Tronco Hernandez, Yessica Abigail
(2020)
“Where is the fun in eating without fat or salt?” A qualitative study on healthcare students, foodways, and dietary advice in Mexico.
PhD thesis, University of Nottingham.
Abstract
Background: What to eat in order to maintain health is a controversial topic. Influences from our social context and contradictory messages affect society’s views, behaviours, and practices, especially in a time and context where diseases associated with diet are increasingly threatening the quality of life globally. As a result, gaining compliance and achieving health goals in patients is a challenge for future health professionals. Current evidence on food choices is mostly quantitative and has not sufficiently addressed questions of how and why people develop ‘foodways’, and the significance of healthcare students (HS) foodways in practice.
Aims: This research sought to understand the influence that HS foodways have on dietary advice (DA) that is offered in primary care, especially in a country with a unique gastronomic diversity, and high rates of obesity and chronic diseases.
Data collection: As foodways’ influence on dietary advice is an unexplored topic, a qualitative study underpinned by critical realism (CR) was conducted in Mexico. Observation of the food environment was carried on. Food diaries or 24-hour-recalls were collected, and 3 focus group interviews and 21 individual interviews conducted. These were transcribed verbatim, coded and analysed.
Findings: Five main categories emerged from the thematic analysis framed by CR: food culture, gender, a cultural system, professional identity, and power issues. Most of these categories were rooting their grounds in a critical dietetics’ framework. HS described various influences on their foodways, which were mainly structural (from their social and cultural environment) and related to their professional and lay knowledge and the way in which they negotiated their professional identity. Additionally, social representations of foodways and health influence importantly their patients’ compliance with the offered DA. There were gaps in HS’ professional knowledge, and authoritative attitudes highlight moral connotations on patients’ dietary behaviours were shown. The evidence suggested that HS hold stereotyped and biased views on food, obesity, and health, which becomes an important influence in offering DA. HS’ way of addressing diet discourages consumption of Mexican traditional food, regardless of whether they consume this. Additionally, hierarchies between students and professionals, and amongst healthcare professions, influence how DA is offered and affect professionals’ credibility with patients.
Conclusions: New approaches are essential to address the cultural and social aspects of nutrition and diet in healthcare curricula. Health policies should encourage a more compassionate and comprehensive approach to dietary health, which showed an influence by moral, social and cultural aspects within a Mexican environment.
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