Small fish are an important part of the diet in Ghana, but malnutrition rates remain high. The nutritional quality of fish consumed in Ghana may be affected by food processing and cooking practices, but the extent to which these processes are practiced among poor Ghanaian households along the coastal belt is unknown. This study explored how poor Ghanaian households process, prepare, and cook meals containing small fish. This exploratory qualitative study used Attride-Stirling thematic network analysis. Respondents were purposively sampled from fishing communities in the coastal regions of Ghana. One-on-one interviews were performed by trained field assistants, audio recorded and videotaped, and transcribed for further data analysis. The most common small fish species identified were anchovies and herrings. Anchovies were fried and eaten whole. Herrings were eaten either smoked or fresh; for fresh herring, the head, fins, and viscera were removed before boiling. Herrings were smoked with the head and viscera; however, both the head and viscera were removed before being added to boiling soup and were not consumed. Anchovies were fried for 10 min, and herrings were boiled for 15–30 min. Processing methods and further meal preparation depend on the small fish species. Nutrient composition and contribution of small fish depend on the processing method, preparation method, and what tissues are eaten. Thus, these results will be of importance for sampling schemes for food composition tables and for the calculation of nutrient intake from small fish.