Abstracts

Introduction

Healthy cooking - which consists of preparing meals using mostly unprocessed or minimally processed foods and culinary ingredients, such as salt, sugar, oils, and fats ¹1. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Guia alimentar para a população brasileira. 2nd Ed. Brasília: Ministério da Saúde; 2014.^,22. Louzada M, Canella D, Jaime P, Monteiro C. Alimentação e saúde: a fundamentação científica do guia alimentar para a população brasileira. São Paulo: Faculdade de Saúde Pública, Universidade de São Paulo; 2019. - has been increasingly gaining ground within the guidelines for healthy eating habits. Recent studies have related home cooking to a better diet quality ³3. Engler-stringer R. Food, cooking skills, and health: a literature review. Can J Diet Pract Res Fall 2010; 71:141-5.^,44. Brunner T, van der Horst K, Siegrist M. Convenience food products. Drivers for consumption. Appetite 2010; 55:498-506.^,55. Hartmann C, Dohle S, Siegrist M. Importance of cooking skills for balanced food choices. Appetite 2013; 65:125-31.^,66. Lavelle F, McGowan L, Spence M, Caraher M, Raats MM, Hollywood L, et al. Barriers and facilitators to cooking from 'scratch' using basic or raw ingredients: a qualitative interview study. Appetite 2016; 107:383-91.^,77. Martins C, Machado P, Louzada M, Levy RB, Monteiro CA. Parents' cooking skills confidence reduce children's consumption of ultra-processed foods. Appetite 2020; 144:104452.^,88. Monteiro C, Cannon G, Lawrence M, Costa Louzada ML, Pereira Machado P. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome: Food and Agriculture Organization of the United Nations; 2019.^,99. Wolfson J, Leung C, Richardson C. More frequent cooking at home is associated with higher Healthy Eating Index-2015 score. Public Health Nutr 2020; 23:2384-94. and lower consumption of ultra-processed foods ⁷7. Martins C, Machado P, Louzada M, Levy RB, Monteiro CA. Parents' cooking skills confidence reduce children's consumption of ultra-processed foods. Appetite 2020; 144:104452., which are widely associated with the prevalence of overweight and obesity, diabetes, and hypertension, as well as with the risk of cancer ⁸8. Monteiro C, Cannon G, Lawrence M, Costa Louzada ML, Pereira Machado P. Ultra-processed foods, diet quality, and health using the NOVA classification system. Rome: Food and Agriculture Organization of the United Nations; 2019..

Despite its known strategic role in health promotion, home cooking is a complex practice, since “cooking is not merely a matter of mechanical skill” ¹⁰10. Trubek A, Carabello M, Morgan C, Lahne J. Empowered to cook: the crucial role of "food agency" in making meals. Appetite 2017; 116:297-305. (p. 297). In a systematic review of 38 articles on health and social determinants and outcomes of home cooking, Mills et al. ¹¹11. Mills S, White M, Brown H, Wrieden W, Kwasnicka D, Halligan J, et al. Health and social determinants and outcomes of home cooking: a systematic review of observational studies. Appetite 2017; 111:116-34. found that gender, available time, employment, family support network, culture, and ethnicity are key determinants of cooking practice. The putative outcomes analyzed were mostly at the individual level and focused on potential dietary benefits. In another review, McGowan et al. ¹²12. McGowan L, Caraher M, Raats M, Lavelle F, Hollywood L, McDowell D, et al. Domestic cooking and food skills: a review. Crit Rev Food Sci Nutr 2017; 57:2412-31. observed that a large share of the studies analyzes cooking as a skill centered on know-how, that is, on technical aspects related to the moment of preparing meals.

The findings by Kesteren & Evans ¹³13. Kesteren R, Evans A. Cooking without thinking: how understanding cooking as a practice can shed new light on inequalities in healthy eating. Appetite 2019; 147:104503. extend beyond the concept of cooking as a person-centered task; they used an in-depth qualitative approach with 25 mothers (including interviews and cooking observations) and a quantitative survey of 310 respondents in England. The authors found that “social deprivation can impact upon the materials, meanings, and competencies of cooking practices in ways that severely limit the capacity for those in more deprived areas to frequently cook with healthier unprocessed ingredients” ¹³13. Kesteren R, Evans A. Cooking without thinking: how understanding cooking as a practice can shed new light on inequalities in healthy eating. Appetite 2019; 147:104503. (p. 1).

However, no studies have related (in addition to individual skills) the actions that can be developed in the sphere of public policies for the promotion and strengthening of home cooking. By focusing on the State’s role, we aim to enhance the discussion of this relevant public health subject, which has already proven too complex to be treated exclusively from an individual perspective ¹⁰10. Trubek A, Carabello M, Morgan C, Lahne J. Empowered to cook: the crucial role of "food agency" in making meals. Appetite 2017; 116:297-305.^,1111. Mills S, White M, Brown H, Wrieden W, Kwasnicka D, Halligan J, et al. Health and social determinants and outcomes of home cooking: a systematic review of observational studies. Appetite 2017; 111:116-34.^,1313. Kesteren R, Evans A. Cooking without thinking: how understanding cooking as a practice can shed new light on inequalities in healthy eating. Appetite 2019; 147:104503.^,1414. Wolfson J, Lahne J, Raj M, Insolera N, Lavelle F, Dean M. Food agency in the United States: associations with cooking behavior and dietary intake. Nutrients 2020; 12:877.. The objectives of our study are to elaborate the concept and to develop a multilevel conceptual model of cooking autonomy (CMCA) that considers the individual as the protagonist in cooking decisions and includes the State’s responsibility in this significant health-promoting practice.

Methodology

This is a conceptual study with the following stages: a narrative literature review, conducted by searching the keywords “cooking autonomy”, “culinary”, “home cooking”, “domestic cooking practices”, “cooking skills”, “ecological theory”, “agency”, and “capability approach” in international databases; mapping of concepts related to cooking autonomy, and elaborating the CMCA and charts with examples of components and actions developed in the policy-making sphere.

The construction of conceptual models, i.e., graphic schemes, is recommended to organize the theory of a new concept, to support the construction of measurement instruments and to guide studies and interventions aimed at a particular subject ¹⁵15. Streiner D, Norman G, Cairney J. Health measurement scales: a practical guide to their development and use. 5th Ed. Oxford: Oxford University Press; 2015..

Theoretical and conceptual basis

Frances Short ¹⁶16. Short F. Domestic cooking practices and cooking skills: findings from an English study. Food Service Technology 2003; 3:177-85.^,1717. Short F. Kitchen secrets - the meaning of cooking in everyday life. Oxford: Berg; 2006. was the author chosen as the main bibliographic reference on this subject since she presents cooking as a set of skills that extend beyond the preparation phase, including planning and creativity, in addition to conceiving skills that focus on the individual and not on the meal preparation.

Another cornerstone in cooking autonomy was the concept of autonomy in the capability approach, thoroughly discussed by Amartya Sen ¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999. as the notion of “agency”. One of the central ideas of the capability approach is that people have different skills to convert resources into functions (that the individual manages to do or to be). Conversion factors may be personal (physical condition, skills, intelligence), social (power relations related to class, gender, race), and environmental (natural or built environment in which the person lives) ¹⁹19. Robeyns I. Wellbeing, freedom and social justice: the capability approach re-examined. Cambridge: Open Book Publishers; 2017..

Agency was another significant concept, both from the point of view of Human Sciences ¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999.^,2020. Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol 2001; 52:1-26., and that of its application to cooking ¹⁰10. Trubek A, Carabello M, Morgan C, Lahne J. Empowered to cook: the crucial role of "food agency" in making meals. Appetite 2017; 116:297-305.^,1414. Wolfson J, Lahne J, Raj M, Insolera N, Lavelle F, Dean M. Food agency in the United States: associations with cooking behavior and dietary intake. Nutrients 2020; 12:877. and to eating as an “essential dimension of food security” ²¹21. High Level Panel of Experts on Food Security and Nutrition. Food security and nutrition: building a global narrative towards 2030. Rome: Food and Agriculture Organization of the United Nations; 2020. (p. 24). An agent is anyone that changes the environment with their free and rational action ²⁰20. Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol 2001; 52:1-26.^,2222. Giddens A. The constitution of society: outline of the theory of structuration. Los Angeles: University of California Press; 1984.^,2323. Sen A. Rights and agency. Philosophy and Public Affairs 1982; 11:3-39.. In the field of eating habits, the term “food agency”, represents the capacity of a person who cooks at home to perform cooking through a dynamic process ranging from planning to the consumption of meals, not limited to isolated technical performances ¹⁰10. Trubek A, Carabello M, Morgan C, Lahne J. Empowered to cook: the crucial role of "food agency" in making meals. Appetite 2017; 116:297-305..

In Human Sciences, the notion of “autonomy” is broader and more complex, defined as an agents’ power to achieve their objectives, according to their own properties and limitations, not imposed by external conditions, highlighting the State’s role in guaranteeing individual rights ¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999.^,2323. Sen A. Rights and agency. Philosophy and Public Affairs 1982; 11:3-39.. To be autonomous entails two essential conditions, to have internal resources to act as protagonist according to one’s wishes ²⁴24. Kant I. Critique of pure reason. Cambridge: Cambridge University Press; 1988. and to be exposed to a favorable environment for one’s free action ¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999..

An additional theoretical reference was the Dietary Guidelines for the Brazilian Population published in 2014 ¹1. Departamento de Atenção Básica, Secretaria de Atenção à Saúde, Ministério da Saúde. Guia alimentar para a população brasileira. 2nd Ed. Brasília: Ministério da Saúde; 2014.^,22. Louzada M, Canella D, Jaime P, Monteiro C. Alimentação e saúde: a fundamentação científica do guia alimentar para a população brasileira. São Paulo: Faculdade de Saúde Pública, Universidade de São Paulo; 2019.. This document orients public policies for healthy food, with internationally acknowledged value ²⁵25. Ahmed S, Downs S, Fanzo J. Advancing an Integrative Framework to Evaluate Sustainability in National Dietary Guidelines. Front Sustain Food Syst 2019; 3:76.^,2626. United Nations Children's Fund. Review of national food-based dietary guidelines and associated guidance for infants, children, adolescents, and pregnant and lactating women. New York: United Nations Children's Fund; 2020., and addresses cooking and skills involved in preparing meals from unprocessed or minimally processed foods and cooking ingredients, as emancipatory skills and practices for the promotion of adequate and healthy food on an individual and collective level.

The model is based on the concepts drew on Urie Bronfenbrenner’s Ecological Systems Theory (an ecological approach) ²⁷27. Glanz K, Rimer B, Viswanath K. Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass; 2019.^,2828. Bronfenbrenner U, Ceci S. Nature-nurture reconceptualized in developmental perspective: a bioecological model. Psychol Rev 1994; 101:568-86., which presents five systems that involve the individual and model their behavior: the microsystem (the basic core in which the individual develops); the mesosystem (the links between the microsystems); the exosystem (the contexts that influence the microsystems, such as public policies); the macrosystem (a society’s cultural and political values, economic models, and social conditions); and the chronosystem (the historical moment in which the individual lives) ²⁸28. Bronfenbrenner U, Ceci S. Nature-nurture reconceptualized in developmental perspective: a bioecological model. Psychol Rev 1994; 101:568-86.^,2929. Bronfenbrenner U, Evans G. Developmental science in the 21st century: emerging questions, theoretical models, research designs and empirical findings. Soc Dev 2000; 9:115-25..

Expert consultation

In 2018, two workshops at the State University of Rio de Janeiro in 2018 and several individual consultations were carried out to enhance the knowledge on some specific topics and to listen to foreigners, until reaching the final version of the model. These activities involved 28 experts: 25 were professors and researchers from 15 universities in Brazil (n = 12), Canada (n = 1), Netherlands (n = 1), and Northern Ireland (n = 1). Other participants included two nutritionists and a lawyer working in Brazilian social movements connected to the food and nutrition agenda, as well as a regional advisor on nutrition from an international public health agency. Among these experts, 25 were women, so the inputs have a predominantly female perspective, corroborating other studies on the same subject that were included in the review by Mills et al. ¹¹11. Mills S, White M, Brown H, Wrieden W, Kwasnicka D, Halligan J, et al. Health and social determinants and outcomes of home cooking: a systematic review of observational studies. Appetite 2017; 111:116-34..

Content validity

Content validity was assessed with a qualitative (commentary and discussion) and a quantitative procedure (content validity ratio - CVR) ¹⁵15. Streiner D, Norman G, Cairney J. Health measurement scales: a practical guide to their development and use. 5th Ed. Oxford: Oxford University Press; 2015.. We assembled a panel of experts who had already been consulted in the prior stage. Each expert received an online form with a list of the CMCA components and assessed each item on a four-point scale, where 4 = “highly relevant” and 1 = “not relevant”.

Each item CVR was obtained by using the following equation: CVR = (ne - N/2)/(N/2), in which “ne” is the number of experts that classified each item as “essential” (4 or 3), and “N” is the total number of respondents. The CVR varies from -1 to +1, in which 0 means that half of the panel consider the item essential. To ensure that the result is not due to chance, for 10 evaluators (the number of experts participating in this phase of the study), Lawshe ³⁰30. Lawshe C. A quantitative approach to content validity. Pers Psychol 2011; 64:289-313. recommended a cutoff of 0.62 for considering an item essential. Items that reached values below this were ruled out. As for the qualitative procedure, the document that was sent had a space for comments. After this stage, the final versions of the model and charts were produced.

Results

Conceptual model of cooking autonomy (CMCA)

The activities developed to achieve the study objective produced a multilevel conceptual model of cooking autonomy, i.e., a graphic scheme used to organize the concept that expresses the necessary components to develop cooking autonomy according to the principles of ecological perspective ²⁷27. Glanz K, Rimer B, Viswanath K. Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass; 2019.^,2828. Bronfenbrenner U, Ceci S. Nature-nurture reconceptualized in developmental perspective: a bioecological model. Psychol Rev 1994; 101:568-86.. In the CMCA, agents at multiple levels contribute to the development of autonomy, and the influences interact between the levels (Figure 1).

Figure 1 shows the agent’s circle in moss green to represent the intersection of the other colors, which result in the most saturated or pigmented color, and thus a synthesis-color. This technique was chosen to express the idea that individuals who act are a result of everything to which they are exposed (other levels). However, the logic of circles would not be adequate for representing cooking autonomy, which is the product of this interaction between the individual’s characteristics, i.e., a distinct event that is the outcome of a process. In the model, cooking autonomy takes the shape of a red hexagon, thus a different shape and color from those used in the levels.

As an alternative to the chronosystem traditional representation, usually expressed as an outer circle in the model ³¹31. Watson M. Exploring the concept of community in relation to early years practice. Education in the North 2017; 2:63-71. or as an arrow pointed to the right and positioned below the central figure ³²32. Halpern R, Figueiras A. Environmental influences on child mental health. J Pediatr (Rio J.) 2004; 2:104-10., this model innovates by depicting the chronosystem as a spiral in order to communicate two important messages in the figure: the environmental events and transitions that occur over time permeate and influence all levels; and what happens in the social and historical moment in which one lives is fluid, mutable, malleable, and nonlinear or non-unidirectional, like an arrow. By permeating the levels, the chronosystem can influence the development of autonomy, highlighting an ecological system interdependence ²⁷27. Glanz K, Rimer B, Viswanath K. Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass; 2019.^,2828. Bronfenbrenner U, Ceci S. Nature-nurture reconceptualized in developmental perspective: a bioecological model. Psychol Rev 1994; 101:568-86..

The food system proposed (based on the work by Mozaffarian et al. ³³33. Mozaffarian D, Angell S, Lang T, Rivera J. Role of government policy in nutrition - barriers to and opportunities for healthier eating. BMJ 2018; 361:k2426. and Swinburn et al. ³⁴34. Swinburn B, Kraak V, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet 2019; 393:791-846.) within the CMCA embodies “qualities that support the six dimensions of food security” ²¹21. High Level Panel of Experts on Food Security and Nutrition. Food security and nutrition: building a global narrative towards 2030. Rome: Food and Agriculture Organization of the United Nations; 2020. (p. 11) (availability, access, utilization, stability, agency, and sustainability), which are necessary to achieve the right to food. The proposed food system opposes the hegemonic food system, shaped by capitalism, founded on competition and on women’s oppression and exploitation, highly dependent on large corporations that do not aim at women’s autonomy and people’s quality of life, but at the maximization of short-term profits ³⁵35. Forum for Food Sovereignty. Declaration of Nyéléni. https://nyeleni.org/spip.php?article290 (accessed on 22/Jun/2020).
https://nyeleni.org/spip.php?article290... ^,3636. Albritton R. Let them eat junk: how capitalism creates hunger and obesity. New York: Pluto Press; 2009.^,3737. Cheney T. Historical materialism and alternative food: alienation, division of labour, and the production of consumption. Socialist Studies 2016; 11:105-26.^,3838. Nestle M. Centering capitalism in a world of foodie-ism. Oakland: Food First/Institute for Food and Development Policy; 2017.. The strategy used for the maintenance of this hegemonic system is to keep people dependent on ultra-processed foods and alienate them from daily cooking tasks that could strengthen local food culture. The chronosystem thus presents components that relate to an economic and social system based on justice, equality, and solidarity, that cooperate for human emancipation in the sense of freedom discussed by Sen ¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999.^,3939. Sen A. The idea of justice. London: Allen Lane; 2009. and Davis ⁴⁰40. Davis A. Freedom is a constant struggle: Ferguson, Palestine, and the foundations of a movement. Chicago: Haymarket Books; 2016.. Thus, when addressing autonomy, it is necessary to consider capitalism influence on the processes of interpersonal discrimination and segregation.

The macrosystem includes the guarantee of the “human right to adequate and healthy food” (“Food and nutritional security consists in upholding the right to regular, permanent, and unrestricted access to quality food, in sufficient quantity, without compromising the access to other essential needs, based on health-promoting food practices that respect cultural diversity and are environmentally, culturally, economically, and socially sustainable” - free translation) ⁴¹41. Brasil. Lei nº 11.346, de 15 de setembro de 2006. Cria o Sistema Nacional de Segurança Alimentar e Nutricional - SISAN com vistas em assegurar o direito humano à alimentação adequada e dá outras providências. Diário Oficial da União 2006; 18 sep., which is considered necessary for the development of cooking autonomy. The same is true for the guarantee of “food sovereignty”, which “is the right of peoples to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems” ³⁵35. Forum for Food Sovereignty. Declaration of Nyéléni. https://nyeleni.org/spip.php?article290 (accessed on 22/Jun/2020).
https://nyeleni.org/spip.php?article290... . Also related to the empowerment in meal preparation is the guarantee to health and education, important foundations for decision-making based on critical reflection, essential for the development of autonomy.

The exosystem includes “social well-being”, which is the comprehensive set of actions taken by the public management and society, targeted to ensuring rights in health, welfare, and social assistance ⁴²42. Brasil. Constituição da República Federativa do Brasil. https://www.senado.leg.br/activity/const/con1988/CON1988_05.10.1988/CON1988.asp (accessed on 22/Jun/2020).
https://www.senado.leg.br/activity/const... ; it deals with something intrinsically bound to the achievement of fundamental rights, which are the “existential minimum”. The aim of including this component in the conceptual model is to show that an individual develops they cooking autonomy, having the guarantee of physical survival as well as the development of their overall personality. Just as living is not only surviving; eating is not only about ingesting nutrients. Regardless of cooking autonomy being an individual process - the concept of autonomy is related to the individual and not to the collective ⁴³43. Maclean A. Autonomy, informed consent and medical law: a relational challenge. Cambridge: Cambridge University Press; 2014. - it cannot be experienced only to ensure existence (the guarantee of human life), instead it should be aimed toward a healthy and decent life, one with dignity ⁴⁴44. Rawls J. Justice as fairness: a restatement. Cambridge: Harvard University Press; 2001..

Other components in which the State plays an essential protective role are “food and nutrition security,” which consists of universal guarantee of “access to quality food, in sufficient quantity, without compromising the access to other essential needs” ⁴¹41. Brasil. Lei nº 11.346, de 15 de setembro de 2006. Cria o Sistema Nacional de Segurança Alimentar e Nutricional - SISAN com vistas em assegurar o direito humano à alimentação adequada e dá outras providências. Diário Oficial da União 2006; 18 sep. the promotion of gender equity and racial equality, through actions to promote equal treatment between men and women of all races to minimize the inequalities that structure relations, and the “healthy use of time”, in the sense of promoting the conditions for individuals to manage their time in such a way as to preserve their health (build intimate personal relations, exercise citizenship, work, play, care, and rest) ⁴⁵45. Zuzanek J. Work, leisure, time pressure and stress. New York: Taylor and Francis Routledge; 2004.. Time for cooking is also necessary, since the lack of time is one of the main reasons people forgo healthy foods ⁴⁶46. Jabs J, Devine C. Time scarcity and food choices: an overview. Appetite 2006; 47:196-204.^,4747. Jabs J, Devine C, Bisogni C, Farrell TJ, Jastran M, Wethington E. Trying to find the quickest way: employed mothers' constructions of time for food. J Nutr Educ Behav 2007; 39:18-25.. No matter how extensive one’s cooking skills is, cooking requires time, and different foods have specific cooking times. According to Strazdins et al. ⁴⁸48. Strazdins L, Griffin S, Broom D, Banwell C, Korda R, Dixon J, et al. Time scarcity: another health inequality? Environ Plan A 2011; 43:545-59.^,4949. Strazdins L, Welsh J, Korda R, Broom D, Paolucci F. Not all hours are equal: could time be a social determinant of health? Sociol Health Illn 2016; 38:21-42., the failure to consider time as an important element in health guidelines is “politically unpalatable”, since it is unthinkable to suggest interventions and actions that demand more time precisely from the population that most needs it, for example, to suggest that people cook more without taking measures to support them in doing so.

Also, the State should promote and support health actions, such as cooperating with healthy cooking through “incentives for cooking” and “incentives for family and urban agroecological farming”. Encouraging the use of foods from a sustainable cultivation of the land, done by small family-based farms, in which the processes and distribution of foods is managed by family members in short food supply circuits, positively influences the development of cooking autonomy.

In the capability approach, the macro and exosystem levels express resources that make the individual’s action possible (i.e., “guarantee of health” and “food and nutrition security”), providing the conditions for decision-making, contrary to when the State is absent or coercive, which ends up inhibiting human action. Thus, access to reliable health information is important for food and nutrition security. Food and nutrition education becomes central in this context: by using cooking as a method for teaching and learning, abstract concepts in nutrition and health materialize. The subject’s knowledge and past experiences are brought to the surface, situating participants as protagonists in this educational process and also allowing for an experience that mixes rational and sensorial aspects, mobilizing individuals for transformation ⁵⁰50. Garcia R, Castro I. A culinária como objeto de estudo e de intervenção no campo da alimentação e nutrição. Ciênc Saúde Colet 2011; 16:91-8.. However, educational initiatives in cooking and the promotion of healthy eating will have a limited effect if they fail to consider the structural issues identified at these levels.

The mesosystem includes “availability and access to unprocessed or minimally processed foods”, which is the supply and possibility of acquisition of foods as they are found fresh or with minimal alterations aimed at product conservation; and “social movements”, which is the collective sociopolitical and cultural actions that allow different ways for society to organize and to express its demands.

The microsystem is the environment in which the same cooking stove is shared; it includes elements pertaining to structure and purchasing power with critical analysis, but it also includes the values and relations between people of the same household. Thus, in order for healthy cooking practice to materialize at home, the purchase of foods needs to be a conscious action, hence the concept of “purchasing power with critical analysis”, as well as having a place that allows for the preparation of meals: a “kitchen with basic infrastructure”. Regarding the field of values and relations in the private sphere, a positive contribution to the development of cooking autonomy is that people living together assign “importance to cooking” in addition to exercising “sharing of cooking activities”, ranging from purchase of groceries to cleaning the kitchen.

The agent level, defined here as individuals’ ability to change their food environment by preparing meals, includes the components pertaining to individual skills. Since information is necessary for decision-making and thus for autonomy, the model entails components pertaining to individual knowledge: “knowledge on adequate and healthy food”, which consists of understanding that eating should be balanced, prioritizing fresh or minimally processed foods, and that culinary preparations should be made with these foods, limiting the consumption of ultra-processed foods; and the knowledge obtained by cooking practice (“experience and contact with cooking”). Meanwhile, the components “interest, confidence, and disposition for cooking” and “cooking skills” express the individual’s powers in developing autonomy in the kitchen.

Besides these components, considering the great work involved in the daily practice of home cooking, this level also covers the “strategic attitude” component, consisting of a dynamic stance towards the daily challenges in cooking, such as organizing specific days for cooking larger amounts to freeze. Box 1 provides more examples of this and other components of the agent level.

Thus, based on this model, we defined cooking autonomy as the capability to think, to decide, and to act to prepare meals from scratch, influenced by interpersonal relations, environment, cultural values, access to opportunities, and guarantee of rights. This definition is also intended to emphasize the relational nature of cooking autonomy. In other words, it is not an attribute developed exclusively by the individual’s intention or characteristics, but also by the fundamental role of relations and dynamics with their surroundings, State action, and values of the time in which one lives.

As for content validation, the experts considered most of the components highly relevant. Only “planting and production of foods”, present in the microsystem in preliminary versions, was discarded, since the CVR value (0.60) fell below the study’s cutoff (0.62) (Table 1).

The largest share of suggestions for rewording referred to the component “equal gender division of cooking activities”, the final version of which is shown in Figure 1. Some experts voiced the need to expand the people involved in the division of cooking tasks to include the entire family, since it is not exclusively between men and women, but everyone within the household. The children’s involvement in cooking meals was thus raised as a relevant point.

There were some suggestions in response to the question, “In your opinion, are there other components besides those already identified that should be included?”, but they were not adopted since their content had already been included in other components, such as the suggestion “the right to information” and “the right to land and housing”, already covered in “food and nutritional security” and in “social well-being”, respectively. Notably, it would be didactic if these elements appeared explicitly in the model; however, with a view towards the model parsimony, an effort was made to produce a more concise text with greater conceptual density of the terms.

Connecting home cooking and policy

The concept of cooking autonomy is a step forward in the scientific literature on home cooking, since it not only links constructs that have been adopted in other models on cooking skills ¹¹11. Mills S, White M, Brown H, Wrieden W, Kwasnicka D, Halligan J, et al. Health and social determinants and outcomes of home cooking: a systematic review of observational studies. Appetite 2017; 111:116-34.^,1212. McGowan L, Caraher M, Raats M, Lavelle F, Hollywood L, McDowell D, et al. Domestic cooking and food skills: a review. Crit Rev Food Sci Nutr 2017; 57:2412-31.^,5151. Jomori M, Vasconcelos F, Bernardo G, Uggioni PL, Proença RPC. The concept of cooking skills: a review with contributions to the scientific debate. Rev Nutr 2018; 31:119-35. and human agency ¹⁰10. Trubek A, Carabello M, Morgan C, Lahne J. Empowered to cook: the crucial role of "food agency" in making meals. Appetite 2017; 116:297-305. but also integrates the public policy dimension with them.

Expanding the understanding of the event empowers a new view from an ecological perspective, focusing especially on public policies that can influence home cooking practice, an aspect not previously studied in the literature. Box 2 presents some examples of actions that can be developed in the public policy sphere, contributing to the development of cooking autonomy. These examples aim to underline how public policies intervene and have a direct interface with issues experienced by the individual in home cooking practice, making clear that individuals do not have the sole responsibility for their eating habits.

Recent publications also view the State as a fundamental and determinant figure in food choices ³³33. Mozaffarian D, Angell S, Lang T, Rivera J. Role of government policy in nutrition - barriers to and opportunities for healthier eating. BMJ 2018; 361:k2426.^,3434. Swinburn B, Kraak V, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet 2019; 393:791-846.. According to Otero ⁵²52. Otero G. The neoliberal diet: healthy profits, unhealthy people. Austin: University of Texas Press; 2018. (p. 70), the important solution to malnutrition “should come from the State, with strong regulation, through a profound and systemic change”. The author is emphatic in disagreeing that the solution might come from consumption, since for him most people lack the economic wherewithal to decide ⁵²52. Otero G. The neoliberal diet: healthy profits, unhealthy people. Austin: University of Texas Press; 2018.. Other studies have made similar observations ⁵³53. Bratanova B, Loughnan S, Klein O, Claassen A, Wood R. Poverty, inequality, and increased consumption of high calorie food: experimental evidence for a causal link. Appetite 2016; 100:162-71.^,5454. Popkin B. Nutrition, agriculture and the global food system in low and middle income countries. Food Policy 2014; 47:91-6.^,5555. Otero G, Pechlaner G, Liberman G, Gürcan E. The neoliberal diet and inequality in the United States. Soc Sci Med 2015; 142:47-55..

According to Swinburn et al. ³⁴34. Swinburn B, Kraak V, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet 2019; 393:791-846., a central element in the syndemic of obesity, undernutrition, and climate change is “policy inertia”, which consists of the combination of political weakness (or lack of political will) with strong opposition from economic sectors and insufficient pressure by civil society. As a response, they point to actions the State can take to improve eating habits as well as the environment, such as completely implementing the human rights obligations to protect socially underprivileged populations (the right to health and education, for example), reducing the influence of large vested commercial interests in policy development processes to allow governments to implement relevant policies for public health, equity, and planetary sustainability, and eliminating subsidies for products that contribute to the global syndemic, redirecting funds to actions that mitigate it. These proposals converge with the issues covered in our CMCA.

Otero et al. ⁵²52. Otero G. The neoliberal diet: healthy profits, unhealthy people. Austin: University of Texas Press; 2018. note that currently, the forms of dehumanization caused by extreme poverty permeate various spaces and are expressed in the consequences of an economic system in which the market determines the development model. Approaches to cooking that fail to address consumerism when interpreting the reality thus seem to be insufficient. Therefore, without protective action by the State, people (especially the more vulnerable ones) can easily be subjugated by the impositions of the food industry, for example.

Cooking autonomy and the capability approach

Since the development of the CMCA is influenced by the theory that considers Development as Freedom¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999., it includes elements of the basic essential needs for the exercise of fundamental rights and fundamental freedoms, that is, a sufficient material basis for the person’s independence and feeling of self-respect. Self-esteem and trust in one’s own worth are the most important primary asset. Having a sense of one’s own worth increases the confidence in one’s capabilities and thus their capacity to execute plans ¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999.^,4343. Maclean A. Autonomy, informed consent and medical law: a relational challenge. Cambridge: Cambridge University Press; 2014..

Sen ¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999. and Nussbaum ⁵⁶56. Nussbaum M. Capabilities and human rights. Fordham Law Review 1997; 66:273-300. present freedom as an individuals’ capability to choose the functions that will comprise their way of life, but the choice depends on the availability of options and access to them. Individuals can only choose the cooking function if they have access to a “kitchen with basic infrastructure”. Moreover, for an individual be able to prepare healthy meals, it is necessary not only kitchen equipment and utensils but also “knowledge on adequate and healthy food” and “purchasing power with critical analysis”. Cooking healthy meals requires not only “cooking skills”, “interest”, or “disposition,” which are individual elements, but also other elements, such as the guarantee of “education”, “health”, and “social well-being”. Thus, based on the capability approach, cooking autonomy is a human capability, that is, a choice of such functions as buying groceries, reflecting on what to purchase, and having the disposition to cook.

Cooking autonomy can thus be seen as the tip of an iceberg, under which there are numerous intrinsic elements. These are the elements that the model intends to identify as basic in this construct in order to extend, beyond the individual sphere, the components that contribute to the development of cooking autonomy. The capability approach is a theoretical framework that entails two core normative claims: first, the claim that the freedom to achieve well-being is of primary moral importance, and second, that freedom to achieve well-being is to be understood in terms of people’s capabilities, that is, their real opportunities to do and be what they have reason to value ⁵⁷57. Robeyns I. The capability approach in practice. J Polit Philos 2016; 3:351-76.. Thus, mapping the conditions leading to the real possibility of cooking autonomy is an important contribution by the CMCA.

The capability approach has been used traditionally in population studies to identify the poor, but it has also been adopted for other purposes ¹⁹19. Robeyns I. Wellbeing, freedom and social justice: the capability approach re-examined. Cambridge: Open Book Publishers; 2017.. Although most normative theories in the capability approach relate it to justice, other values have also been developed and analyzed with it. In the last 25 years, the range of fields in which it has been applied and developed has expanded greatly ¹⁹19. Robeyns I. Wellbeing, freedom and social justice: the capability approach re-examined. Cambridge: Open Book Publishers; 2017.. Other studies have been developed in the public health field, similar to ours; still, the largest share of studies have focused on poverty and the assessment of well-being and quality of life ⁵⁸58. Mitchell P, Tracy M, Roberts E, Coast J. Applications of the capability approach in the health field: a literature review. Soc Indic Res 2017; 133:345-71.. Although it has still not been incorporated by the field of Nutrition, other studies have used the capability approach as part of the concepts constructed on quality of life ⁵⁶56. Nussbaum M. Capabilities and human rights. Fordham Law Review 1997; 66:273-300.^,5757. Robeyns I. The capability approach in practice. J Polit Philos 2016; 3:351-76.^,5959. Claassen R. An agency-based capability theory of justice. European Journal of Philosophy 2017; 25:1279-304. and as to expand the health concept ⁶⁰60. Venkatapuram S. Health, vital goals, and central human capabilities. Bioethics 2013; 27:271-9..

As discussed above, the capability approach refers to what individuals are capable of. The CMCA perspective aims to reflect on the degree to which the individuals have the possibility of being protagonists in their eating (being) or in practicing home cooking (doing). The concept extrapolates the simple fact of knowing or not knowing how to eat adequately or to cook, while it encompasses the degree to which the individual has the opportunity to be capable of “being” autonomous in the kitchen. Thus, it refers not only to qualifications and training alone, but to conditions to perform a given event, in this case cooking autonomy.

As illustrated in Box 1, in the component “strategic attitude”, the agent can cook a full meal in a single pot or pan, for example, rice with vegetables (which are stored cut and sanitized in the refrigerator) and chicken (already stored clean and in pieces) in order to optimize time in the kitchen. However, this individual attitude, aimed at saving time, in both the preparing and cleaning stages, involve a very different complexity from that of the State’s action in the same component. The State can act to implement food and nutrition education, such as practical cooking activities for the development of cooking skills, in the National Common Curricular Base, which is a Brazilian document that determines the essential learnings to be addressed in the country’s schools. The State can also act in the development, implementation, and financing of training initiatives for cooking skills, home economics, and adequate and healthy food, providing individuals with “enabling processes”, i.e., the structure, and expanding their “capability set” ¹⁸18. Sen A. Development as freedom. New York: Knopf; 1999..

Finally, Robeyns ¹⁹19. Robeyns I. Wellbeing, freedom and social justice: the capability approach re-examined. Cambridge: Open Book Publishers; 2017. emphasizes that for philosophers and politicians interested in further developing the capability approach into a coherent political theory, a clear understanding of capabilities as freedoms to choose or freedom of opportunities may pave the way for future work. Therefore, by considering this approach for the conception of the CMCA, cooking autonomy is seen as freedom for cooking, developed based on individual skills in a favorable environment, that is, with available resources for the agent’s actions.

Conclusion

In conceptualizing cooking autonomy, a highly complex event, the intention was not to develop something that sounds as being unattainable or to develop a paralyzing approach. Conversely, the purpose was to conceptually reveal, through an ecological approach, which elements at the different levels are associated with protagonism in the preparation of healthy homemade meals, evidencing the roles of the State and of the individual in this process and contributing to overcoming the discourse that blames the individual for rarely or never cooking at home.

We hope that the conceptual model proposed here will contribute to studies and public policies that address home cooking from a broader perspective, which also considers important elements beyond the home and the individual sphere. This conceptual model can also provide the basis for building indicators of cooking autonomy to be used in population-based studies.

Finally, we hope that the study outputs may help expand the dialogue among the fields of Law, public policies, and cooking and support measures to promote healthy eating and food and nutrition security.

Acknowledgments

The authors thank all the experts consulted in this study for their inestimable contributions.

References

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