**Background:** Childhood obesity is a growing public health problem globally and in Ecuador, where 35.4% of children and 29.6% of adolescents are overweight or obese. School canteens are recognized as important environments for promoting healthy eating. In 2014, Ecuador issued a regulation to control school canteen operations, focusing on ensuring that food and drinks sold are innocuous and contribute to a varied and healthy diet. However, little is known about how this regulation has been implemented or perceived by key stakeholders. This study aimed to explore perceptions of the challenges and facilities related to compliance with the school canteen regulation among canteen owners, school directors, health experts, and parents in three provinces of southern Ecuador: Azuay, Cañar, and Morona Santiago.
**Methods:** This was a descriptive qualitative study conducted according to established qualitative research methodology and reported following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Semi-structured interviews were conducted via video call on the Zoom platform from April to June 2021, each lasting approximately 45 minutes. Participants included six owners of school canteens, six directors of educational units, five health experts, and seven parents of children aged 6 to 11 years. Participants were recruited from a list provided by the zonal Health Coordination 6. Four people declined participation and 12 did not respond. Interviews focused on challenges and facilities regarding compliance with school canteen regulations and the sale price of products. Verbatim transcription was performed, and thematic analysis was conducted using an inductive coding process with ATLAS.ti software, following the phases described by Braun and Clark. Rigor was supported by detailed description of data collection and investigator triangulation, with two independent researchers reviewing the analysis. The study was approved by the Research Bioethics Committee of the University of Cuenca (number 2020-288EO-MST-EP).
**Key Results:** From the 24 participants (10 males, 14 females), several themes and subthemes emerged. Challenges to compliance included: (1) Expenses generated by school canteen operation—canteen owners reported that healthy foods are not attractive to students, leading to economic losses, and that high-calorie foods are more profitable. (2) Motivation for food consumption at home and school—parents and teachers sometimes send or promote unhealthy foods, and children lack exposure to healthy eating at home. (3) Functions of control committees—health experts reported confusion about institutional roles, inconsistent supervision criteria, and lack of standardized forms; school directors noted that monitoring does not lead to changes and that sanctions are needed. (4) Lack of control of street vendors around schools—all participant groups stated this creates unfair competition and allows children access to unhealthy products. (5) Lack of collaboration from some canteen owners—some only comply during inspections. (6) Marketing and promotion of unhealthy foods—advertising influences children's preferences. (7) Little variety of healthy foods—canteen owners report that healthy options are not well received by students. (8) Children's taste preferences for unhealthy foods. (9) Need for nutrition and gastronomy professionals in schools. (10) Inadequate infrastructure. (11) Control focused on packaged products rather than prepared foods, which may still be high in sugar and fat. (12) Need for sanctions for non-compliance. Facilities for compliance included ease of checking processed product labels and improvements in cleanliness and use of uniforms in canteens. Regarding cost, parents reported that healthy eating is more expensive, while health experts and directors had divided opinions; the state-funded school snack was noted as not being consumed by most children.
**Clinical Implications:** This study reveals that despite a national regulation aimed at promoting healthy eating in schools, multiple barriers prevent effective implementation. These include economic disincentives for canteen owners, inconsistent enforcement, lack of nutritional education, and the powerful influence of marketing and taste preferences on children's food choices. The findings suggest that单纯 restricting unhealthy foods is insufficient; interventions must also focus on making healthy foods appealing, affordable, and culturally appropriate. The authors emphasize the need for multi-level approaches involving schools, families, and the broader community, including training programs, consistent monitoring, sanctions for non-compliance, and the involvement of nutrition professionals. The study is limited by its qualitative design, which does not allow national extrapolation, and by data collection during COVID-19 school closures, which may introduce bias related to internet access and participant comfort with video interviews.