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Eating behaviour of adolescent schoolgirls in Malang, East Java: A qualitative

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Mal J Nutr 25 (Supplement): 87-96, 2019

Eating behaviour of adolescent schoolgirls in Malang,

East Java: a qualitative study
Mulia Sondari1,2*, Inge Brouwer2 & Judhiastuty Februhartanty3
1
National Agency of Drug and Food Control, Ministry of Health Republic of Indonesia,
Jakarta, Indonesia; 2 Division of Human Nutrition, Wageningen University,
Netherlands; 3 Southeast Asian Ministers of Education Organization Regional Centre
for Food and Nutrition (SEAMEO RECFON)/Pusat Kajian Gizi Regional (PKGR),
Universitas Indonesia, Jakarta, Indonesia

ABSTRACT

Introduction: Poor eating behaviour is known to lead to nutritional deficiency

among adolescents. At the same time, poor eating behaviour characterised by
dietary excesses could lead to overweight and obesity. The present study aimed
to explore the eating behaviour of adolescent schoolgirls in Malang, East Java
Province, Indonesia, and to determine the factors that influenced their eating
behaviour. Methods: This was a qualitative study, guided by the Social Cognitive
Theory (SCT), which focused on individual and environmental influences to better
understand health-related behaviours, such as eating behaviour. Triangulation
was applied to the study subjects (adolescent girls, their mothers, and school
staff). The methods used included individual in-depth interviews and focus group
discussions. Qualitative data analyses were performed using Atlas.ti 7. Results:
Most participants showed poor eating behaviour that was characterised by skipping
breakfast, frequent consumption of fast foods and the consumption of local food
with low nutrient content. Their eating behaviour was influenced by individual
factors including personal preferences, the price of the food, and by environmental
factors, such as the family, school and neighbourhood. Conclusion: Our findings
showed that adolescent girls in Malang appeared to be aware of healthy eating
but they showed unsatisfactory eating practices. Interventions are suggested to
improve the poor eating behaviour of the adolescents toward avoiding malnutrition
consequences.

Keywords: Eating behaviour, adolescent schoolgirls, Malang, Indonesia

INTRODUCTION of energy-dense foods, sugar-sweetened

beverages, and a low intake of fruits and
As adolescence is a critical stage of
vegetables (Rathi, Riddell & Worsley,
physical and psychological growth and
2017). Adolescents, particularly girls,
development, healthy dietary behaviour
are prone to nutritional deficiencies
during this period is important. A
owing to poor intake of nutrients that
previous study has reported that
are needed to support the growth spurt
adolescents are prone to poor eating,
and the body’s demand for iron during
with a tendency to a high consumption

__________________________
*Corresponding author: Mulia Sondari
Directorate of Processed Food Registration, National Agency of Drug and Food Control
Ministry of Health Republic of Indonesia, Jl. Percetakan Negara No 23, Jakarta, Indonesia.
Tel: +6289687554782, Fax : +62-21 4245267; Email: [email protected]
S88 Sondari M, Brouwer I & Februhartanty J

menstruation (Mesias et al., 2013). On MATERIALS AND METHODS

the other hand, dietary excesses during
The primary subjects were adolescent
adolescence may lead to overweight and
obesity (Sahoo et al., 2015). Poor eating schoolgirls while the secondary subjects
habits formed during adolescence may were mothers and school staff as
persist into adulthood (Craigie et al., informants to validate the opinions of the
2011). Therefore, establishing a healthy girls. The study was conducted in three
eating behavior during adolescence public high schools in Malang. Malang
has both short- and long-term health is the second largest city in the East
benefits. Java Province. According to the National
In Indonesia, a study found that Socioeconomic Survey (Central Bureau
low socioeconomic status (SES) is of Statistic Indonesia, 2013), it has the
associated with iron deficiency among highest proportion (16%) of adolescent
adolescent girls (Sumarlan, Windiastuti girls aged 15-18 years within the total
& Gunardi, 2018). In East Java, the number of women aged 15-49 years.
prevalence of chronic energy deficiency The triangulation technique was
in women of reproductive age (15–49 used in validating the interpretation
years) was higher than the national rate, of the data collected from different
while the prevalence of stunting among sources. In this study, the triangulation
adolescents was comparable to the sources used were different subjects
national rate (MOH Indonesia, 2013). (girls, mothers, and school staff), as
Several qualitative studies have well as different methods (individual
reported that adolescent food choice interviews and focus group discussions
behaviour was influenced by the SES
[FDGs]). The FGD approach provides a
(Maulida et al., 2016), food preferences,
relaxed atmosphere as the subjects are
familial factors (home food environment,
in the company of their peers (Daley,
parental style), food accessibility
and availability (Fitzgerald et al., 2013). Therefore the FGDs were done at
2010). However, there are currently their schools at the beginning of the data
few qualitative studies on the eating collection stage to gain a preliminary
behaviour of Indonesian adolescents understanding of the general situation of
and its associated factors. the eating behaviour of the adolescents
The aim of the study was to explore and their lifestyles. Following this first
the eating behaviour of adolescent stage of understanding, individual
girls (aged 15-18 years) from low SES interviews of the girls and their mothers
backgrounds in Malang, East Java were done separately at home, in order
Province, Indonesia and to identify the to obtain more insightful responses. The
factors that drove their eating behaviour. interviews with the school staff were
The study used a qualitative research conducted at the schools.
approach and was guided by the Social The FGD and interview questions to
Cognitive Theory (SCT) (Bandura, 1998). the girls were similar because the two
The SCT is a widely used theory applied methods were used to different girls as a
in interventions to promote healthy way to triangulate communal perception.
eating among adolescents (Fitzgerald et However, we started the interview by
al., 2010; Hall, Chai & Albrecht, 2016). asking about the daily routine and daily
This theory focuses on the interactions eating practices of the participants. The
among individuals, and their social FGD started with a discussion of similar
and physical environment to explain
and/or different eating habits among the
health-related behaviour such as eating
participants. Examples of the questions
practices.
posed to the girls are stated in Table 1.
 Qualitative study on adolescents’ eating behaviours in Malang, Indonesia S89

Table 1. Sample questions for adolescent The mothers of the adolescent girls
girls (aged 15-18 years) that fulfilled the
No. Sample questions inclusion criteria above were selected for
1. Tell me about your daily eating
triangulation. The school staff members
routine during weekdays and who were selected were employed at
weekends? one of the selected schools and were
2. What kinds of food do you like to willing to participate on the day of data
eat? Why do you like them? collection.
3. What does a healthy eating mean to Purposive sampling was used to
you? recruit mother and girl (daughter) pairs
4. Tell us about the places in your for the interviews. Participants were
neighbourhood where you can get selected from two of the most highly
food. populated sub-districts in Malang,
5. What do you think about the food namely Kedungkandang (43,666
available in your school? households) and Sukun (45,666
households) (Central Bureau of Statistic
Participants Indonesia, 2013). The screening process
Our study focused on adolescent girls involved visiting the homes of the girls
aged 15-18 years, from low-income and asking them and their mothers about
families who were enrolled in a public the household income and expenditure.
high school or public vocational school
Participants for the FGD were
in Malang. The girls who were selected
selected from the three public schools
were mostly of low SES and attended
public schools which charged school that were willing to participate in the
fees that were reasonably affordable to study. At each school, the staff selected
them. In addition, the SES level was 10-20 female students who received
determined based on demographic school fee subsidy. The researcher
information gained during the screening then invited the selected students to
process and their monthly household complete a demographic information
income range IDR 700,000–2,000,000 form to screen the parental income so
IDR (US$47.51–135.75) which was as to ensure it met the requirements
categorized as C and D classes based on for low socioeconomic level. Out of the
Nielsen’s classification in 2010 (Table 2). 45 adolescent girls from three schools,
The girls were excluded from selection 25 were eligible. A total of 19 girls were
if they had difficulty in communicating, included in the FGDs as the rest were
mental illness and/or learning disability.

Table 2. The Nielsen’s classification of the Indonesian socioeconomic segments†

Monthly household expenditure
Segment Proportion (%)
(Indonesian Rupiah /month)‡
A ≥ 3,000,000 13
B 2,000,000 – 3,000,000 27
C1 1,500,000 – 2,000,000 28
C2 1,000,000 – 1,500,000 21
D 700,000 – 1,000,000 8
E ≤ 700,000 3
†
Nielsen (2010)
‡
The expenses included daily food, electricity, water and monthly rent and excluded paid
yearly rent, installment payment, furniture and irregular expenses.
S90 Sondari M, Brouwer I & Februhartanty J

absent or because the discussion times conclusions. Recordings of the FGDs

conflicted with their examinations. and interviews were transcribed
Each FGD involved 6-7 students verbatim and the field notes were
per school. The staff members at the documented. Each individual transcript
schools were recruited for the FGD by was repeatedly reread and re-examined
convenience sampling. Two of the three to ensure reliability. The key concepts
staff who were selected had worked in were identified by coding the data and
the school for 15-20 years. One was a then by categorising the codes. Coding
teacher and the others were student and categorising were carried out using
counsellors. qualitative data analysis software Atlas.
No specific criteria were applied ti version 7. When all the data were
when selecting the schools except that categorised, similar categories were
they had to be public schools located grouped into themes.
in the study area and were willing to
participate in the study. RESULTS
The two themes that emerged in
Procedure
relation to the eating habits of the girls
The study was approved by the Ethical
were the skipping of breakfast and the
Committee of Atmajaya Catholic
consumption of fast foods. The factors
University (approval number: 771/
that influenced the eating habits of the
III/LPPM-PM.10.05/08/2014). The
girls are presented below according to
estimated point of saturation was
individual and environmental influences.
observed after interviewing nine
Examples of quotes are shown below to
adolescent girls, their mothers, and
illustrate each theme.
conducting three group discussions with
19 adolescent girls.
Adolescent girls’ eating behaviour
Data collection took place between
Theme 1: Breakfast skipping
September to October 2014. All the
During the weekdays, the majority of the
participants gave written consent prior to
adolescent girls from low socioeconomic
each FGD and interview. The researcher
background in Malang skipped
facilitated the FGDs and interviews with
breakfast.
a note-taker, and the discussions were
also audio-recorded with the consent of
“The food was not ready in the
the participants. The questions in the
morning; anyway, I don’t have time to
FGD and in the interview guidelines were
eat food” (Girl–FGD 1)
similar. The objective of the FGDs, which
were conducted at the beginning of the
“I’m not used to eating breakfast
data collection, was to become familiar
since I was a child; my stomach feels
with the daily activities and food practices
queasy if I have breakfast” (Girl-
of the girls. Topics such as the eating
FGD 3)
behaviour of the girls were addressed
in-depth during the interviews. The
“I must hurry to go to school, so I have
FGD sessions lasted for about 40-50
no time for breakfast, but then I’ll
min, while in-depth interviews lasted
bring a lunch box” (Girl–FGD 2)
for about 50-70 min. Mothers and girls
were interviewed separately, after which
all the participants were interviewed
Although the mothers and school staff
together.
were aware of this behaviour, they did not
Data were analysed using the
mention during the FGD whether they
inductive thematic analysis approach,
encouraged the girls to have breakfast.
moving from specific to more general
 Qualitative study on adolescents’ eating behaviours in Malang, Indonesia S91

“She wasn’t used to having breakfast, Factors influencing the eating

but usually she brings a lunch box to behaviour of adolescent girls
school” (Mother 2) The eating behaviour of girls’ is influenced
by individual and environmental factors.
“Most of them don’t have breakfast;
when they get sick or have a Theme 1: Individual influences
headache, they come to us asking for (i) Knowledge and awareness
medicine and when we ask whether The girls discussed healthy eating and
they had breakfast most of them reply mentioned that it meant eating specific
that they had not” (School staff 2) foods such as vegetables, fruits and foods
containing nutrients. Healthy eating was
Theme 2: Fast food and locally available also defined by the girls as consuming
food consumption food that was prepared at home, as
The majority of the girls in this study they believed that the cleanliness was
reported that they liked to consume fast superior and the ingredients were
foods and local foods, because of the known. One girl in a FGD defined eating
taste and its availability in many places on time as part of healthy eating.
in the neighbourhood, such from street
food vendors and in the school canteen. “I don’t know exactly, but I think
healthy eating is eating vegetables
“I like bakso (meatball soup; meatball and fruit” (Girl 3–Interview)
consisting usually a small quantity
of meat and a lot of flour, or without “Consuming food containing
any meat completely made with carbohydrate, protein, vitamins”
flour); it’s tasty, cheap and available (Girl–FGD 2)
everywhere” (Girl 4–Interview)
“Having meals on time and not
“I like cilok (fried-small bakso served skipping meals” (Girl–FGD 1)
with peanut spicy sauce), it’s tasty”
(Girl 2–Interview) “Eating home-made food is healthy
because we know how it was cooked;
“I like eating burgers, it’s tasty” (Girl we are also sure of the cleanliness of
6-Interview) the processing of the food” (Girl-FGD
2)
“Where do you buy it?” (Interviewer)
“From the street vendors, it’s cheaper The majority of girls reported that they
than from the fast food restaurants” were aware of the general benefits of
(Girl 6-Interview) healthy eating such as providing support
for body growth and immunity.
The school staff confirmed this
behaviour. “Healthy eating makes us strong and
as a result it is not easy to get sick”
“I have observed that high schoolgirls (Girl–FGD 1)
love to eat something that tastes
savory. If you observe them at the “Healthy eating will support our body
canteen, they like to eat bakso and growth” (Girl 1–Interview)
noodles with a lot of spicy sauce”
(School staff 2) Mothers perceived healthy eating as the
consumption of food prepared at home
S92 Sondari M, Brouwer I & Februhartanty J

and which were healthy foods such as (iii) Price of the food
vegetables, tofu and tempeh. Most of the girls indicated that they
often preferred foods that were cheaper
(ii) Food preferences and easy to buy even though they are
The adolescent girls stated that the not healthy.
taste of food was the most important
factor that influenced their decisions “Unhealthy food, like bakso, is cheap,
on the choice of foods. Overall, the girls and the bakso seller is easy to find
were enthusiastic when talking about near the house” (Girl 4–Interview)
savory, sweet or spicy foods. On the
other hand, vegetables were associated “I don’t have enough pocket money,
with unpleasant and negative taste so most of the time I only buy snacks
experiences. at school” (Girl 6-Interview)

“Taste of the food is important. I like “The food sold by street vendors or
savory food because it’s tasty” (Girl– school canteen is cheaper than that
FGD 2) sold in the mall. This is because the
facilities to make the food are not
“I like eating snacks because it tastes good and the ingredients are cheaper”
good” (Girl-FGD 3) (Girl–FGD 2)
“Vegetables? I don’t eat it very
School staff believed that the girls
much because it’s tasteless” (Girl 4–
preferred tasty and cheap foods over
Interview)
healthy food.
“I don’t like cabbage because it’s
“They will consider taste and price for
bitter” (Girl 2-Interview)
food choice. The canteen in this school
sells cheap meals like bakso. They’re
Mothers and school staff also reported
likely to buy this kind of food instead
that taste preferences influenced the
of healthy food” (School staff 2)
girls when making food choices. Mothers
understood that healthy foods such as
Theme 2: Environmental influences
vegetables were good for their children
(i) School and neighbourhood
and which were often available at home.
But they often compromised with their The availability and accessibility of
children and did not put pressure on fast foods and local foods in the school
them to eat vegetables. canteen and the neighbourhood, such
as from street vendors or casual shops,
“It’s hard to tell my daughter to eat was the most frequent reason expressed
vegetables. She said vegetables are by the adolescent girls for deciding on
not tasty” (Mother 6) their food choices.

“If I force her to eat vegetables, she “I often buy savory snacks and cold
won’t eat the food at all. So, I let her sweet drinks at the school canteen”
eat what she wants” (Mother 1) (Girl 2–Interview)

“Mostly the students only consider the “I like eating bakso but sometimes
taste of the food without considering I didn’t eat bakso in a week, if the
whether it is healthy or not” (School bakso seller in the canteen was
staff 1) away” (Girl 7-Interview)
 Qualitative study on adolescents’ eating behaviours in Malang, Indonesia S93

“We want to eat fruits, but there’s no said anything to discourage the girls
fruit seller in the school canteen, not from doing so. Instead, mothers tended
even a fresh juice seller” (Girl-FGD 1) to accept the food choices of their
daughters.
“I like eating burgers” (Girl
4-Interview). “Where do you buy it?” “She used to like vegetables, but now
(Interviewer) “From the street vendors she doesn’t. Maybe because now she
near my home” (Girl 4-Interview) often buys varieties of food that are
sold by the street vendors” (Mother 9)
“She used to like vegetables, but
now she doesn’t. Maybe it is because “I don’t think they are eating healthy
she now often buys varieties of food food at school. They mostly eat bakso,
that are sold by the street vendors” I guess. But, at home, they eat food
(Mother 9) that is healthy because I prepare
vegetables, fish, tofu and tempeh”
Some girls commented on the school (Mother 5)
rules about food restrictions in the
canteen, which prohibit spicy foods and DISCUSSION
certain local fast foods. A school staff The findings of this study appear to be
member confirmed that there were some aligned with some of the influences on
rules about foods at school but that they healthy eating that are described in the
were limited to spicy foods and foods SCT (Bandura, 1998). Using the SCT as a
with unpermitted colorants. guide, the influences on the eating habits
of adolescent girls were considered as (i)
(ii) Family individual factors (such as knowledge
All the girls reported that mothers often and awareness, food preferences and
warned them not to eat unhealthy foods. food price) and (ii) environmental factors
Unfortunately, the rules were often (family, school and neighbourhood).
prohibited only spicy foods. Our study found that most adolescent
girls had some knowledge about healthy
“Mom told me not to eat spicy foods, eating and were aware of its benefits.
but I still eat it at school. Sometimes However, their eating behavior did not
I followed her rule, but sometimes I reflect their awareness. They often
disobeyed it” (Girl 5–Interview) skipped breakfast and showed a personal
preference for unhealthy food, such
“Mom told me not to eat too much as fast foods and local, nutrient-poor
spicy food and instant noodles” (Girl- foods. It would appear that knowledge
FGD 3) of healthy eating and its benefits are
not related to healthier eating practices
“Sometimes I eat spicy foods at school (Rathi, Riddell & Worsley, 2017).
or when my mom is working” (Girl The girls frequently reported that the
4-Interview) taste of the food was an important factor
affecting their choice of food. This may,
“I prohibit her eating food with chilli in part, explain the fact that they give
sauce; I told her that it’s not good for priority to short-term considerations
her health” (Mother 8) of eating behaviour, such as pleasure,
rather than long-term outcomes, such
The mothers were aware that the girls as prevention of disease. Other studies
often bought fast foods or poor-nutrient have shown that factors such as taste,
foods from the school canteen or street texture and the appearance of food
vendors, but there were none of them
S94 Sondari M, Brouwer I & Februhartanty J

were more important than knowledge important role in influencing the food
of healthy eating among adolescents behaviour consumption of their children
(Fitzgerald et al., 2010). (Pearson, Ball & Crawford, 2012). The
The main reason given by the girls for mothers in this study recognised that
their preference for fast foods and local their daughters practised unhealthy
foods is that they were affordable and eating habits. However, both girls and
readily accessible. The girls mentioned their mothers did not mention any
several times that unhealthy foods, strict rules regarding eating practices,
i.e. fast foods, nutrient-poor foods, beyond warnings not to consume spicy
and foods sold by street vendors, were foods. The mothers believed that it was
cheaper than healthy foods. The girls difficult to expect their children to eat
in the present study came from low healthily if they (the parents) did not do
SES households and had limited pocket so themselves.
money for purchasing food. Therefore, Based on the SCT, socio-
cost was a determinant in choosing environmental factors, such as parental
food. This is in line with other studies and societal support, can influence
on students from low income families the food intake behavior seen among
who chose foods based on convenience adolescents (Salvy et al., 2011; Story,
and affordability (Maulida et al., 2016). Neumark-Sztainer & French, 2002).
A study among Chinese adolescents Parental knowledge has been associated
similarly reported that unhealthy foods with healthy eating habits in children
were cheaper and popular among them (Grosso et al., 2012; Ansem et al., 2014).
(Chan et al., 2016). Nevertheless, the role of mothers may be
The SCT describes the importance limited only to the provision of healthy
of socio-environmental factors in food at home. Mothers in this study
influencing eating behaviours (Bandura, stated that the healthy food they usually
1998). The lack of school rules and ease prepared were simple dishes such as
of availability of food were revealed as fish, vegetable, tofu and tempeh.
key factors that influenced the eating This study only examined adolescent
behaviours of the girls in this study. girls from Malang and thus our findings
Mothers of the girls and school staff may not apply to all adolescent girls in
members expressed concerns about Java Province, much less throughout
their easy access to fast foods and Indonesia.
local nutrient-poor foods in the school
canteens. Some schools had no rules CONCLUSION
to restrict unhealthy foods. The school
A sample of adolescent girls from low
staff members confirmed that the school
SES in Malang, Indonesia showed some
rules were guided by food hygiene and
knowledge about healthy eating but
safety rather than nutritional quality.
did not show healthy eating practices,
Other qualitative studies have also
in skipping breakfast and consuming
reported that the availability of food at
fast food and nutrient-poor foods.
schools was a factor that influenced the
The factors influencing the adolescent
food consumption habits of adolescents
girls’ eating behaviours were driven
(Naidoo et al., 2017; Verstraeten et al.,
by individual preferences as well as
2014). As school meals can contribute
by the environmental factors. Future
30-40% of daily calorie intake of
interventions should not only target
students (Osowski et al., 2015; Nathan
adolescents, but also schools, the
et al., 2016), it is imperative for schools
community and their family members
to promote healthy food consumption
as well. School breakfast and healthy
(Bevans et al., 2012).
school canteen programmes, nutrition
Parents, especially mothers, play an
 Qualitative study on adolescents’ eating behaviours in Malang, Indonesia S95

education for parents, price subsidy

(to decrease the cost of healthier items) Fitzgerald A, Heary C, Nixon E & Kelly C (2010).
should be considered for future research. Factors influencing the food choices of Irish
children and adolescents: a qualitative
Acknowledgement investigation. Health Promot Int 25(3):289–298.
This study was funded by GAIN (Global Alliance Grosso G, Mistretta A, Turconi G, Cena H, Roggi
for Improved Nutrition). The authors are grateful to C & Galvano F (2012). Nutrition knowledge and
the GAIN team, Ravi Menon, Mart van Liere, Aang other determinants of food intake and lifestyle
Sutrisna, and Agnes Mallipu for their help during habits in children and young adolescents living
the study and to the field team members, namely, in a rural area of Sicily, South Italy. Public
Yusuf Habibie Intan, Dwi Yuwono Kristanto, Health Nutr 16(10):1827–1836.
Paramita Nur Anugerah, Lavrencia Annashopy,
and Gusti Anjar for their participation in data Hall E, Chai W & Albrecht JA (2016). Relationships
collection and processing. Special gratitude is between nutrition-related knowledge, self-
extended to the schools, teachers and other staff, efficacy, and behavior for fifth grade students
pupils, adolescent girl and mothers involved in the attending Title I and non-Title I schools.
study. Appetite 96:245–253.
Maulida R, Nanishi K, Green J, Shibanuma A
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MS, undertook data collection and wrote the adolescents in Jakarta, Indonesia: the roles of
manuscript; IB, provided expertise on data gender and family income. Public Health Nutr
interpretation and writing input; JF, provided 19(15):2760–2768.
expertise on the study design and data analysis. All
Mesias M, National S, Seiquer I, National S &
authors approved the final draft of the manuscript.
National S (2013). Iron Nutrition in Adolescence.
Crit Rev Food Sci Nutr 53(11):1226-1237.
Conflict of interest
The authors declare that there are no conflicts of MOH Indonesia (2013). Riset Kesehatan Dasar
interest. 2013 (Indonesia Basic Health Research 2013).
National Institute of Health Research and
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