ORIGINAL RESEARCH

Process of constructing an album on regional food

Mariana Cavalcante Martins^I; Julliana dos Santos Aires ^II; Lorena Barbosa Ximenes^III; Viviane Martins da Silva^IV; Maria Vera Lúcia Moreira Leitão Cardoso^V

^I PhD in Nursing. Adjunct Professor at the Nursing Department of the Federal University of Ceará. Fortaleza, Ceará, Brazil. E-mail: marianaenfermagem@hotmail.com
^II Master in Nursing. Federal University of Ceará. Fortaleza, Ceará, Brazil. E-mail: jullianaaires@yahoo.com.br
^III PhD in nursing. Professor at the Federal University of Ceará. Fortaleza, Ceará, Brazil. E-mail:lbximenes2005@uol.com.br
^IV PhD in Nursing. Adjunct Professor at the Nursing Department of the Federal University of Ceará. Fortaleza, Ceará, Brazil. E-mail:viviane.silva@ufc.br
^V PhD in Nursing. Full Professor at the Nursing Department of the Federal University of Ceará. Fortaleza, Ceará, Brazil. E-mail: cardoso@ufc.br

DOI: http://dx.doi.org/10.12957/reuerj.2016.12682

ABSTRACT

Objective: to describe the process of assembling a flip-chart album on foods of Brazil's Northeast Region as educational technology. Method: the album, Regional foods promoting food security, was constructed in four stages: interview on diet; photographs of the locality; pilot test; and validation by judges. The study was approved by the research ethics committee (report number 98/09). Results: seven figures and five script forms involving problem situations represented by illustrations. These forms were developed using the literacy-building process described by Paulo Freire, which comprises the following phases: inventory of common vocabulary; selection of related words; creation of existential situations; and development of script forms. Conclusion: use of a flip-chart album is found to become effective to the extent that there are health professionals mediating the discussion and encouraging the consumption of regional foods, so as to contribute to healthy eating habits.

Keywords: Nursing; health promotion; teaching materials; food habits.

INTRODUCTION

Food is considered a key aspect in the health care of children¹. In general, the early eating habits of under-five children are influenced by their caregivers. Therefore, it is important to investigate cultural aspects that may play a predominant role in feeding habits. This is timely because it is at this age that children acquire more knowledge and strengthen habits, values ​​and customs that will contribute to their proper growth².

The consumption of processed foods by Brazilian families has been analyzed in three household surveys and these identified an evident replacement of unprocessed by ultra-processed ​​food in the course of three decades, with increased intake of sugar, saturated fat and sodium³.

On the other hand, it is known that fruits and vegetables are important sources of vitamins, minerals and fibers and are valuable components of a balanced nutritional diet⁴. In this context, regional food (fruits, vegetables, tubers and legumes) stands out, as they are available in every region of Brazil and are products of easy access, low cost and high nutritional value⁵.

A previous survey conducted in the municipality of the present study identified that regional foods have been underutilized by mothers because they are unaware of other forms of preparing them⁶.

It is known that various nutrition education programs have been developed in health units, schools and communities in an attempt to improve the nutrition of children. However, is not yet clear which methods contribute, in fact, to increase or maintain the consumption of fruits and vegetables by children ⁷.

Therefore, the preparation of an album entitled Regional Food promoting Food Security was considered relevant. This technology is intended to encourage parents to use these foods, thereby contributing to the adoption of healthy eating habits. In this perspective, the objective of this study was to describe the process of building an album on the Northeast regional food.

LITERATURE REVIEW

Currently, a nutritional transition process characterized by lower rates of malnutrition and increased prevalence of overweight and obesity has taken place in many countries. In 2010, a population survey conducted in 144 countries, found that 43 million preschool children were overweight and obese, and other 92 million at risk of overweight. Thus, the global prevalence of overweight and obesity increased from 4.2% in 1990 to 6.7% in 2010⁸.

Given these numbers, it is worth noting that children are vulnerable to environmental conditions. Parents or caregivers play a crucial role in shaping the children's eating habits⁹ by providing healthy foods and adopting an adequate eating behavior¹⁰ to serve as a reference for the children.

Another important aspect to be considered in the food context concerns the food security situation of the household, which may influence the choice of types of food. Food security is defined by law as the guarantee of regular and permanent access to high quality food and in sufficient quantity without compromising other basic needs, and respecting cultural adversity and corresponding to environmentally, economically and socially sustainable options¹¹.

From this start point, several strategies have been implemented to promote food education actions that respect regional traditions and the cultural and social context in which individuals are inserted, prioritizing the usual eating habits of each region.

Among these, we can highlight the incentive to consume in natura (or minimally processed) food by making it accessible to the population. In this sense, the realization of group activities as a nutritional intervention strategy aiming at the multiplication of information on healthy eating seems to effectively contribute to positive changes in eating habits¹².

Therefore, educational technologies become facilitating and complementary tools to the liberating educational proposal¹³. Because of this, the preparation of such materials must be grounded in the proposition that individuals become multipliers of knowledge and transformers of their reality.

METHOD

This is a descriptive study about the building process of an album entitled Regional Food promoting Food Security. This technology was developed from the context of the rural area of ​​a municipality of the metropolitan area of ​​Fortaleza, Ceará.

The development of this album took place in four stages. The first stage consisted in a preliminary study carried out in the same municipality through interviews to address the families' eating habits. From these interviews was extracted the vocabulary to be used in the material ⁶. The manual entitled Brazilian Regional Food⁵ and the report The State of Food Insecurity in the World¹⁴ were also consulted to complement the vocabulary. The second stage employed photographs of the local reality to portray the peculiarities of the context in which countryside people live. It was necessary to hire a designer who drew illustrations based on the photographs and on the description of the researcher; eight meetings were needed to accurately portray the reality of the countryside.

Then, the album was prepared with the following structure: each sheet with an illustration that must be exposed to subjects and short script (on the back) which must remain turned to the professional.

These short scripts were prepared according to the purposes of Paulo Freire's Pedagogy of Freedom, to guide the group dialogue and promote the action-reflection-action practice.

This process consists of five phases. First phase: survey of the vocabulary universe; second phase: choice of selected words through previous research in the municipality to unveil perceptions, beliefs, feelings and difficulties; third phase: creation of existential situations based on the pictures taken in the site, which were the basis for problem-situations; fourth phase: preparation of short scripts from the pictures and from the created situations that would serve as a guide to the professional during discussions. The fifth phase, namely, reading the scripts for decomposition of phonemic families corresponding to generator words,¹⁵ was not preformed because it does not fit the object of the present study.

The third phase consisted in a pilot test conducted with fifteen mothers who were awaiting the nursing consultation in a Basic Health Unit (BHU) in the municipality studied. The aim was to improve the album based on the perceptions of these mothers. They evaluated the clarity and intelligibility of the figures, pointing some necessary changes. At the end, changes were made in the illustrations, including food coloring and adaptation of drawings.

Finally, after construction of the album, it was necessary to validate it, featuring the fourth phase. At that phase, a group of twelve judges composed of nine professionals of the Family Health Strategy and three professors of universities evaluated the illustrations and the short script as to the validity of appearance (clarity/intelligibility) and content (relevance). They considered the work fully valid.

In respect to the ethical aspects established by the National Health Council in its Resolution 466/2012,¹⁶ the study was approved by the Research Ethics Committee of the Federal University of Ceará (UFC) under Opinion nº 98/09. Written consent was obtained from all participants.

RESULTS AND DISCUSSION

It is known that the album represents an interesting visual tool that can be used in various situations such as in educational activities¹⁷ respecting the cultural context in which participants live ¹⁸.

In this sense, a study developed with eight nurses who were interviewed about childcare consultation identified that the cultural context is one of the factors that can influence the performance of this consultation ¹⁹. Because of this, professionals must develop their actions in accordance with the reality of the population.

Thus, the present album becomes an important educational tool, as it was grounded in the population context, enabling learning, dialogue, with the essential presence of the professional as mediator of the interactive and effective communication process.

This technology is intended to be used by nurses during childcare consultations and/or educational groups with families of children treated at the BHU. Furthermore, it is emphasized that this tool can be used in other locations in the Northeast and can also be adapted to other regions of the country, depending on the availability of such food.

The album has 40 centimeters in length and 35 cm in height and consists of illustrations, which are exposed to the participants and corresponding short script turned to the professional to guide the discussion and exchange of knowledge. The work has a total of seven illustrations (including the cover) and five short scripts (the cover and the final illustration do not have scripts).

For the construction of this educational technology, we sought to develop simple illustrations reproducing the situation experienced by individuals in a fictional story. It is known that the active participation of all involved is essential to gain knowledge²⁰ and understanding of their cultural identity and social reality.

Initially, the cover of the album was designed aiming to introduce the theme, that is, food, and to promote dialogue between professionals and participants, as shown in Figure 1.

FIGURE 1: Album cover: Regional food promoting food security. Fortaleza, 2010.

In the cover, it was decided to represent a mother (Mary - main character) and her son (Johnny) and a table containing regional food known among the population (pumpkin/squash, pineapple, cashew, jocote, banana, orange). The choice of this initial presentation aims to emphasize that the family (mother, father and/or other caregiver) are primarily responsible for the formation of eating habits of children.

However, it is known that mothers are the ones who usually decide on family eating habits²¹. These habits can even be modified in the course of development, but the impression and the importance of early learning and some acquired social forms have lifelong effects²¹.

Moreover, the cover also has the title, Regional foods promoting food security. The idea is to involve the two main topics selected to be explored during the presentation of illustrations: regional food and food security.

Given the great diversity of Brazilian regional food, the following items were selected to compose the album: cashew, banana, pumpkin/squash and jocote⁵. This choice was based on the greater availability of these items in the region, as reported in previous research⁶.

After this, initial illustrations were developed to introduce two characters, Francisca and Mary.

In the illustration of the short script 1, they appear going shopping in the Zé's bodega ("bodega do Zé", terminology used in the municipality studied that refers to a small trade or grocery store) with the same amount of money, R$ 10.00 (US $ 4.27) each. However, Mary is in the fruit and vegetable section while Francisca chooses industrial products, as shown in Figure 2. It is noteworthy that, in order to contribute to the contrasting situation created, it was decided also to characterize the characters differently.

FIGURE 2: Script 01 (Food and nutrition security), 02 (Food consumed in the day-to-day) e 03 (Hygiene habits) Album cover. Fortaleza, 2010.

Thus, we sought to portray the situation experienced by residents of the municipality, given that the act of buying processed foods in these establishments is commonplace in the region, as they offer more affordable values, are usually close to families' homes and facilitate payment.

By now, it is believed that the illustrations become important when encoded from local situations. With this, they allow the analysis of problems and portray elements that will be decoded by the group, with the assistance of the mediator. The debate centered in the illustrations prompts awareness on the issue addressed¹⁵.

Noteworthy is also that the cash value (R$ 10.00) was based on a previous research⁶ that found that most families has a monthly income of up to one minimum wage, with an average of four residents in each household. Thus, we opted for that amount because, from an informal inquiry, it was found that this is the amount available on average per day to buy food.

In the sequence of the story, in the illustration of the short script 2, the same characters are portrayed after the purchases made in the previous scene, making a comparison of the food bought by them. Then, Mary appears with regional foods (orange, banana, cashews, beans, pineapple and sweet potato) in larger quantities; and Francisca who, with the same amount of money, acquired only processed foods (cookies, soda, instant noodles, industrialized juice and canned food), according to Figure 2.

Thus, the idea of representing two opposing situations, healthy versus unhealthy food, was created to foster dialogue between the mediator and participants. Thus, the corresponding short script to this illustration addresses a critical reflection on situations, emphasizing food security.

It is important, then, building a problem-based education based on the dialogical-dialectical relationship between educators and learners, for the training of critical and participatory subjects. Thus, the relationship becomes horizontal, with the exchange of knowledge and experience and enabling the mutual and continuous learning¹⁵.

The aim is that individuals be able to make distinction, in fact, between the kinds of food acquired by the two women. The first woman bought high nutritional value food and the second, items with high energy content but low nutritional value. Therefore, space to address the importance of healthy eating is open, and to emphasize the definition of the terminology regional food. It is intended also that individuals may be able to reflect on the feasibility of having a healthy diet despite reduced financial resources.

In this sense, it must be noted that, the usual diet of Brazilians nowadays includes foods classified as ultra-processed, with high levels of fat, sodium and sugar, but low levels of micronutrients, and high calorie content. The average consumption of fruits and vegetables is far from the recommendations of the food guide for the Brazilian population²² . Yet in this context, a study conducted in the city of Maranguape-Ceará found that food intake among children less than two years old was of low nutritional content and high cost, with the predominant use of processed foods (instant noodles, soda and industrial juice) to the detriment of regional foods⁶.

In addition, a survey that assessed the most consumed food in Brazil found that the most frequently cited by the population were: rice (84%), coffee (79%), beans (72.8%), salt bread (63%), beef (48.7%), juice/soft drinks (39.8%) and soda (23%); with less mentions of fruit (16%) and vegetables (16%)²³.

These data corroborate the worldwide trend of the pattern of infant feeding, which is characterized by frequent consumption of high-fat foods, refined carbohydrates and sugar, such as soft drinks, biscuits and sweets ²⁴.

In the short script 3, the character Mary is illustrated performing the necessary care with food after purchase; and her son Johnny is sanitizing hands, as shown in Figure 2.

We believe it is important to introduce this short script because it points out the right way to sanitize the food, the time needed to do this, and the way that they must be wrapped and the importance of properly cooking them. The script also focuses on the quality of drinking water (preference for filtered or boiled water) and the importance of hand washing, especially before preparing and consuming food.

Importantly, from that moment on, only the character Mary is featured on the album because she had a positive behavior when buying healthy foods. Furthermore, the sequence of events is important, because as the situations unfold, a story is built.

Then, after Mary goes shopping and buy food (short script 1 and 2) and sanitizes them (short script 3), options to prepare the selected regional foods (cashew, banana, pumpkin/squash and jocote) are presented.

Noteworthy is also that these recipes were not developed by the researcher, but were chosen after extensive survey^{5, 25} and cost/benefits analysis.

In the sequence of the story, the illustration of the short script 4 depicts the character Mary picking cashews directly from cashew tree in the backyard of her own house (common situation in the countryside of the region studied), and then preparing a meal with these fruits, as shown in Figure 3.

FIGURE 3: Script 04 (Regional food, Cashew and banana in the daily eating), 05 (Regional food pumpkin/squash and jocote in the daily eating) e 06 (Regional Food promoting Food Security). Fortaleza, 2010.

Thus, the objective here is to increase the availability of regional food and discuss with the participants the various options to use cashews. Then, based on the answers, the recipe in the short script can be presented, making it a new option for the family.

It is emphasized that the choice of cashew aims to contribute to food security of the population and promote a new way of consuming it, with the transformation of what would be wasted. Cashew has great importance for the economy of the Northeast region, especially the state of Ceará, where cashew nuts are the main exported product. In turn, the use of the peduncle (pulp) is directed to the domestic market only in the production of juices, jams and wines²⁶.

Because of this, we opted for the cashew beef recipe, given that this recipe uses the pulp of the fruit, which is usually wasted. There is also the option of preparing it in the format of cashew-burger; a possible attraction for children.

Complementarily, the script also contains the method of preparation of a recipe using banana, which is consumed in the city mainly in the natural form and in the preparation of milkshakes. The additional option selected for the album was streusel enriched with banana peel ²⁵.

Still in this context, pumpkin (squash) and jocote are also present in the illustration of the short script 5, with more recipe options, as shown in Figure 3.

The consumption of pumpkin in the municipality was mainly related to its use in preparation of beans or meat. Because of this, the optional recipe chosen was the preparation of rice with the small pieces of pumpkin skin; considering that this is a source of protein, iron, calcium, fibers, and ascorbic acid, which have higher concentrations in the skin than in the pulp²⁶.

As for jocote, this is also a fruit is often consumed in natura in the municipality. Thus, the option in the album is the juice of jocote leaves. This juice is little known, but their access to consumption is easy, as the leaves are available at any time of year and are of high nutritional value. According to a study that determined the chemical composition of jocote leaves, it was found that leaves have 2.40 g of lipids and 113.16 Kcal. These values are ​​higher than those of the fruit, which has 0.10g of lipids and 83Kcal²⁷.

It should be noted that these preparation options mentioned highlight the complete use of the food, including parts that are often overlooked (peels, stems, leaves and seeds), in order to take full advantage of nutrients and reduce waste thereof.

It is noteworthy that the recipes suggested in the album are described in each short script, including the ingredients and method of preparation. Health professionals should advise families to use these foods and adapt their preparation according to their preferences (with respect to flavor, cooking point, among others).

Finally, the illustration of the short script 6 shows the family of Mary sitting around the table with all the recipes mentioned (cashew flesh, streusel with banana peel, rice with pumpkin skin and jocote sheet juice). These represent regional food preparations that can be consumed on a daily basis, thereby promoting food safety, as shown in Figure 3.

From this last illustration, the professional has the opportunity to remind the main points (food security, regional food and hygiene) evidenced throughout history, as well as the kinds food addressed and the suggested recipes as a way to verify a possible initial acquisition of knowledge.

CONCLUSION

The development of this album seeks to provide the nurse an instructive educational tool that may facilitate the guidelines provided, as situations were built in the context experienced by rural families. The tool must also be a support to the family so that doubts about healthy eating are clarified.

However, we still need to carry out further studies to develop training to professionals so that they may understand the theoretical framework of problem-based education and use it in their daily practice as a way of learning and exchanging knowledge with family members.

Furthermore, much effort is still needed to print the album and make it available to health units in the countryside, as well as future studies to assess its impact on changing eating habits.

Therefore, it is believed that the use of this technology becomes effective to the extent that health professionals, especially nurses, mediate the discussion with families of preschool children and encourage consumption of regional foods in order to contribute to the healthy eating habits. This, therefore, reinforces the importance of nurses to produce new educational technologies as a way to highlight health education activities aimed at promoting health.

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