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Introduction
Food is conceived as a topic of international relevance that occupies one of the first lines of development in the academic, research and political spheres. It is linked to a series of stages ranging from cultivation, procurement, food preparation and extends to the nutritional status of individuals1.
The fact that the procurement and utilization of food is related to the cultural, social, economic and family situation is clearly recognized2,3. However, what is found is a robust research trajectory related to the feeding process focused on the nutritional status of people in different age groups and its relationship with other variables4-8. The narrative review on cultural approaches to feeding rural elderly people by Rivero Jiménez et al. and collaborators report that qualitative approaches that include subjective worlds of experiences are scarce and require investigation2.
The political importance related to the nutrition process in Colombia is made explicit in the National Plan for Food and Nutritional Security, which includes all the components of the agrifood chain that have to do with availability, access, consumption, biological use and the quality and safety of food required1.
On the other hand, there is a conviction that rural areas and their population play a key role in achieving the sustainable development goals, since rural territories usually occupy more than 90% of the surface area of countries. Precisely for this reason they are themselves a response to different factors, whether in terms of food, energy generation, environment, biodiversity and existing lifestyles9,10.
Farmers are recognized for being a group with particular characteristics, including their relationship with agricultural and animal production, which is conceived as part of their values11, also for living in isolation, having various difficulties of access, diverse socioeconomic conditions and specific epidemiological profiles9,11-14. Some of them are even recognized for their knowledge and healing practices15.
The aforementioned characteristics highlight the importance of focusing on peasants, whether at the individual, family and/or community level, and, in projection, trying to give value to their popular knowledge, including the symbolism of their food16.
According to Ropero Beltrán, at least a quarter of Colombia's population is rural, and this is the main setting for the dynamics of the internal armed conflict, a factor related to poverty in the countryside, population displacement, dispossession and, in general, conflicts over land use and tenure12, which is why they are considered a vulnerable population group.
Research processes related to the nutrition of peasant families have not been exempt from the emphasis developed with other cultural and age groups. Thus, there is a predominance of research focused on determining the nutritional status, especially of children and young people in rural areas, and its relationship with other variables6,8,17,20. This demonstrates the importance of obtaining other qualitative research findings that allow understanding the dynamics related to the feeding process. Therefore, the following research objective is proposed: To interpret the perceptions related to nutrition in peasant families of a municipality in the rural area of the department of Caldas (Colombia).
Methodology
An interpretative ethnographic research21 was conducted with families in the rural area of the municipality of Villamaría, Caldas (Colombia). The sampling was intentional22. The introduction to the field was a lengthy process based on the inclusion of the researchers as part of the family visits conducted by the Primary Social Care team of the municipality, which allowed the achievement and maintenance of trust and acceptance by the participating families23.
The study was carried out with seven families in five villages. The families were chosen according to the inclusion criteria proposed in the study: Informant of legal age, living in the village for more than two years and presenting a high risk score in the Observatorio Social de Caldas (Social Observatory of Caldas). The Observatorio Social de Caldas is a web application where family profiles, completed as part of the primary social care strategy, are recorded and analyzed. In this application, health information and social determinants of the population are centralized to measure tracer indicators, as well as morbidity and mortality, and generate knowledge for decision makers24. Family risk was classified according to the score obtained in the family record as follows: low < 7.08, medium < 10.11 and high > 10.1124. In addition, families were included, with population evidence of economic, educational, and access to health restrictions.
The information was obtained through participant observation in 29 family visits, executed between September 2017 and November 2018, a photo-ethnographic record was taken and from each visit the respective field diaries were captured25. Ethnographic interviews were also conducted, transcribed verbatim, in order to delve in depth into the daily chores of the families.
The analysis of the field diaries, of the transcribed ethnographic interviews and the selected photographs, was carried out constantly since entering the field and in spiral, as proposed by Leininger26. The "emic" and "etic" perspectives were taken into account and the Atlas ti version 8.3.1 program licensed by the Universidad de Caldas was used.
The validity and reliability of the study was demonstrated by keeping in mind the six criteria set by Leininger: credibility, confirmability, meaning in context, recurrent patterns, data saturation and transferability26.
Results
In the analysis of the information related to the food consumption of peasant families, the category "With food we take care of ourselves, we nourish ourselves, we unite" emerged. This category is supported by three subcategories: Food is very important because it nourishes us, we also take care of ourselves with food, food gives us joy and unites us. These subcategories are explained in more detail below.
When analyzing the issue of food consumption in peasant families, the existence of a daily practice related to three dimensions is identified and interpreted: The consumption of food for the purpose of nourishing the body, the consumption or abstention from certain foods to avoid the onset or complications of the disease, and the consumption of food as a symbol of affection.
Food is very important because it nourishes us
Nutrition, or in the words of peasant families, "food", is a factor that is at the top of their list of basic needs to be covered.
The procurement and preparation are divided by gender in a marked way, thus, men are in charge of providing the money for the procurement of what cannot be acquired by cultivation or in home animal production, and women are in charge of the preparation of such food for the whole family.
"Mrs. Sorany says that she gets up at 4:45 to make and pack breakfast and lunch for her husband, generally, breakfast is arepa, egg, and lunch sometimes is beans, pasta, rice and a large quantity of a beverage like lemonade, because it gets very hot in the cultivation working under the plastic". P6: 6.24"
Source: personal archive of the authors.
Figure 1 A family's encounter with the Primary Health Care team.
Food preparation carries several connotations, including timeliness, i.e., adhering to established schedules, flavor is another important element as well as the nutritional contribution. In terms of nutritional intake, although the consumption of flour is high, mothers are aware of the benefits of certain foods. This situation that prompts them to include, in a disguised way, nutritious foods even if they may be rejected due to taste. Thus, they prepare juices, cakes, desserts, etc. with fruits or vegetables to ensure a minimum intake of nutrients.
"She told us that she makes soy milk and always has it at home to drink, she told us that when she used to cook with firewood 8 years ago she also made soy cakes and that, although her son doesn t like it, she manages to give it to him mixed with some juices." P10:26.35
We also take care of our nutrition
For peasant families, healthy and balanced nutrition is a determining factor to maintain health, it is a knowledge that is obtained and emphasized by health professionals, and as a popular and daily knowledge.
"We asked them: apart from food what else do they do to take care of themselves, and curiously all they are concerned about is food". P10:26.35
However, for these families, knowledge is not enough to make the decision to eat healthily, because several factors, including cultural and economic factors, interfere in obtaining an adequate source of protein, vegetables and fruits, despite living in rural areas where some of these can be grown.
"Mrs Marleny told us that they do eat vegetables in their salads but they do not eat fruits, I asked her the reason why they do not do it and she said it was because of economic reasons". P10:26.35
The control of salt and sugar consumption is also an important element that emerges as health care. For peasant families, the reduction of salt, sugar and fats in meals are activities that they try to carry out frequently in order to stay healthy or avoid illness.
"She says that she eats a lot of cucumber and cabbage; she also tries to prepare salad for her family but lately, with Mr Augusto 's diagnosis of hypertension, she has decreased and sometimes suspended salt consumption at home". P2:17. 35
Food brings us joy and unites us
In addition to considering the act of eating as a physiological need, eating fulfills an emotional function and strengthens relationships in peasant families. Lack of access to food, apart from being concerning due to the decrease in nutrients, also induces feelings of sadness.
"No for God's sake! if one day I have no breakfast, what a sadness my god (laughter in conversation)". Q 41:6.9
For peasant families, food also represents a unifying factor, an act of appreciation for acquaintances and love for relatives and friends. In various ways according to the possibilities, food is present in the meetings of couples or groups that these people usually have.
For peasant families, offering, giving or donating food, especially in the warmth of their homes, has several meanings. This act is a way of welcoming, thanking and "attending" the newcomer to the house.
Despite the fact that peasant families live in a limited way in several aspects of daily life, they do not skimp on sharing the food they have with whoever needs it or those they want to serve or thank. In particular, the prepared food is offered without reserve, in large portions and loaded with love and gratitude.
Mothers may show their affection or anger through the action or omission of preparing food. They strive to show their love by preparing delicious meals which are well seasoned and well prepared. On the contrary, when these women are angry or sad, they think of punishing their family members by omitting to prepare food.
"Particularly Mrs Marleny said "a good afternoon snack is very important for us", she even laughed and told us that when she was angry she told them that she was not going to give any snack but that hunger made her get up to cook it and her family took advantage of that moment to eat as well". P10:21.32
Discussion
At the international level, the rural population has been no stranger to the quantitative assessment of nutritional status. Research studies related to the topic of nutrition in this cultural group have focused on quantifying one or more variables and relating them to nutritional status6-8,17-20. A different and complementary paradigm to the one developed in this study, which managed to understand the meanings of the nutrition process in peasant families. The above is explained because, as other authors have indicated, feeding is not a static or isolated phenomenon27.
From a qualitative point of view, it is recognized that the nutrition process is an inherent element of the human being, which materializes as a result of several socio-cultural factors2,28. In the case of peasant families it is related to the nutritional status, the disease process and affective relationships.
The results obtained enable the identification and comparison of several aspects of the nutrition process in different cultural groups. One of them is the gender division in involved in acquiring and preparing, similar to what was reported in the review of cultural approaches in the nutrition of older people, where strong gender roles were identified with respect to the preparation and choice of foodstuffs2.
The results obtained here also made it possible to recognize the rejection that children, in particular, have of some foods that mothers consider important, either because of their nutritional value, as in the present study, or because of their cultural value, as reported by Calderón et al.28. In relation to this, within the justification of the food project called ""Familias + Activas" (more active families), the rejection of some children towards some vegetables associated with the cultural modeling obtained from their parents is recognized29.
On the other hand, there is robust quantitative scientific evidence that shows the importance of the nutritional status of people in different age groups, in certain situations and its relationship with other variables4,5,7,8. The existence of a current study that determines the nutritional status of the rural population in Spain in the last century18, demonstrates the importance of the longitudinal order that prevails on this subject.
This study is consistent with the importance of the nutritional contribution provided by food for peasant families. Additionally, its importance is a key component for the procurement and preparation of the same.
Furthermore, the correlation between health and nutritional status that emerges in the present study, more specifically the one related to decreasing or increasing the consumption of certain foods to maintain physical health and reduce disease or its consequences, has also been reported in the study developed by Calderón et al. with the Nasa indigenous community. However, for this indigenous group, in addition to the fact that food produces a decrease in illness, it is also related to the pursuit of longevity and spiritual well-being28, a situation that was not identified with the peasant families.
Source: personal archive of the authors.
Figure 2 Meal offered by families to the Primary Health Care team.
Thus, in accordance with what was proposed by Rupflin, 1995, to know the meaning or meanings that a symbol has in a certain situation, requires familiarity with the symbolic system to which it belongs and the worldview of the society or individuals who create it. Equally important is comprehending the intended audience and the individuals who interpret it.30.
The relational or emotional element concerning food preparation and consumption established here is not directly evident in the literature. The study with the Nasa indigenous community demonstrates a holistic character of the nutrition process; it differs in that, while for the peasant families the prepared food unites them as a family group, for the Nasa indigenous community their food autonomy unites them as a community28.
Subtly, one of the educational components of the "Familias + Activas" project consists of learning to eat as a family by recognizing the direct influence that parents have on their children's nutrition29. Thus, this program infers an evident relationship between the family and the lifestyles of the children, a situation that is similar to the factor of family relationships, but not of emotions, as is the case with the results found here.
Additionally, in relation to the third subcategory, the findings align with perspectives coming from studies on the anthropology of food. These studies do not view food as an isolated phenomenon such as an inanimate object but rather emphasize its role within individual and collective dynamics27,30. Furthermore, they correspond with approaches referring to the fact that food has been mainly and traditionally constructed as a structural paradigm, where the analysis is located in the symbolic field27.
"Food unites us" is directly related to what Aguilar Piña stated, when he expressed that social forces are expressed in food, such as the processes of creation and recreation of personal or social relationships27.
With the completion of this qualitative study, where several subcategories emerge around food from different perspectives (nutritional status, illness and expression of affection), coherence is observed with Aguilar Piña's proposition. He suggested that comprehending the phenomenon of human feeding is challenging, since the number of measurable and non-measurable variables on which it depends makes the task complicated27.
In conclusion, the analysis of the results allows us to conclude that for peasant families the food process is related to the procurement, preparation and various implicit and heterogeneous meanings of consuming food. Specifically, the act of eating is related to nutritional intake, the prevention of disease or its complications, and the act of preparing and sharing food as a sign of affection.
In the nutrition process, taste emerges as a determining factor, especially with children, an element that should be considered as a component of the care, attention and education provided to peasant families.
The taste of food drives the recognition of a series of cultural elements that must be listened to and negotiated. This pursuit aims to shift from an unidirectional paradigm centered solely on the benefits of food to a bidirectional paradigm where the voice and tastes of people are considered.
The results allow us to determine the importance of understanding and directing health care and attention related to the nutrition of peasant families to various cultural aspects and not only to nutritional aspects. For the specific case, the results motivate health professionals to make incursions into emotional, cultural, lifestyle aspects and beliefs without forgetting nutrition to address food issues.
This study motivates curricular changes in health programs, as it demonstrates the urgent need to complement the dominant hegemonic medical model focused on physiological risk factors and disease with one that transcends the social and cultural element of the individuals and families served.
