Mothers’ Perceptions About Cooking at Home: A Qualitative Systematic Review Protocol

Abstract

Background: Cooking at home has been associated with better diet quality and, consequently, promoted by nutrition guidelines as necessary to avoid or reduce ultra-processed food consumption. Mothers are the main agents of culinary socialization, and the main cooks in the context of the home environment. Therefore, to effectively put dietary guidelines into practice it is desirable that public policies be informed by mothers’ perceptions about home cooking. The aim of this systematic review is to gather evidence on mothers’ perceptions about cooking-related matters at home. Methods: Qualitative studies or qualitative data from mixed methods studies which investigated mothers’ perceptions about cooking at home will be included in this review. Databases to be searched for published studies include SCOPUS, Web of Science, PubMed, PsycINFO and SciELO. The search for unpublished studies (grey literature) will include Google Scholar, ProQuest Dissertations and Theses Global, as well as Brazilian Theses and Dissertations catalog, with no date or language restrictions. Titles and abstracts will be screened. The full texts of selected studies will be assessed in detail, and findings and illustrations will be extracted and aggregated. Any disagreements between the two independent reviewers that arise at each stage will be resolved through discussion, or by a third reviewer. Systematic review registration: Submitted to PROSPERO for systematic review registration: CRD42023456505.

Background

High consumption of ultra-processed foods is a reality in several countries, such as Australia, Belgium, Brazil, Chile, Colombia, the United States of America (USA), Italy, Mexico, and the United Kingdom (UK). Contribution of ultra-processed foods to the daily caloric intake in these countries exceeds 15%. Regarding adolescents, this percentage increases to over 20%, reaching up to more than 60% in countries like the USA and the UK (IBGE, 2020; Neri et al., 2022b; Rauber et al., 2022; Ruggiero et al., 2021; Vandevijvere et al., 2019; Wang et al., 2021). The high consumption of ultra-processed foods during adolescence is associated with negative health outcomes, such as total overweight/obesity, abdominal and visceral obesity (De Amicis et al., 2022; Neri et al., 2022a, 2022b), high blood pressure (Zhang et al., 2021), negative changes in lipid parameters (Beserra et al., 2020; Lima et al., 2020), decreased muscle mass (Viola et al., 2020), cardiometabolic risks, asthma (Elizabeth et al., 2020), wheezing, and metabolic syndrome (Lane et al., 2021). Further studies are required to define long-term associations more clearly in children and adolescents (Lane et al., 2021), but negative outcomes associated with this consumption are already well established in the adult population (Elizabeth et al., 2020; Lane et al., 2021).

Considering this scenario, actions are needed to promote the consumption of unprocessed and minimally processed foods, as well as homemade culinary preparations made with these. Dietary Guidelines from Brazil (BRASIL, 2014), Canada (Health Canada, 2019), Uruguay (Uruguay, 2016), Peru (Serrano & Curi, 2019), and Ecuador (Ecuador, 2020) recommend and encourage home cooking to promote healthy eating and improve the current dietary pattern. Cooking and consuming homemade meals have been associated with a lower risk of developing Non-Communicable Chronic Diseases (NCDs) and with a lower BMI (Body Mass Index) (Hanson et al., 2019; Méjean et al., 2018; Mills et al., 2017a; Tani et al., 2020; van der Horst et al., 2011; Zong et al., 2016). These outcomes are likely related to one’s diet quality, such as higher intake of important nutrients (fiber, iron, calcium, folic acid, vitamin C, and vitamin D) (Berge et al., 2016; Mills et al., 2017a), higher consumption of whole grains, fruits, vegetables (de Jong et al., 2015; Fertig et al., 2019; Méjean et al., 2018; Zong et al., 2016), and lower consumption of ultra-processed foods (Méjean et al., 2018; Zong et al., 2016), in addition to psychosocial benefits (Berge et al., 2016; Garcia et al., 2018; Rees et al., 2022).

Concomitantly, in recent decades a culinary transition has taken place, characterized by a reduction in the time individuals dedicate to cooking, as part of an adaption to new financial, career, family, and meal consumption demands (Caraher & Lang, 1999; Diez-Garcia & Castro, 2011; Lang & Caraher, 2001). Lack of time and skills are the main barriers identified by individuals to adopt cooking as a routine (BRASIL, 2014; McCloat et al., 2017; Namin et al., 2020). Time and cooking skills also intersect, as better skills can reduce the time spent in meal preparation and cooking (BRASIL, 2014). The development of cooking skills requires that individuals experience a culinary socialization process, through which they learn culinary patterns from various agents (individuals, groups, and institutions) for proper functioning within their social group (Kushkova, 2011). In culinary socialization, distinct agents assume varying roles over time; however, mothers are still considered the main agents of culinary socialization (Banna et al., 2016; Bowen & Devine, 2011; Mazzonetto et al., 2020; Martin Romero & Francis, 2020; Smith et al., 2016; Wolfson et al., 2017).

Mothers are defined as women who have had at least one child, or as those who raise or educate a child or adolescent with whom they establish maternal bonds (Michaelis, 2020). Women have been considered the main sources of culinary learning in the family (Mills et al., 2017b) and, although to a lesser extent than in past decades, still play a central role in domestic activities - this is related to the culture in which they are embedded (Bowen & Devine, 2011; Mazzonetto et al., 2020; Martin Romero & Francis, 2020; Smith et al., 2016). Culinary knowledge is transmitted by mothers, grandmothers, and aunts because they are primarily responsible for preparing family meals, which provides a more regular observation of their behaviours and attitudes (Engler-Stringer, 2010; Smith et al., 2016). The transmission of culinary knowledge between mothers and children can occur through observation (Martin Romero & Francis, 2020) and by receiving meal preparation tasks (Banna et al., 2016; Mazzonetto et al., 2020; Smith et al., 2016). Mothers also teach techniques when providing recipes to their children (Wolfson et al., 2017) or even general guidance without precise measurements since they often tend to not use measuring utensils or follow recipes (Smith et al., 2016). As daughters, women describe learning culinary practices by observing, cooking together, receiving instructions, and eating their mothers’ food (Mazzonetto et al., 2020). In addition to culinary knowledge, mothers are also responsible for intergenerationally transmitting responsibility for cooking, attitudes, and feelings related to this aspect (Mazzonetto et al., 2020). Furthermore, individuals who primarily learned to cook from their mothers appear to have a higher consumption of fresh foods compared to those who learned to cook from other agents (Lavelle et al., 2016).

In recent years, a devaluation of cooking skills has been observed in the domestic environment, and many mothers no longer have sufficient capacity to teach their children to cook (Lai-Yeung, 2015; Lavelle et al., 2016). In fact, young people report they did not learn to cook at home because they shared little time preparing meals with their parents (Lai, 2007). Thus, we argue that there is a need to understand and to frame the perceptions of mothers about cooking at home and, based on their experiences, inform public policies that promote the transmission of culinary knowledge in the home environment. In this regard, qualitative studies are ideal for exploring how certain processes occur and providing an understanding of the phenomenon through the lens of those who have directly experienced it (Yin, 2011).

A preliminary search of existing qualitative systematic reviews regarding mothers’ perceptions of cooking in the domestic environment was conducted on PROSPERO, JBI Evidence Synthesis, Scopus, PubMed, and Web of Science, and no review with a similar theme was identified. Our review question is: What are the perceptions of mothers about cooking at home? This systematic review aims to gather evidence on mothers’ perceptions about cooking-related matters at home and therefore help inform the development of public policies focused on the transmission of culinary knowledge in the home environment.

Methods

The proposed systematic review will be conducted in accordance with JBI methodology for systematic reviews of qualitative evidence (Lockwood et al., 2015, 2020). This protocol has been registered in PROSPERO (CRD42023456505) and is being reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement (Moher et al., 2015).

Inclusion Criteria

Participants

The population of interest in this review are adult mothers with at least one child (at any age), biological or adoptive, regardless of their cultural background, residential/citizenship status, or language spoken. Studies with adolescent mothers will be included, provided that at least 50% of the sample is composed of adult mothers (over 18 years of age); also will be included studies with parents, provided that at least 50% of the sample is composed of mothers; studies with women, as long as it identifies that at least 50% of the sample were mothers; and studies with pregnant women, provided that as least 50% of the sample already has at least one child. Studies conducted specifically with adolescent mothers (under 18 years old) will not be included.

Phenomenon of Interest

This review will consider studies that explore the perceptions of mothers about their experiences, feelings and practices related to cooking and other issues pertinent to the theme. “Cooking is a complex activity that can involve various stages, and this complexity is reflected in its definition, so there is no consensus in the scientific literature” (McGowan et al., 2017). In this present review, ‘cooking’ encompasses all practical activities associated with the act, such as cutting and frying, as well as activities related to one’s own theoretical knowledge, such as the ability to organize and prepare a meal and use available ingredients (Short, 2003).

Studies that address the theme of cooking as a secondary aim, without presenting relevant results on the phenomenon of interest will not be considered. Neither will be considered studies that address cooking focusing only on ‘Good Practices in Food Handling’.

Context

This review will consider studies if they include the perceptions of the population of interest in the domestic environment. Studies addressing the theme of cooking in other environments, such as school and work, will not be included.

Types of Studies

This review will consider all qualitative studies regardless of methodology (e.g. phenomenology, grounded theory, or action research). It will also include qualitative descriptive studies employing any qualitative method, including interviews, focus groups, as well as qualitative data reported within mixed method study designs, such as the findings of open-ended responses to surveys. Only studies available in English, Spanish and Portuguese will be included. Studies for which ethical requirements are not clearly described will also not be included.

Search Strategy

The search strategy will seek to find published and unpublished studies. A preliminary limited search of PubMed, SCOPUS and Web of Science was undertaken to identify published articles on the subject matter. Words from the titles and abstracts of relevant papers, as well as index terms used to describe them were used to develop a full search strategy for each information source. Search strategies consist of two sets of words and terms, one related to the population and the other to the phenomenon of interest. The preliminary search revealed that using a set of words and terms related to the context limited the number of retrieved documents and therefore this third set was not included. Furthermore, certain terms related to the phenomenon of interest already encompassed words related to the context, for example, “home meal”. An example of a search strategy for PubMed is: ((“Parents” [Mesh] OR “Parents” OR “Mothers” OR “Mothers” OR “mother” OR “mum” OR “mom” OR “guardian”) AND (“Cooking” [Mesh] OR “Cooking” OR “culinary” OR “cookery” OR “food skills” OR “home food” OR “domestic food” OR “homemade food” OR “homemade meal” OR “home meal” OR “home-prepared meal” OR “meal produced at home” OR “meal prepared at home” OR “food preparation” OR “kitchen practice” OR “family meal” OR “family dinner” OR “meal practice” OR “meal routine”)). The reference list of all studies selected for critical appraisal will be screened for additional studies. The following databases will be searched: SCOPUS, Web of Science, PubMed, PsycINFO and SciELO. The search for unpublished studies (grey literature) will include Google Scholar, ProQuest Dissertations and Theses Global, as well as Brazilian Theses and Dissertations Catalog. The search will not limit date and language.

Study Selection

Following the search, all identified citations will be uploaded into Rayyan QCRI - web and mobile app for systematic reviews (Ouzzani et al., 2016) and duplicates will be removed. Titles and abstracts will then be screened based on the inclusion criteria by two independent reviewers, blinded to each other’s screening (First and Last Author). Articles identified as potentially suitable will be retrieved in full and their citation details imported into the reference manager Zotero. A full-text review of the identified articles will be done by two independent reviewers (First and Last Author) to assess in detail if each study meets the inclusion criteria. Reasons for exclusion of full text studies will be recorded and reported in the systematic review. In the event of disagreement over the inclusion of an article not solved with a discussion between the two reviewers, a third reviewer (Second Author) will be consulted. The results of the search will be reported in full in the final systematic review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram (Liberati et al., 2009).

Assessment of Methodological Quality

All qualitative studies eligible for inclusion in the review will be critically assessed for methodological quality using the standard JBI critical appraisal instrument for qualitative research (Lockwood et al., 2015). Two independent reviewers (First and Second Author) will conduct the critical appraisal of each selected paper. Reviewers will be blinded to each other’s assessment and assessments can only be compared after the initial appraisal of an article has been completed by both reviewers. Whenever there is a lack of consensus, discussion among reviewers will ensue. If necessary, a third reviewer (Last Author) will be consulted to reach consensus on the article’s evaluation. More details regarding the appraisal questions is available at the JBI Manual for Evidence Synthesis (Lockwood et al., 2020).

Studies will be excluded in case of: not presenting a representation of the participants and their voices (e.g. direct quotes) (not matching criterion number 8); or not describing ethical considerations (not matching criterion number 9) of the standard JBI critical appraisal instrument for qualitative research (Lockwood et al., 2015, 2020). Results of the critical appraisal will be reported in narrative form and in a table.

Data Extraction

The general details of studies will be extracted first and will include specific details about the population, context, culture, geographical location, study methods and the phenomena of interest relevant to the review question. Qualitative data will be extracted from papers included in the review by two independent reviewers (First and Second Author), using the JBI Qualitative data extraction tool (Lockwood et al., 2015, 2020) in the original language. Findings and their illustrations will be extracted and assigned a level of credibility, as follows (Lockwood et al., 2015, 2020):

1. Unequivocal (findings accompanied by an illustration i.e. beyond reasonable doubt and therefore not open to challenge);

2. Credible (findings accompanied by an illustration lacking clear association with it and therefore open to challenge);

3. Unsupported (findings are not supported by the data).

Data Synthesis

Qualitative research findings will be pooled using QDA Miner Lite with a meta-aggregation approach. Data synthesis will involve the aggregation of findings to generate a set of statements which represent that aggregation, through assembling the findings and categorizing these findings based on similarity in meaning. These categories will be then subjected to a synthesis to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Only unequivocal and credible findings will be included in the aggregation (Lockwood et al., 2015, 2020). At this stage, the unequivocal and credible findings used to illustrate the synthesis will be translated into English, when necessary.

Assessing Confidence in the Findings

The final synthesized findings will be graded according to the ConQual approach (Munn et al., 2014) for establishing confidence in the output of qualitative research synthesis and presented in a ‘Summary of Findings’ table. This table will include the title, population, phenomena of interest, and context for the specific review. Each synthesized finding from the review will then be presented, along with the type of research informing it, score for dependability and credibility, and the overall ConQual score.