The “ Comida de República ” web-based course to promote healthy eating among college students

Objective The work aimed to investigate dietary practices of university students after an action aiming to promote adequate and healthy food

The "Comida de República" web-based course to promote healthy eating among college students O curso online "Comida de República" para promover alimentação saudável entre estudantes universitários(as)

A B S T R A C T Objective
The work aimed to investigate dietary practices of university students after an action aiming to promote adequate and healthy food.

Methods
The article reports the experience of the distance education course Comida da República, promoted by the Universidade Federal de São Paulo as an educational space for sharing and exchanging knowledge, experiences, and thoughts on eating in the university context, especially in student homes or fraternities (repúblicas). Online questionnaires assessed the profile of participants and changes in their perception or relationship with food. The Students' t-test was adopted to compare perceptions before and after the intervention, and content analysis for qualitative data.

Results
The course had 201 students enrolled and 82 who concluded it, with 35.4% living in repúblicas. Before the course, 89.6% of those who completed the course indicated the need to improve their diets, and 57.3% classified their diets as "regular". There was a significant change in perception after the course: 58.5% of those who completed it rated their food as "good". Dietary changes were categorized into two themes: "vision on food production and distribution" and "food and meal consumption". The emerging codes show a greater awareness and criticism about food systems and a greater appreciation of cooking, commensality, and unprocessed and minimally processed foods. Participants identified environmental, personal, and interpersonal barriers (67.1%) to dietary changes. The course emerged as a facilitator of these changes.

I N T R O D U C T I O N
Admission into university implies modifications in the student life and routine, and constitutes a critical period regarding changes in health behavior [1][2][3][4]. The eating patterns in college population are characterized by the high consumption of ultra-processed products and fast foods, frequently skipping meals, and low consumption of natural or minimally processed foods, such as rice, beans, milk, fruits, and vegetables [4,5]. Less healthy eating patterns in the higher education context can be associated with sedentary behavior and alcoholic beverage consumption, which leads to low quality of life and negative health outcomes [2,6].
Several factors influence the eating behavior of university students, including socioeconomic issues, knowledge, values and beliefs about food, body perception and self-image, preferences, time available for meals, discipline, level of physical activity [3,4,7]. In addition, there are specific factors related to the students' experience (i.e. type of housing, groups, university lifestyle, academic activities), the social and family context (i.e. parental control, family education, social support, peer pressure), the physical environment (i.e. availability, geographical and financial access to healthier foods, cooking utensils), as well as structural determinants (i.e. policies, programs, legislation, socio-cultural norms, media and advertising) [1,3,8].
The Plano Nacional de Assistência Estudantil (PNAES, National Plan of Student Assistance), promulgated in 2010, has encouraged the implementation of affirmative actions to guarantee assistance, permanence, and conclusion of courses by students inserted in Brazilian higher education, including housing, food, and health attention [9]. In view of this, public universities invest in policies focused mainly on university restaurants, which are subsidized and associated with meals of better nutritional quality [4,10]. Considering that not all universities (especially the private ones) can count on these restaurants, and not all daily meals are included on their menus, it is essential to promote actions that encourage students' autonomy to choose and prepare their own food [11,12].
Access to information, culinary practice, and commensality are fundamental principles for an adequate and healthy diet [4,[11][12][13][14][15]. Living with family members or with colleagues and friends in student fraternities and sororities (popularly known as repúblicas in Brazil), as well as cooking and sharing meals increase the chances of eating healthier foods [12]. In contrast, the lack of meal planning and poor cooking skills are linked to a higher consumption of ultra-processed foods [13,15]. Thus, there is a need to investigate the dietary practices of university students and develop viable and appropriate intervention strategies focusing on the students' realities [5,9]. Various food and nutritional intervention programs targeting young adults in university have been adopting information and communication technologies, and studies in this field are fundamental in the current context, especially when utilizing innovative virtual learning environments and participatory methodologies [6,16,17]. Educational interventions should foster comprehensive discussions about food systems, and eating habits under culture, environment and society debates [15]. Furthermore, universities have an actual and essential role in promoting health even besides the academic context, for instance encouraging commensality in repúblicas and cooking as an emancipatory practice [11,13,14].
Therefore, this article presents the course Comida de República as an institutional action promoted by the Universidade Federal de São Paulo (Unifesp), which promotes a virtual learning environment to encourage adequate and healthy eating in the context of university life. The objective is to present the theoretical and methodological framework of the intervention and investigate its potential to influence students' eating decisions.

M E T H O D S
The study was a web-based intervention promoted by the Universidade Federal de São Paulo, Pró-Reitoria de Assuntos Estudantis (PRAE, Office of the Dean of Student Affairs) as a Distance Education Course based on the Moodle software platform. The intervention targeted undergraduate students, with the aim of problematizing the university experience in its various determinations, especially food and its biological, psychological, social, cultural, economic, environmental, and political interfaces.
The pedagogical inspiration came from the principles of Popular Education, which emerges from the socio-historical reality of the participants to produce dialogic relationships and an educational space for reflection and knowledge-sharing to build concrete, meaningful, and transformative social strategies in the context of the university and life [18]. In this perspective, the following pedagogical moments were proposed: reality study, theoretical deepening, and action strategy. The educational practice relied on the Freirean concept of "praxis", the action-reflection-action cycle [19]. Thus, the educational process raised and proposed new ways of acting, employing the students' experiences and life stories, as well as dialogic and horizontal relationships, to deepen the theoretical debate [18,20].
Online discussion forums were facilitated by the research team aiming to stimulate interactivity and participation by enabling recursion and multiple manifestations, connections, and trajectories. The https://doi.org/10.1590/1678-9865202134e200016 4 GM VEDOVATO & FG LEONARDI coordinators (a nutritionist and a social worker) were responsible for the elaboration of pedagogical strategies, materials, and contents, and for providing technical-scientific support to tutors. The tutors had the task of continuously interacting with the participants, raising reflections and answering questions, and this role was played by nutritionists linked to PRAE-Unifesp, scholarship students, and previous participants.
The course was oriented by the Reference Landmark for Food and Nutrition Education and had the Dietary Guidelines for the Brazilian Population as the main theoretical framework [15,21]. The educational activities, structured in six blocks (Chart 1), were developed over eight weeks (total of 20 hours). During the formative process, the participants were mobilized to reflect and discuss about the dimensions and main issues involved in the act of eating, especially in the face of the challenges of the contemporary university routine. Although the course covers food-related questions in repúblicas (focusing particularly those students living far away from their family homes), many students still live with family members and/or in different contexts of life, which increases diversity in the discussions and the possibilities and configurations of eating dynamics. Thus, the course is not limited to dealing with issues individually, but aims to foster debates about the food that comes to the plate, and about the current dilemmas as eaters, consumers, and citizens.
Besides the thematic units, resources and activities (online presentations, readings, videos, forums), the course had a transversal component: Caldeirão de Dicas (Cauldron of Clues). In this space, participants were encouraged to share recipes, ideas, innovations, and strategies (images, videos, texts) that facilitate  Images about what families consume around the world (Project Hungry Planet); Video with testimonials from university workers about how was their eating habits during the time spent at the university; Reading: "Beans with rice and rice with beans: Brazil in the Brazilian dish" (Lívia Barbosa); Thematic forum: "What do university students eat in repúblicas?".
2..To identify the student's relationship with their universe of experience and housing with other people (students and/or family) in the context of food. daily eating. And so, the role of tutoring was to problematize issues such as access, quality of ingredients, availability of resources (cost, equipment and utensils, etc.), and skills.
The course was advertised to all six undergraduate campuses and by the coordinators on websites, social networks, and posters. It was created in 2015 and, in 2019, its seventh edition was held. Since 2018, it has been promoted as an extension action and open to the external community, including students and professionals from other public and private universities. A total of 459 students was enrolled, and an average proportion of 60.6% of participants started the course's activities and 37.8% of them completed the course.
In this study, were analyzed data obtained from participants who completed the initial (n=201) and the final (n=82) online questionnaires of the seven editions of the course. The questionnaires were made available on the course's platform, and were filled out by the participants of each edition (2015-2019) at the time of the course. The variables to describe the participants' characteristics and some eating practices were: area of the university campus; type of residence; company for meals; meal location at home; cooking skill; use of the university restaurant; perception of the need to change eating habits. Pearson Chi-Square test (2-sided) was performed to compare differences between the characteristics of participants' who started and finished the course. The frequency, central tendency, and dispersion of the variables were obtained to Reading "Capitalism and food policy: The world cannot be a great supermarket" (João Pedro Stédile) and "Food Sovereignty: a necessity of the peoples" (João Pedro Stédile and Horacio Martins de Carvalho); Quizz about the articles; Thematic forum: "Building together: food production in the capitalist system". 5 Gastro-anomy 1..To discuss the concept "Gastroanomy" (Claude Fischler); describe the participants and the possible eating changes. To quantitatively assess these changes, the paired Student's t-test was used to compare the individual's relationship with food before and after the course (outcome variable): (1) very good; (2) good; (3) regular; (4) bad/very bad. Although the outcome variable was very general and not able to capture the complexity of the eating changes, it was adopted to signal any possible food-related perception of change influenced by the intervention, which were better understood by the complementary qualitative approach. A significance level of p<0.05 was considered and the analyzes were performed using the statistical software SPSS ® (version 25, SPSS Inc., Chicago, IL, USA).
The qualitative outcome evaluation was performed to capture perceived changes, barriers, and facilitators among participants, and involved a thematic content analysis. An inductive approach was adopted to identify themes and codes emerging from the answers to three following open questions: "what were the main eating changes after the course? what were the main barriers/facilitators to change?". An ecological framework was used to guide the content analysis, and identify multiple levels of factors (such as intrapersonal, interpersonal, environmental) and structural attributes that may have influenced the reported changes positively or negatively, to an adequate and healthy eating in the context of university life and the course participation. Ecological models of health behavior consider the interactions between individual characteristics and their social and physical contexts, which can include for example, friends, family, housing and community settings, formal and informal groups and organizations, university and urban environments [22]. This study was approved by the Unifesp Research Ethics Committee (Process n. 0479/2019).

R E S U L T S
Of a total of 201 starting participants, 82 completed the activities (adherence rate: 40.8%) and answered both questionnaires in the course ( Table 1). The majority were from campuses in the areas of Health Sciences (37.3% of the enrolled and 40.2% of the ones who completed the course, respectively), Computer Sciences (22.9% and 26.8%) and Human and Social Sciences (19.9% and 15.9%). The average age (±Standard Deviation) of participants was 23 years (±6.2), with 35.4% reporting living in repúblicas and 47.6% with family members. Most undergraduates reported knowing how to cook, even if minimally (97.5%), but have their major meals at the university restaurant (89.0%). The need to change eating habits and improve the relationship with food was strongly recognized by starting (90%) and concluding participants (86.6%) before the course. The concluding participants did not differ from the starting students in the sociodemographic and dietary characteristics, except for the use of the university restaurant, which was significantly less frequent among them.
Before the course, 57.3% of the participants classified their diet as "regular", and only 26.8% as "good" ( Table 2). The perception of the relationship with food changed significantly after the course, with a decrease in "regular" perception (29.3%) and an increase in "good" perception (58.5%). After the course, 87.8% of the participants observed eating changes (Table 3), categorized into two themes: "views on food production and distribution" and "consumption of food and meals".
Five codes of the theme "views on food production and distribution" emerged, which highlighted aspects related to a greater awareness and criticality about food systems: socio-environmental impacts (concerns with social and environmental issues related to the production, commercialization and consumption of food, especially those with high degree of processing); economic and labor issues (logic of profit and exploitation of labor from the perspective of capitalism); concerns with food origin (individual concern that Note: 1 Enrolled participants who completed the initial questionnaire (n=201); 2 Enrolled participants who completed the course activities, as well as the initial and final questionnaires (n=82); *Chi-squared test (2-sided, linear-by-linear association), p< 0.05. the food produced is known and recognized as safe and healthy); valuing healthier and more sustainable food circuits (importance of shorter farming systems, based on agroecology and organic production); reflection on food choices (critical-reflexive attitude about the relationship between human beings and their food).
From the theme "consumption of food and meals", six codes emerged, relating to individual changes in the context of nutrition, health, and well-being: increased repertoire of foods and/or recipes (curiosity to try new foods/recipes); cooking (greater appreciation and availability to prepare their own https://doi.org/10.1590/1678-9865202134e200016

Psychological aspects
It is something psychological that I still need to work on.

Sensory and hedonic aspects
I love to eat tasty foods that are not healthy.

Family and friends
My family doesn't eat very well, so anything new and healthier that I bring is not so well received.

Lack of company
Cooking alone is more boring; it is more difficult to have a more varied meal. food); commensality (recognition of the meal as a moment of social interaction); meal planning (greater investment in planning meals and choosing foods); increased consumption of natural and/or minimally processed foods; decreased consumption of ultra-processed foods.
Attempting to make changes in eating habits, 67.1% of participants faced barriers, categorized into environmental, personal, and interpersonal ( Table 3). The codes that emerged in the "environmental" category are related to the lack of information and difficulties in physical, geographic, or financial access to healthier foods. In the "personal" category, the codes were: lack of money, time and motivation for changes, little ability to cook, issues related to diseases, psychological aspects and the solidity of previous eating habits, and food preferences based on sensory and hedonic aspects. In "interpersonal" barriers, codes were related to family and friends and the lack of company for meals.
Regarding the facilitators (59%) ( Table 3), the course content and educational interactions were identified as important in triggering the process of changing eating practices.

D I S C U S S I O N
The course proved to be a relevant strategy to promote an adequate and healthy diet among university students. The focus given to other dimensions of the act of eating, beyond biological and nutritional issues, shows that the current intervention proposal is in line with the Food Guide for the Brazilian Population [15]. In the literature, most of the interventions for university students focus on outcomes related to health and the nutritional adequacy of the diet, with few studies aiming at stimulating commensality, cooking skills and reflexive attitudes towards food and environmental sustainability [6,11,12,14,17,23]. Incorporating social, cultural, environmental, economic, and political aspects into Food and Nutrition Education programs is essential to achieving greater adequacy and effectiveness [21].
In general, the course produced changes in knowledge and attitudes about food. The participants reported greater awareness and criticality of their own food choices and how they may foster hegemonic food systems, based on agribusiness and large-scale production of foods with a high degree of industrial processing, and negative impacts. Thus, understanding that these issues affect society and the environment in an ethical and macro-political perspective influences food choices and consumption behaviors [24].
After the course, there was a significant modification in the perception of their relationship with food, which went from "regular" to "good". The main eating changes, at the behavioral level, were lower intentions to consume ultra-processed products and higher preference for fruits and vegetables, even in periods of more intense academic routine. Knowledge, perceptions, and positive attitudes towards healthy eating may lead to a better relationship with food and healthier behaviors over time [1,15]. Other web-based dietary interventions with university students identified a predominant effect on cognitive variables, and low on behavioral variables [6]. Thus, achieving changes related to the selection, purchase, and preparation of food in the college context constitutes a methodological challenge for interventions.
The majority of participants reported knowing how to cook at the beginning of the course and, at the end, there was an increase in interest in new culinary techniques and the repertoire of food and recipes. The facilitation of the course forums encouraged the behavior of cooking from an emancipatory and political perspective, which also meant defending the use of fresh foods (and/or with a low degree of industrial processing), and supporting local, fairer, and more sustainable food systems [15]. Likewise, based on the precept that the kitchen constitutes a creative space and structure of the food identity of groups, this intervention presented the Cauldron of Clues as a dialogical component and strategic collection of information and ideas to facilitate and transform the students' food routines [25]. The disclosure of ingredients, equipment, culinary techniques, rituals, traditions, and stories involved in food preparation provides a greater understanding of eating practices, and supports the development and testing of recipes to inform interventions focused on cooking [12,13,25].
Despite the cooking skills, most of the participants reported having their main meals at the university restaurant. In 2017, Unifesp instituted its Food Policy, making progress on issues of the university restaurant related to access and quality [26]. In this context, the course emerged as an observatory of eating practices, and also as a management tool in health care and to promote nutritional security in order to monitor and evaluate the impact of the university restaurant on the students' food dynamics. Interestingly, in this study we observed that among the concluding participants there was significantly less use of the university restaurant, compared to the participants who had just started the course. That may indicate a greater interest and need to improve knowledge and eating practices.
Participants identified barriers, such as lack of access, time, money, organization, motivation, support, and company for meals at home. Issues related to the lack of physical and financial access corroborate other studies with university students in Brazil [4,5,10] and in other countries [3]. Also, social support at this phase of life, especially from family and friends, seems to have an important influence on food quality, because it affects psychosocial and environmental aspects [3,10]. In this study, although a large part of the participants lives in repúblicas or with family members, a considerable proportion of students ate alone. As eating with company positively influences food consumption, the course encourages the gathering of efforts and division of tasks related to planning food purchases and cooking in shared houses, in addition to sharing meals [15]. Future studies may deepen the understanding of factors that influence eating behaviors during the academic journey, including commensality and aspects of the physical and social environment.
The course was identified as an important facilitator for eating changes. The educational resources stimulated wide reflections on aspects that go beyond the complexity of the food path from "field to table", and included socioeconomic and ethical discussions. Hence, they allowed the collective and collaborative construction of strategies for less industrially processed food, more planned, shared, and suitable for university life. Considering that a large part of the web-based interventions with university students works with standard messages, this course, based on Popular Education, presented an innovative approach close to the students' realities [6,16,17,23]. The role of students as tutors was essential to reach peers and promote the construction of knowledge and practices in a sensitive way and connected to the universe of college life.
Information and communication technologies were powerful devices to promote dialogic teaching using interactive educational processes, which facilitated the collective production at the individual and group level [20]. In this intervention, the internet design was not limited to overcoming space-time distances, nor to the unidirectional transposition of information and rigidly structured tasks. Contrarily, the current action promoted a collaborative learning environment with horizontal knowledge exchange, supportive and dialogic argumentation, and peer feedback. Even though digital technologies facilitate the educational process through the improvement of access, inclusion, time flexibility, agility for tasks, comprehensiveness, and reach among students, the adherence, participation, and completion rates in distance education are still a challenge, and need to be further investigated [20].
It is worth recognizing that this course was an advantageous approach to overcome the geographical distance and involve students from different university campuses and settings. The extensionist nature and the participation of the external audience allow the reproduction of this educational proposal in other institutions. However, some limitations of the study are to be acknowledged: firstly, the students decided to participate in the course themselves, and therefore the study participants may have had a special interest in discussing the intervention topics and been more open to change their eating behaviors. Secondly, the intervention design did not include a control group, and this fact limits the possibility of attributing the changes in students' perceptions we observed exclusively to the effect of the course participation. Additionally, we did not adopt validated questionnaires to evaluate the impact of the intervention on students' eating practices. However, the adoption of both quantitative and qualitative methodologies in a complementary way allowed a greater and deeper understanding of the individual's consumption intention and the relationship with food after participating in the course.

C O N C L U S I O N
In summary, this article presents an overview of the course Comida de República as an educational and management strategy to promote adequate and healthy food in the university context. The course, based on Popular Education, played an important role in building knowledge and perceptions of college students about healthy eating in contemporary times, in line with the Dietary Guidelines for the Brazilian Population. Concerns about the negative impacts of hegemonic food systems on social and environmental issues generated discussions about individual food choices, which may have reflected in eating changes among participants, especially a greater awareness of the importance of cooking, commensality, and meal planning, and the intention to increase the consumption of minimally processed foods and decrease ultraprocessed products, even when the routine of academic work is most intense. Additionally, a positive perception of change occurred regarding participants' relationship with their food after the intervention. The participants also reported environmental, personal and interpersonal barriers to achieve a healthier diet, such as lack of access, time, and support from family and friends. The course worked as a facilitator of the described eating changes, with emphasis on its educational content, strategies, and the tutoring role in the learning process closer to the university students' social reality.

A C K N O W L E D G M E N T S
The authors gratefully acknowledge the students in the Course for their kindness to participate in this research, and all the members of the tutoring team (nutritionists and students) for their enthusiasm, help, and support. We also acknowledge the institutional support from the Office of the Dean of Student Affairs (PRAE-Unifesp).
C O N T R I B U T O R S GM VEDOVATO was involved in designing the study, analyzing and interpreting the data, writing and revising the paper. LEONARDI FG was also involved in designing the study, analyzing and interpreting the data, and critically revising the paper. Both authors read and approved the final manuscript.