Beyond the Normative Family Meal Promotion: A Narrative Review of Qualitative Results about Ordinary Domestic Commensality

Social Eating Among Child and Adult Hospital Patients: A Scoping Review

Current policy attention to the 'public plate' includes a focus on food in hospitals. Recommendations for much-needed improvements include the provision of opportunities for patients to engage in 'social dining', which has been shown to have a range of benefits for health and well-being. However, there has been no synthesis of the literature on the topic to date. This scoping review sets out to identify and examine different types of evidence on social dining in the hospital context, factors shaping its implementation and impact, and knowledge gaps. Following comprehensive searches of two databases and a thorough screening process, 38 papers were included in the review. The outcomes and impacts of social dining were measured in a variety of ways across the studies. Social dining in hospitals can impact dietary intake and nutritional outcomes and have implications for patient well-being. These effects are moderated by a range of factors, including the age and needs of the patient group, eating environment, and presence of staff and visitors. Future research needs to focus on children and their families, an under-researched patient group that may be especially likely to benefit from the opportunity to eat with others in the hospital.

Impact of a Recipe Kit Scheme (BRITE Box) on Cooking and Food-Related Behaviours of Children and Families: Exploring Parental/Carer Views

BACKGROUND

Dietary intakes in UK children fail to meet national recommendations, especially in low-income groups. Involving children in food preparation and cooking may enhance acceptability of a wider range of foods, enhance their skills and increase their enjoyment of food. An innovative recipe meal kit scheme, Building Resilience in Today's Environment (BRITE) Box, was developed during the pandemic primarily to address food insecurity (FI). Administered via schools, it offers pre-weighed ingredients sufficient for a meal for a family of five, plus a child-focused recipe, weekly during school termtimes.

METHODS

Qualitative and quantitative exploration of BRITE Box using questionnaires and semi-structured interviews among parents/carers of children receiving the boxes was conducted at two timepoints a year apart.

RESULTS

A total of 154 parents/carers completed questionnaires and 29 were interviewed. Responses indicated multiple benefits of the scheme, including increased confidence in cooking among both children and parents/carers. Both questionnaire responses and interviews suggested improvements in a range of food-related behaviours, including cooking and eating together and talking more about food. Parents/carers suggested that their children were more willing to eat vegetables and healthy foods and to try new foods and flavours. They also reported greater use of leftovers thereby potentially reducing food waste. Improved behaviours, willingness to try new foods and flavours, reduced food waste and lower stress of trying to think of new and acceptable family meals are likely to have contributed to the positive impact on their mental health reported by BRITE Box parents/carers.

CONCLUSIONS

Meal kits for children may improve dietary diversity, enhance enjoyment and skills and impact positively on a range of family food-related behaviours. We argue that BRITE Box has the potential for widespread positive impacts on cooking and food-related behaviours in children and families, meriting wider study and dissemination as a positive approach to healthy eating in children.

Comparing eating and mealtime experiences in families of children with autism, attention deficit hyperactivity disorder and dual diagnosis

LAY ABSTRACT

Children with neurodevelopmental conditions like autism and attention deficit hyperactivity disorder may experience eating difficulties and related health issues later in life. Sharing family meals can help prevent these issues developing, but most studies have looked at families with neurotypical children. Our goal was to learn more about how families of children with autism, attention deficit hyperactivity disorder and both conditions (autism + attention deficit hyperactivity disorder) experience mealtimes. We developed an online survey asking caregivers about their child's eating, mealtime experience and if they experienced stress. We tested it with nine caregivers and made improvements based on their feedback before recruiting 351 caregivers to complete the main survey. We found that families of children with neurodevelopmental conditions experienced greater food fussiness, emotional undereating, 'problematic' child mealtime behaviours, dietary concerns, higher stress for caregivers and spouses and less frequent conventionally structured mealtimes compared to those without these conditions. Families of children with attention deficit hyperactivity disorder and autism + attention deficit hyperactivity disorder reported greater appetite, 'problematic' mealtime behaviours and increased stress for caregivers and spouses compared to families of children with autism. Meanwhile, families of children with autism and autism + attention deficit hyperactivity disorder reported less enjoyment of food and less structured mealtimes compared to those with attention deficit hyperactivity disorder. Our findings highlight that families of children with neurodevelopmental conditions, particularly those with autism + attention deficit hyperactivity disorder, have different mealtime experiences and eating behaviours compared to those with neurotypical children. These families may benefit from support at mealtimes. Learning why people do or do not participate in shared family meals will be crucial to developing improved mealtime support in the future.

Unpacking family meals: state-of-the-art review critiquing the Western ideals, positioning and promotion of family meals

Family meals are a familiar concept and are practised in many Western households. While academics have been researching family meals for decades, there is much about the family meal we still do not understand. Meanwhile, the promotion of an 'ideal' of family meals across media, health and social discourse ensues. An extensive pool of research has indicated cross-sectional associations between the frequency of family meals and optimal health outcomes. However, evidence surrounding what specifically it is about the family meal that could offer health benefits is limited. Furthermore, family meals carry a level of moral value, evoking pressure for parents to 'achieve' a family meal ideal, unattainable for many. Family meals research has traditionally focussed on mothers' perceptions and roles in family mealtimes. While literature is starting to emerge on the often-overlooked cognitive contribution required to plan and execute family meals, little structural supports exist to streamline these efforts or make them more achievable for contemporary families. The published literature is only starting to include cultural and demographic diversity, making it difficult to understand and promote realistic and feasible family meals across populations. The popular depiction of family meals needs to evolve alongside changes in social norms. Our call to action to address these issues is to draw on existing family meal practices, continue to diversify our investigations, and broaden our definitions and understandings of what a family meal is or could be, and how it should be measured.

'Eating with Others': planning, developing and optimising a self-management intervention to promote social eating for patients living with and beyond head and neck cancer

INTRODUCTION

After treatment for head and neck cancer (HNC), up to 90% of patients have difficulties eating and drinking. Despite the enormity of challenges explicitly relating to the social dimension of eating, there are limited extant interventions to specifically support social eating, nor any replicable for use in contemporary clinical practice. This study aims to plan, develop and optimise a self-management intervention to promote social eating for patients living with and beyond HNC.

METHODS

This research was intervention development of a self-management 'Eating with Others' resource, guided by the person-based approach (PBA) framework. Initially, a systematic review was conducted, with 24 included studies exploring HNC patients' social eating experiences, followed by thematically analysed qualitative interviews with patients (n = 14), family members (n = 12) and healthcare professionals (n = 13). Alongside this data, iterative input was sought from an advisory group (n = 22) to culminate in an intervention prototype. The intervention prototype was iteratively user-tested over three cycles for usability and acceptability, using think-aloud interviews (n = 10).

RESULTS

A patient-centred, evidence-based and theory-driven self-management resource, entitled 'Eating with Others', was designed to promote social eating for patients with HNC. Sections included the benefits of social eating; the impact of HNC on social eating, strategies and reflective activities to overcome social eating barriers; and the use of a social eating card for restaurants. The think-aloud interviews revealed that the resource was appropriate and acceptable for patients with HNC.

CONCLUSION

The systematic and iterative PBA intervention development framework enabled empirical research findings, relevant theory and extensive advisory group involvement to design an acceptable self-management social eating intervention for patients living with and beyond HNC. Mixed-methods evaluation is required to determine feasibility in clinical practice.

Influence of age and self-stigmatization on social eating and drinking issues in French outpatients living with and beyond head and neck cancer: a mixed-method study

PURPOSE

Social eating (SE) is a corner stone of daily living activities, quality of life (QoL), and aging well. In addition to feeding functional disorders, patients with head and neck cancer (HNC) face individual and social psychological distress. In this aging population, we intended to better assess the influence of age on these challenges, and the role of self-stigmatization limiting SE in patients with and beyond HNC.

METHODS

This was an exploratory multicenter cross-sectional mixed method study. Eligibility criteria were adults diagnosed with various non-metastatic HNC, before, during, or until 5 years after treatment. SE disorders were explored with the Performance Status Scale Public Eating rate (PSS-HN PE). In the quantitative part of the study, SE habits, Functional Assessment of Cancer Therapy Body Image Scale (FACT-MBIS) and specific to HNC (FACT-HN35) were also filled in by the patients. In the qualitative study, the semi-structured interview guide was drawn out to explore stigma, especially different dimensions of self-stigmatization.

RESULTS

A total of 112 patients were included, mean age 64.7 years, 23.2% of female. One-third (n = 35) of patients had an abnormal PSS-HN PE rate < 100. Younger patients had more often an impaired Normalcy of Diet mean (70.4 vs 82.7, p = .0498) and PE rates (76 vs 86.9, p = .0622), but there was no difference between age subgroups in MBIS nor FACT-HN scores. Seventy patients (72.2%) found SE and drinking « important» to « extremely important» in their daily life. The qualitative study reported self-stigmatization in two older patients and strategies they have developed to cope with in their behaviors of SE.

CONCLUSION

This study confirms that SE remains of high concern in patients with and beyond HNC. Even in older patients experiencing less often functional feeding disorders, body image changes and SE issues are as impaired as in younger patients and need to be addressed.

Identifying the barriers and facilitators to fruit and vegetable consumption in rural Australian adults: a mixed methods analysis

BACKGROUND

Low fruit and vegetable consumption is a leading contributor to non-communicable disease risk. However, understanding of barriers and facilitators to fruit and vegetable intake in rural settings is limited. This study used a mixed methods approach to determine the barriers and facilitators to increasing fruit and vegetable intake in rural Australian adults and to identify if these varied by gender.

METHODS

Quantitative and qualitative data were used from the 2019 Active Living Census, completed by adults living in north-west Victoria, Australia. Data were collected on fruit and vegetable intakes and barriers and facilitators to meeting fruit and vegetable recommendations. Multivariate logistic regression analyses were used to investigate the association between facilitators, classified using the socio-ecological framework, and meeting recommendations. Machine learning was used to automate content analysis of open ended information on barriers.

RESULTS

A total of 13,464 adults were included in the quantitative analysis (51% female; mean age 48 [SE 0.17] years) with 48% and 19% of participants consuming the recommended two serves of fruit and five serves of vegetables daily, respectively. Strongest facilitators to fruit consumption were at the individual level: never smoked (OR: 2.12 95% CI: 1.83-2.45) and not drinking alcohol (OR: 1.47 95% CI: 1.31-1.64). Strongest facilitators for vegetable consumption were found at all levels; i.e., individual level: used to smoke (OR: 1.48 95% CI: 1.21-1.80), social-environmental level: living with three or more people (OR: 1.41 95% CI: 1.22-1.63), and physical-environmental level: use community gardens (OR: 1.20 95% CI: 1.07-1.34). Qualitative analyses (fruit n = 5,919; vegetable n = 9,601) showed that barriers to fruit consumption included a preference for other snacks and desire to limit sugar content, whilst lack of time and unachievable guidelines were barriers for vegetables. Barriers and facilitators differed by gender; females experienced barriers due to having a more varied diet while males reported a dislike of the taste.

CONCLUSIONS

Barriers and facilitators to fruit and vegetable consumption among rural Australian adults were identified across all levels of the socio-ecological framework and varied between fruit and vegetables and by gender. Strategies that address individual, social, and physical-level barriers are required to improve consumption.

Individual and family factors correlated with children's fruit consumption

Background

Fruits are essential for health, yet their consumption in children is inadequate, with unclear influencing factors.

Methods

A cross-sectional study was conducted among students in grades 3-12 in Beijing, China, from September 2020 to June 2021. Fruit consumption in children was surveyed using a self-administered food frequency questionnaire. Additionally, children's food and nutrition literacy and family food environments were assessed using the "Food and Nutrition Literacy Questionnaire for Chinese School-age Children" and the "Family Food Environment Questionnaire for Chinese School-age Children," respectively.

Results

Out of 10,000 participating children, 62.5% consumed fruit daily, with a lower frequency among boys (59.3%) compared to girls (65.8%), and among senior students (48.6%) compared to junior (63.6%) and primary students (71.2%). Fruit consumption was positively associated with other healthy foods (vegetables, whole grains, etc.) and negatively with unhealthy foods (sugared soft drinks). Children with higher food and nutrition literacy consumed fruits daily more frequently (82.4% vs. 59.9%, ORs = 2.438, 95%CI: 2.072-2.868). A significant positive correlation was found between children's fruit consumption and a healthy family food environment (66.4% vs. 50.2%, OR = 1.507, 95%CI: 1.363-1.667).

Conclusion

The results indicate that individual food and nutrition literacy and family food environment are key positive predictors of children's fruit consumption. Future interventions should focus on educating children and encouraging parents to foster supportive family environments.

Exploring unequal class logics of mealtime food socialisation. An ethnography of family meals in France and Australia

Regular family mealtimes are occasions to model food consumption and have been associated with health and well-being benefits for children. This study aimed to investigate children's mealtime food socialisation in socially diverse households. Nine families from France and five from Australia were recruited, ranging from lower middle-class to upper-class positions, with children mostly between the ages of five to eight. The data is composed of the observations of 47 mealtimes and semi-directive interviews with both parents. The results showed that food socialisation and parents' understanding of children's taste development were linked to the household's social class position as well as to the temporal, cognitive and emotional resources parents possessed at mealtimes, in a similar manner across France and Australia. The more capital and resources the parents had, the more they were able to perform an intensive food socialisation style, which led them to prepare balanced menus and get children to eat the food served. The less capital and resources the parents had, the more they engaged in a hands-off food socialisation style, leading them to serve more child-oriented and less diverse menus. Importantly, all parents strived to serve healthy food, but limited resources prevented some of them from doing so. These food socialisation styles were also connected to the development of different social skills in children: with the intensive model, children were closely managed by their parents at the table but also learnt negotiation skills, whereas with the hands-off style, children learnt to be quite autonomous in their eating. The findings presented here contribute to Hays' intensive mothering concept and to Lareau's class-based parenting models. They also challenge Bourdieu's differentiation between a taste of necessity and a taste of luxury.

Transmission of food literacy to youth in Norwegian childcare institutions - a qualitative study

Background

Youth in childcare institutions may have lower levels of food literacy compared to other youth. Food literacy, indicating the ability to plan and prepare meals from scratch, is associated with consuming healthier diets.

Objective

The objective of this study was to explore how food literacy is transmitted to youth through involvement and participation in food-related activities in Norwegian childcare institutions.

Design

Data were collected through qualitative semi-structured interviews with 13 staff and 8 adolescents (>16 years of age) selected by convenient sampling in childcare institutions (n = 6) in South-East Norway.

Results

We found that the institutional context provided both opportunities and limitations for transmitting food literacy. The staff tended to prefer a soft approach to transmitting food literacy due to the youth being perceived as vulnerable and a focus on youth autonomy. The youth showed ambivalent interests in participating in food-related activities and wished for their need to decide how much to be involved to be respected. A firm approach was perceived to increase the risk of conflict.

Discussion

Our findings are best interpreted in light of a childcare institution being at the intersect between the homely and public spheres. There was ambivalence among staff between following institutional guidelines and caring for the different needs of residents. Food was often referred to as symbolizing something else in the relationship between staff and youth, such as care, structure, autonomy, and a normal family life.

Conclusion

Initiatives aiming at including food literacy in care relations in childcare institutions are recommended.

Barriers and enablers to the family meal across time; a grounded theory study comparing South Australian parents' perspectives

Family meals are positively associated with numerous beneficial health and social outcomes. Current discourse however claims that parents are faced with numerous barriers when trying to bring the family together to share a meal. Solutions for overcoming barriers to a positive shared family meal are often individualistic and do not address the systemic pressures and burdens families have faced for decades. The aim of this study was to explore the systemic and novel barriers and enablers to shared family meals as experienced by families across time. To achieve this, a qualitative study informed by grounded theory was conducted. Parents of South Australian families were recruited and interviewed in the 1990s, and a new sample of parents were recruited and interviewed in 2020. Transcripts were analysed using grounded theory and comparative analysis methods. Thirty-two parents from 16 families were interviewed in the 1990s, and 22 parents from 10 families in 2020. Ten factors were identified presenting as either enablers or barriers to the family meal, depending on the context they were experienced. Barriers and enablers were largely consistent across time. Scheduling and flexibility, children's disruptions and children's independence, privileges required to have family meals and motivation and commitment to the family meal were identified as persistent enablers and barriers across time. These findings indicate that parents are faced with similar challenges they have been facing for decades and are still not being adequately supported to execute family meals regularly. Recognising that factors present as either barriers or enablers to the family meal provides us with opportunities to transform barriers to enablers and support families to have regular, meaningful family meals.

The family meal, a ritual frozen in time; an Australian grounded theory study

Family meals are recognized as an opportunity to promote the health of families. Popular discourse posits that changes to contemporary family life have made family meals harder to achieve and promotion of the 'traditional' family meal may be adding pressures to contemporary families. While research has been conducted on family meals over the last three decades, there is no explicit investigation of the experiences and practices of family meals over this time. Understanding the evolution of family meal practices across time is important for developing achievable expectations in relation to this ritual. Qualitative interviews were conducted with a diverse population of South Australian parents in the 1990s (n = 32) and with a separate population of parents in 2020 (n = 22) to gather their experiences of family meal practices. A comparative analysis, informed by grounded theory, was undertaken to identify similarities and differences in experiences across these two time periods. The results indicated stability in many family meal experiences across time, particularly in their value and significance in family life. Negotiations balancing time, cost, food preferences and responsibility persisted. The stability of family meal values and practices is important to consider when making recommendations, designing interventions and creating services targeting the family meal.

Situating the Father: Strengthening Interdisciplinary Collaborations between Sociology, History and the Emerging POHaD Paradigm

(1) Background: Albeit the main focus remains largely on mothers, in recent years Developmental Origins of Health and Disease (DOHaD) scientists, including epigeneticists, have started to examine how a father's environment affects disease risk in children and argued that more attention needs to be given to father's health-related behaviors for their influence on offspring at preconception (i.e., sperm health) as well as paternal lifestyle influences over the first 1000 days. This research ushers in a new paternal origins of health and disease (POHaD) paradigm and is considered a welcome equalization to the overemphasis on maternal influences. Epigeneticists are excited by the possibilities of the POHaD paradigm but are also cautious about how to interpret data and avoid biased impression of socio-biological reality. (2) Methods: We review sociological and historical literatures on the intersection of gender, food and diet across different social and historical contexts to enrich our understanding of the father; (3) Results: Sociological and historical research on family food practices and diet show that there are no "fathers" in the abstract or vacuum, but they are differently classed, racialized and exist in socially stratified situations where choices may be constrained or unavailable. This confirms that epigeneticists researching POHaD need to be cautious in interpreting paternal and maternal dietary influences on offspring health; (4) Conclusions: We suggest that interdisciplinary approach to this new paradigm, which draws on sociology, history and public health, can help provide the social and historical context for interpreting and critically understanding paternal lifestyles and influences on offspring health.

Children's experiences of meals after obesity treatment: a qualitative follow-up four years after a randomized controlled trial

Background

The practice of eating together, commensality, is rarely explored in the context of childhood obesity treatment. This is noteworthy given long-standing debates about the physical, psychosocial, and societal benefits of meals, especially family meals. Moreover, as children with obesity experience weight bias and stigma both within and outside the home, it is important to examine meals as a locus of social exchange around food and the body. Our study is based on the premises that eating together (i) matters and (ii) occurs in different environments with diverse social organization, where food-related interactions create varying arrangements of individuals, groups, their statuses, and their actions.

Method

The study explores children’s experiences of meals in different social contexts. Thirty-two children (age 8–10 years) living in Sweden were interviewed, 4 years after they entered an obesity intervention trial. Thematic analysis was applied to the data.

Results

We thematized three meal types, with each meal type having two subthemes: (i) “The family meal”, with “Shared routines, rituals, and rules” and “Individual solutions and choices”; (ii) “The school meal”, with “Rules and norms of the school” and “Strategies of the child”; and (iii) “The friend meal”, with “Handling food that was disliked” and “Enjoyment of food”. These three different meal types carried different experiences of and knowledge about how they were socially organized.

Conclusions

While the children spoke about the family and school meals as meaningful, the friend meal stood out as particularly positive. Contrary to our expectations, the children did not express experiences of weight bias or obesity stigma around meals, nor did they speak negatively about parental control of their food intake. Our findings, especially regarding the friend meal, have implications for further research into commensality and social influences on eating among children with obesity, from early childhood into adolescence.

Family Food Environments and Their Association with Primary and Secondary Students' Food Consumption in Beijing, China: A Cross-Sectional Study

Family is the most fundamental and proximal context for children, and children’s eating behavior occurs mostly in the home or together with family members. With this study, we aimed to evaluate the distribution of family food environment dimensions and their relationship with healthy and unhealthy food consumption in primary and secondary students in order to provide evidence in the Chinese context and explore environmental solutions for improved child nutrition. Multi-stage stratified cluster sampling was used to conduct a cross-sectional survey among students in Beijing, China, from September 2020 to June 2021. Family food environment (FFE) was measured by the validated Family Food Environment Questionnaire for Chinese School-age Children, which was self-administered by the children’s caregivers. The students were asked to answer questions about food consumption frequencies in the past 7 days. Binary logistic regression models were used to investigate the relationships between food consumption frequency and FFE, and odds ratios (ORs) with 95% confidence intervals (CI) were computed for independent variables. Among the study population, 9686 students in grades 3−12 and their caregivers completed the survey. The mean score of FFE was 65.7 (±8.4) out of a total possible score of 100, with 76.6% of students categorized as relatively healthier according to their FFE score (≥ 60). Compared with the reference group, students in primary schools and those cared for principally by parents were more likely to be in a healthy FFE category (p < 0.05). Daily consumption of fruits and vegetables was reported by 62.6% and 71.6% of students, respectively, and weekly sugared soft drink consumption was reported by 70.9% of the students. Students with a healthier FFE score (≥60) were more likely to consume fruits (OR = 1.578, 95% CI: 1.428~1.744) and vegetables (OR = 1.402, 95% CI: 1.263~1.556) but less likely to consume sugared soft drinks (OR = 0.592, 95% CI: 0.526~0.667). Family food availability (β = 0.137), caregivers’ nutritional literacy (β = 0.093), meal practices (β = 0.079) and food rules (β = 0.050) were positively correlated with food consumption behavior (p < 0.05). The students with healthier FFE scores (OR = 1.130, 95% CI: 1.014~1.258) and whose caregiver was obese (OR = 2.278, 95% CI: 1.973~2.631) were more likely to be overweight. The family food environment plays an important role in shaping food consumption in children. Provision of healthy foods instead of unhealthy foods, positive meal practices and food rules, and nutrition education for parents can promote healthy eating in children.

Culinary Solitude in the Diet of People with Functional Diversity

This qualitative ethnographic study identifies how problems in the feeding process of a group of people with functional diversity influence different eating situations. The study, which was carried out in the Autonomous Community of Castilla La Mancha, Spain, is based on interviews conducted at the headquarters of the different participating associations for functionally diverse people, at the participants’ homes, and in public spaces. The study included 27 subjects aged between 18–75 years. Their functional diversity had caused significant changes in their sociability, particularly in contexts associated with food consumption. The analysis identified three main themes: social ghettoisation and culinary loneliness; stigma, shame, feeling like a burden, and loneliness; and exclusion or self-exclusion at the dining table. Our participants’ narratives underscored the importance of acknowledging the significance of changes in eating-related sociability due to functional diversity. For the study subjects, grief, loneliness, and shame contributed to disassociating food consumption from social celebrations, withdrawing from restaurant meals, or conversations while eating to avoid other people’s stares.

What Is Commensality? A Critical Discussion of an Expanding Research Field

Commensality (the act of eating together) is studied in a range of disciplines and often considered important for social communion, order, health and well-being, while simultaneously being understood as in decline (especially the family meal). However, such claims are also contested in various ways. In this paper, we discuss the expanding field of commensality research and critically reflect on the debates surrounding its social functions, including its role in public health. We illuminate the deep social and cultural significance of commensality, through time and space, and conclude that whether or not commensality is the preferred social form of eating for any given individual, it is difficult to escape its sociocultural desirability and idealization. As a cross-cultural phenomenon in both past, present, and future, we suggest that commensality deserves further research. This includes commensality as a research topic in itself and as an entry point to unveil different dimensions of social relations between people, as well as interactions between humans and material objects.