Categorizations of Trust and Distrust in the Classifications and Social Representations of Food among Pregnant and Breastfeeding Women in Spain—Applying the Cultural Domains’ Pile Sort Technique

International Journal of Environmental Research and Public Health · 4 authors, 9 centres

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TL;DR

This study explores how pregnant and breastfeeding women in Spain classify foods based on trust and distrust, using pile sort techniques and focus groups with 62 women. Fruits, vegetables, and organic meats were generally trusted, while processed, precooked, and highly artificial foods were distrusted; fish and meat generated ambivalence depending on origin and production methods. The findings highlight that women's emic knowledge and classification criteria should inform food safety programs and public health interventions for this population.

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**Background:** Pregnancy and lactation are critical periods during which food choices become central to maternal and child health. Women face complex decisions about food safety within a globalized food system, often experiencing tension between trust and distrust. This study, part of a broader interdisciplinary research project (2015–2021), explores how pregnant and breastfeeding women in Spain classify foods and assign attributes of trust and distrust, using cognitive anthropology methods to understand shared cultural knowledge.

**Methods:** The study was conducted in two phases across Catalonia and Andalusia, Spain. In the first phase (2015–2017), 111 semi-structured interviews (62 pregnant, 49 breastfeeding women), 4 focused ethnographies, 2 focus groups, 71 food diaries, 71 free listings, and 12 interviews with health professionals were conducted. The second phase (2018–2021) involved 8 focus groups and 62 pile sorts with 62 mothers (26 pregnant, 36 breastfeeding). Inclusion criteria: women born in Spain, ≥20 weeks pregnant or breastfeeding (exclusively or with formula) within the last six months, with no pathology altering diet. The pile sort technique used 20 food categories for trust and 20 for distrust, derived from the most cited items in the first-phase free listings. Participants sorted cards into piles based on perceived similarities/differences regarding trust/distrust. Data were analyzed using ANTHROPAC software and nonmetric multidimensional scaling (nMDS) to generate proximity/distance maps. Focus group narratives were analyzed using Grounded Theory with ATLAS-ti software.

**Key Results:** The nMDS analysis revealed five associative subdomains for trust: (1) items trusted due to nutritional properties and/or origin/manipulation (fruits, vegetables, organic meats); (2) cereals, legumes, and nuts; (3) dairy products; (4) eggs; (5) items with ambivalent trust (fish and meat). For distrust, five subdomains emerged: (1) prepared or precooked products; (2) basic processed products; (3) highly artificial processed products with chemical additives; (4) items distrusted due to origin, manipulation, and/or distribution; (5) items distrusted due to concerns about added preservatives. Women expressed great concern about food quality and its effects on their own and their child's health. Fruits and vegetables were trusted as healthy and nutritious, though concerns about pesticides in intensive agriculture were noted. Organic certification generated trust. Cereals, legumes, and nuts were trusted due to ease of storage and minimal processing. Dairy and eggs were generally trusted but viewed with some suspicion regarding industrial production. Fish and meat generated ambivalence: trusted for nutritional properties (proteins, omega 3, iron) but distrusted depending on origin, production methods, and potential contaminants (e.g., mercury in large fish). Distrusted foods included prepared/precooked products (unknown substances), basic processed meats (preservatives, stabilizers, colorants), and highly artificial products (industrial pastries, crisps, packaged juices, soft drinks) due to saturated fats, sugars, and chemical additives. Frozen fish raised concerns about cold chain integrity. Women emphasized reading labels and seeking information, but also acknowledged that excessive worry could lead to not eating. Distrust did not necessarily prevent consumption, as many distrusted foods were still eaten.

**Clinical Implications:** The study underscores that pregnant and breastfeeding women's food classification systems and trust/distrust criteria are shaped by perceptions of origin, processing, and chemical additives, not solely by biomedical nutritional advice. Women prioritize fresh, minimally processed foods and express ambivalence about animal products depending on production methods. These emic perspectives should be integrated into food safety programs and public health interventions targeting this population. Health professionals should recognize that women's food decisions are influenced by environmental concerns, distrust of industrial processing, and the precautionary principle to protect the fetus/infant. Understanding these social representations can improve communication about dietary risks and promote healthier eating behaviors during pregnancy and lactation. The study also highlights the need to address barriers such as price and availability that may prevent women from acting on their preferences.

STUDY TYPE

other

SPECIALTY

nutrition

SUMMARISED BY

AI pipeline

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ORIGINAL PAPER

PMC10002182

Categorizations of Trust and Distrust in the Classifications and Social Representations of Food among Pregnant and Breastfeeding Women in Spain—Applying the Cultural Domains’ Pile Sort Technique

International Journal of Environmental Research and Public Health

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ABSTRACT

Food is fundamental in the decision making of pregnant and breastfeeding women to care for their own health and that of their child. In this paper, we explore some common food classification systems and certain attributes assigned to these categories, represented by values of trust and distrust. This study is based on an interdisciplinary research project in which we analysed discourses and practices regarding the dietary intake of pregnant and breastfeeding women in relation to the presence of chemical substances in foods. The results presented are part of the second phase of this research where we explored the results of our analysis of the pile sort technique based on an analysis of cultural domains in order to explore the categories and semantic relations among terms regarding trust and distrust in food. This technique was applied to the 62 pregnant and breastfeeding women of Catalonia and Andalusia. These women also participated in eight focus groups that provided information and narratives enabling us to analyse the meanings of the associative subdomains obtained in the pile sorts. They classified different foods and assigned certain attributes to them according to the level of trust and mistrust, providing a social representation of food risks. The mothers expressed great concern about the quality of the food they consume and about its possible effects on their own health and on that of their child. They perceive that an adequate diet is one based on the consumption of fruits and vegetables, preferably fresh. Fish and meat generate serious concern, as their properties are considered ambivalent depending on the food’s origin and mode of production. These criteria are perceived by women as relevant to their food decisions and, therefore, emic knowledge should be taken into account when developing food safety programmes and planning actions aimed at pregnant and breastfeeding women.

CITATION EXPORT

Araceli Muñoz, Cristina Larrea-Killinger, Andrés Fontalba-Navas et al.. Categorizations of Trust and Distrust in the Classifications and Social Representations of Food among Pregnant and Breastfeeding Women in Spain—Applying the Cultural Domains’ Pile Sort Technique. International Journal of Environmental Research and Public Health. (2023). https://doi.org/10.3390/ijerph20054195

AUTHORS

4 · 9 CENTRES

Araceli Muñoz, Cristina Larrea-Killinger, Andrés Fontalba-Navas, Miguel Company-Morales

1Training and Research Unit—School of Social Work, University of Barcelona, 08035 Barcelona, Spain
2Research and Innovation Group in Social Work (GRITS), TRU—School of Social Work, University of Barcelona, 08035 Barcelona, Spain
3“ToxicBody” Interdisciplinary Network, Department of Social Anthropology, University of Barcelona, 08001 Barcelona, Spain
4Research Group “Anthropology of Crisis and Contemporary Transformations (CRITS)”, Department of Social Anthropology, University of Barcelona, 08001 Barcelona, Spain
5CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
6Antequera Hospital, Northern Málaga Integrated Healthcare Area, 29200 Antequera, Spain
7Department of Public Health and Psychiatry, University of Málaga, 29016 Málaga, Spain
8Seron Primary Care Centre, Northern Almería Integrated Healthcare Area, 04600 Huercal-Overa, Spain
9Department of Nursing, Physiotherapy and Medicine, University of Almería, 04120 La Cañada, Spain

EDITOR / REVIEWER

F. Xavier Medina, Francesc Fusté-Forné, Nela Filimon, Paul B. Tchounwou