Food choices made by primary carers (mothers/ grandmothers) in West Java, Indonesia.

Background: Indonesian children currently face a decreasing prevalence of underweight and an increasing prevalence of overweight. For children aged 0-12 years, mothers/grandmothers hold the primary role in feeding practices. This study specifically aimed to explore mothers'/grandmothers' decision-making around food choices in West Java, Indonesia.

Methods: Twelve focus groups discussions were conducted between June and October 2016. Ninety-four carers of children aged under-five and 7-12 years from three socioeconomic groups participated. Data analysis followed a grounded theory approach.

Results: We developed six main themes: 1) Decisions on food served at home, which were mainly influenced by socioeconomic status and family member requests. 2) Attitudes toward instant noodles consumption. The low and intermediate SES children consumed noodles on a daily basis, even up to five times daily, while the high SES children only consumed noodles as 'emergency' food. 3) Decisions on food/snacks and drinks consumptions. Low and intermediate SES children bought snacks/sugary drinks from street vendors while the high SES children bought them at supermarket. 4) Feelings about food/snacks and drinks choices. All carers shared similar concerns and uneasiness about their children's choices. 5) Consideration of money issues, which were prominent among the low and intermediate SES carers. 6) Consideration of Halal issues, which were only mentioned by high SES carers. Most similarities were found between the low and intermediate SES groups, while most differences arose between these two groups compared to the high SES.

Conclusions: The six interrelated categories affected one another around participants' decision-making around the family's food consumption. Developing countries could improve their multi-sectoral collaboration in ensuring better availability and affordability of healthier food. Education targeted at behavior modification toward healthier lifestyles should be implemented countrywide.