To trace the course of building a pictorial instrument that explores semiotic resources about food and nutrition education. The instrument is directed at the treatment and prevention of obesity, considering the food and nutrition problems of the Brazilian population. The criteria for photo production were: images that could cause visual impact and transmit applied nutrition information, insinuating positive and negative eating practices for promoting healthy eating, and preventing and treating obesity. Themes were created to guide photo production, and preparations, food composition tables, and food labels were used for composing the images. Focus groups were conducted with nonobese and obese women, and dietitians to evaluate image comprehension. The pictorial instrument totaled to 20 photos, with 5 photos in each of the following themes: 'Sweet life, being aware of sugar', about sugar content in sweets and drinks; 'Tasty food with little fat', about fat content in foods; 'Eating well by making the best choices', about food replacements; and 'I take care of myself by eating healthy food, about encouraging fruit and vegetable intakes. The photos contain food, meals, and semiotic resources. The pictorial instrument describes four relevant themes to approach food problems in the Brazilian population. It can easily be used for both preventing and treating obesity, and for promoting healthy eating.
Methods of food guidance have shown to be increasingly more necessary because of the frequent and high consumption of processed food, which have much fat and sugar, and contribute to obesity growth. In the obesity treatment, methods of food guidance are necessary to support healthy food choices providing energetic and nutritional information that possibilities the subject to make better food choices. Researches about health education methods show that the use of pictures closely linked to written or spoken text can markedly increase cognitive process, like attention to and recall of information, and supports adherence to it. The aim of the study was to build, validate and assess the memorization of food guidance, communicated with support of an instrument of images, in normal weight and obese women. There were made four themes of photos to make the instrument of images: "Sweet life, taking care of sugar", "Eat well doing better choices", "Pleasant food and with little fat" and "I take care of me with healthy food". Each theme had five photos. The criterions used were impact images that convey information about negative and positive aspects of nutritional principles. The validation of the instrument was performed using quantitative methods, with Likert scale, and qualitative, using focus groups. Ten women participated in the validation, 6 normal weight and 4 obese, to assess whether the messages transmitted by the instrument were consistent with those that were aimed to convey, and a group of 5 nutritionists to technically validate the instrument and get suggestions about it. The instrument was used in workshops about nutritional guidance and validated by means of a structured questionnaire with opened and closed questions. Thirty-three women participated in this stage, between normal weight (n=18) and obese women (n=15). The food guidance with image instrument was done in groups with 3 to 5 people, in two workshops, each of it approaching two themes of photos. After 30 and 60 days of workshops, participant"s weights were reassessed and the women had to answer a questionnaire to assess their memorization about food information that was transmitted at the workshops. In all assessed periods of time it was observed that obese women recalled the messages addressed in the workshops better than normal weight women, and this last group showed a reduction recall of the messages in the first period of time assessed. The photos themes that were most recalled by both groups were those with approach on sugar content of foods and drinks and healthy food, and it was observed that the type of photo instrument influenced the memorization of the messages. There was no significant variation at normal weight and obese women" weight after the workshops. The instrument of images stands out as a tool to be used in the treatment and prevention of obesity, since it was effective in transmitting the desired messages, and it covers food themes that are important to the improvement of the Brazilian"s diet.
Agradeço à Deus pelas oportunidades que se abriram durante toda a minha trajetória no Doutorado. À minha família querida que sempre me apoiou e incentivou e me inspira a seguir sempre em frente. Mãe, tias, vó e Gui, muito obrigada! Sem vocês não chegaria até aqui. Ao meu marido Rodolfo, pelo amor, companheirismo, compreensão e por me apoiar sempre. À minha orientadora, profa. Dra. Rosa Wanda Diez Garcia. Agradeço pela oportunidade da orientação, por todo aprendizado ao longo desses 8 anos (especialização, mestrado e doutorado), pela oportunidade de integrar o grupo do PrátiCA, por tantas experiências e amadurecimento profissional obtidos no período em que participei do Ambulatório de Nutrição da Endocrinologia Ginecológica do HCFMRP/USP e também pela amizade, convivência, descontração e boas risadas. Obrigada Rosa! Ao pessoal do grupo de pesquisa PrátiCA, pela amizade, apoio, amadurecimento profissional e contribuições para o trabalho. Agradeço especialmente à Fer Penaforte, pela leitura do trabalho e sugestões. Às participantes da pesquisa, por contribuírem na viabilização do trabalho. Ao Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ) pelo apoio financeiro concedido para a realização desta pesquisa.
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