Parental perspectives on physical inactivity and unhealthy diet as linked Non-Communicable Disease (NCD) risk factors among adolescents in Coastal Karnataka, India: a qualitative study.

Abstract

Unhealthy dietary practices and physical inactivity during adolescence are key contributors to the future burden of non-communicable diseases (NCDs). Although parental influence on adolescents' lifestyle behaviours is well recognized, evidence from low- and middle-income countries (LMICs), particularly within context-specific settings, remains limited. This study aimed to explore parents' perspectives on physical inactivity and unhealthy dietary practices as inter-related risk factors for NCDs among adolescents in Coastal Karnataka, India. This qualitative study employed semi-structured interviews with 16 parents (10 mothers and 6 fathers) of adolescents aged 11-17 years in Coastal Karnataka, India. Participants were purposively recruited to ensure variation across school types and socio-economic backgrounds. Interviews were audio-recorded, transcribed verbatim, and analysed using a hybrid inductive-deductive thematic approach informed by the Capability-Opportunity-Motivation Behaviour (COM-B) model, Social Cognitive Theory, and the Theory of Planned Behaviour. Six interrelated themes were identified: (1) sustained awareness of healthy behaviours with a persistent awareness-practice gap; (2) the home environment as a space of negotiation rather than control; (3) normalization of intermittent unhealthy dietary practices and episodic physical inactivity; (4) academic demands as key barriers to healthy lifestyles; (5) schools as conditional but time-limited protective environments; and (6) gendered and culturally embedded influences on physical activity. Despite high levels of awareness, parents reported increasing difficulty in sustaining healthy behaviours due to academic pressures, adolescents' autonomy, and environmental constraints. Parental recognition of the importance of healthy behaviours is constrained by structural, academic, and socio-cultural factors that limit sustained adoption. Interventions targeting adolescent NCD prevention in LMIC settings should adopt multi-level strategies that integrate family support, school-based initiatives, and context-specific considerations such as academic pressures and cultural practices. Clinical Trials Registry of India (CTRI/2025/05/087338), dated: 14/05/2025.