Why food stays contaminated: a COM-B framework analysis of child feeding practices in Dhaka’s informal settlements

Abstract

Abstract Background Foodborne diseases are the major public health concerns in low- and middle-income countries, particularly during the complementary feeding period. Children become increasingly exposed to environmental pathogens at this age. Food hygiene during this period is critical to prevent such diseases. This formative study aimed to identify the behavioral determinants of complementary food hygiene practices among caregivers of complimentary aged children using the COM-B (Capability, Opportunity, Motivation Behaviour) framework to develop food hygiene interventions. Methods The study was conducted in the Korail slum, Dhaka, between August 2023 and March 2024. Multiple qualitative methods were employed, including semi-structured household observations (8 h per household, n = 32), semi-structured interviews ( n = 16), and focus group discussions (3 groups, n = 24). Participant selection varied by method, such as observation; households were purposively selected to ensure contextual diversity; interview participants were selected based on observed hygiene practices to explore behavioral drivers; and FGD participants were recruited to capture variation by caregiving experience. Data were analyzed iteratively using thematic analysis guided by the COM-B framework, with triangulation across methods to enhance credibility. Results Findings reveal that five key behaviors food reheating, food and water storage, utensil cleaning, surface cleaning, and hand hygiene are central to reducing microbial contamination and protecting children from enteric infections. Caregivers demonstrated strong psychological capability and reflective motivation, expressing awareness of recommended practices and concern for child health. However, physical opportunity constraints, including irregular fuel access, overcrowded shared kitchens, inadequate storage, distant communal washing areas, and the absence of designated handwashing facilities, consistently limited safe practice. Automatic motivation further shaped behavior, with reliance on visual cleanliness and sensory cues rather than microbial risk influencing routine decisions. Conclusions Food hygiene behaviors in low-resource urban settings are constrained by inadequate technical knowledge, structural barriers, and habitual practices. Interventions should address these limitations by combining enabling environments with behaviorally informed strategies that target routine practices. Integrated approaches are essential to improve complementary food hygiene and reduce child exposure to contamination in informal settlements.