehensive study to investigate the HFE in Chinese families with children aged 6–11 years using a mixed-methods approach. It confirms that the HFE is an important determinant of children’s dietary behaviours, shaped by socioeconomic status, regional context, and multigenerational caregiving. The findings underscore the importance of culturally tailored interventions that recognise the central role of parents and grandparents as “choice architects” within the home. The pilot demonstrates the feasibility of simple, low-cost nudge strategies to promote healthier eating. Larger-scale interventions are now needed to evaluate effectiveness and inform national nutrition policy, contributing to ongoing efforts under the Healthy China 2030 framework.