In 2020, the Food Safety Authority of Ireland (FSAI) published, for the first time, food-based dietary guidelines for 1 to 5-year-olds. The guidelines highlight suboptimal intakes of vitamin D (VitD) and iron in toddlers and preschoolers. To help parents meet their child’s daily nutrient requirements, the FSAI recommends parents of 1-5 year-olds offer their child (1) a low-dose (5 μg/day) VitD-only supplement during the extended winter months (2) 30 g red meat three days a week and (3) 30 g ready-to-eat cereals (RTECs) with added iron (≥ 12 mg iron per 100 g) five days a week(1). Findings from our previous survey of parents of 1- to 5-year-olds (n=185) revealed low awareness of, and adherence to, the FSAI recommendations (2). The present qualitative study aimed to gain insight into factors influencing parental guideline adherence.

One-to-one, online, semi-structured interviews were conducted among a sample of 15 parents of 1to-5-year-olds who had completed our online survey (2). Participants were college-educated mothers, with the majority being Irish and within the age range of 36 to 45 years old. The interviews investigated participants’ attitudes towards the recommended items and perceived barriers and facilitators of adherence to the recommendations. Qualitative data were analysed using Braun and Clarke’s six-phase thematic analysis framework (3), facilitated by NVivo 12 Plus software.

Thematic analysis identified five themes capturing factors that were perceived to influence guideline uptake by parents: (1) Perceptions of healthy eating (i.e., eating a varied, balanced, and nutrient-dense diet); (2) Impact of the community food environment on the accessibility of the recommended items (i.e., food price and availability in community settings); (3) The interplay between family members’ dietary preferences and meal choices within the familial food setting (e.g., child food dislikes and picky eating habits, as well as parents’ preferences and experiences about the recommended items); (4) Convenience in food preparation and supplement use (i.e., time, energy, and skills required to adhere to the recommendations); and (5) Gaps in communicating the guidelines and opportunities to promote them (i.e., visibility of credible nutrition-related information).

Overall, this study showed that guideline adherence is a complex, multi-dimensional phenomenon that is affected by individual factors, the food and nutrition environment. It highlights the need for implementing a holistic approach, such as the socio-ecological model, to improve guideline adherence that involves families, healthcare professionals, policymakers, and the food industry to create a supportive, positive food environment for parents.