Hygienic food handling behaviours. An application of the Theory of Planned Behaviour

Food safety knowledge, hygiene practices among food handlers, and microbiological quality of animal side dishes in contract catering

Food poisoning is a major concern in catering services in Indonesia, with multiple outbreaks being reported in factories and offices. This study aimed to assess the level of food safety knowledge, personal hygiene practices, and microbiological quality of chicken and egg dishes at three catering companies in the Yogyakarta Special Region of Indonesia, which provide mass catering for workers. From March to July 2019, a cross-sectional study was conducted using validated questionnaires, observation checklists, and microbiological tests to measure the parameters of Escherichia coli and Staphylococcus aureus. Pearson and Rank-Spearman correlation tests, as well as independent sample t-tests, were used for statistical analysis. The study revealed that 75% of the subjects had limited knowledge of food safety, with only 5% having a good understanding. Furthermore, 95% of the subjects had not received any food safety training, resulting in poor hygiene practices among the food handlers. Although there was no significant correlation between food safety knowledge and hygiene practices (p>0.05), certain practices, such as appearance and hand washing, were significantly correlated with age. Employment duration was negatively correlated with food safety knowledge (p=0.027; r=-0.494). While chicken samples were free from E. coli and S. aureus, one egg sample was found to be contaminated with E. coli. The research emphasizes the significance of providing frequent food safety training to food handlers, ideally every year. Additionally, it recommends conducting larger sample studies and collaborating with government agencies for future research.

Does knowledge and concern regarding food supplement safety affect the behavioral intention of consumers? An experimental study on the theory of reasoned action

In recent years, health crises have led consumers to make more frequent purchases of food supplements. The global food supplement market, which reached $61.20 billion in 2020, is estimated to reach $163.12 billion by 2022 and $350.96 billion by 2032. However, many consumers still have concerns about the safety of food supplements. Within the scope of the research, firstly, the health consciousness (HC) level of food supplement consumers was determined. Secondly, food safety knowledge (FSK) and food safety concerns (FSCs) were measured. Thirdly, consumers' attitudes (ATUs), subjective norms (SNs), and behavioral intentions (BIs) toward food supplements were determined within the scope of the theory of reasoned action. The study used a convenient sampling, and 327 participants were included in the sample population. The data for the analysis was collected using the online survey method in the third quarter of 2023. The relationships between hypothesized items in the structural model were tested using the Smart-PLS. The validity and reliability of the measurement model were evaluated at the start of the structural equation modelling approach using confirmatory factor analysis (CFA). Regression analyses were performed in the structural model phase to evaluate overall fit and suggested relationships by way of the Smart-PLS. In light of the findings, it was determined that the interaction between HC and ATU was mediated by FSK, and the interaction between HC and the SN was mediated by FSK. Consequently, this research presents a variety of theoretical and practical implications to give clues for consumers' health regarding food supplement consumption.

What motivates food workers to adhere with WHO guidelines to combat the COVID-19? A social cognitive theory perspective

Background

COVID-19 has become a public health emergency and pandemic of global concern, and the hundreds of millions of foodborne illnesses that occur each year also wreak havoc on human lives, society and the economy. Promoting workers in food service establishments to adhere to the hygiene practices in the WHO guidelines is a two-birds-one-stone strategy in preventing the spread of COVID-19 and limiting the occurrence of foodborne illness. The aim of this study was to determine the drivers that motivate workers to adhere to hygiene practices based on social cognitive theory.

Methods

The cross-sectional survey targeting food workers using face-to-face interviews was conducted from July to September 2022. Stratified random sampling and convenience sampling were employed to locate survey sites and respondents, respectively. The survey uses a credible questionnaire evaluated by multiple reliability and validity measures. Binary logistic regression was employed to identify significant determinants of adherence to WHO-initiated hygiene practices.

Results

A total of 900 workers were interviewed and 609 valid questionnaires were received. The study showed that the average correct rate of knowledge about hygiene practices was only 51.09%, that perceived non-adherence to hygiene practices was most likely to result in lower customer satisfaction and the spread of COVID-19, and that only about 11.7% of the workers always adhered to hygiene practices. Three of the cognitive dimensions in the personal factors, self-efficacy, risk perception, and knowledge, had significant positive effects on adherence practices. Among the demographic variables, there were significant differences in adherence practices differing by income level and place of residence.

Conclusion

It was found that workers' knowledge of the WHO-initiated hygiene practices is insufficient and that the frequency of adherence to hygiene practices is poor and require improvement. The significant drivers and effects of demographic variables provide evidence-based guidance to identify priority intervention information and populations to improve worker hygiene practices.

Do Brazilian consumers intend to use food labels to make healthy food choices? An assessment before the front-of-package labelling policy

Front-of-package labelling is a measure that can facilitate consumption of healthier foods. This study examined the predictors of consumers' intentions to use food labelling to make healthy food choices and prevent non-communicable diseases before the implementation of the front-of-package labelling policy in Brazil. An extended theory of planned behaviour incorporating knowledge and food literacy served as the theoretical foundation. First, experts (n = 6) and the target population (n = 30) validated the questionnaire, and the validation data were analysed using content validity coefficients (CVC). An online questionnaire was administered to 783 participants, and data were collected between May and October 2022. Partial least squares structural equation modelling (PLS-SEM) was used to test the prediction hypothesis. The questionnaire showed adequate content validity, with all indicators of CVC ≥ 0.75. In the PLS-SEM attitudes (p < 0.001), subjective norms (p < 0.001), knowledge (p < 0.001), and food literacy (p < 0.001) positively predicted the intention to use food labels to make healthy food choices, confirming the main hypothesis. Also, Food literacy and knowledge predicted all constructs of the theory of planned behaviour (p < 0.001). The results highlight the importance of providing nutritional knowledge and food literacy, developing nutritional skills and abilities to encourage consumers to make healthy food choices, and to strengthen other policies such as front-of-package labelling.

Behavioral predictors of household food-safety practices during the COVID-19 pandemic: Extending the theory of planned behavior

The epidemiological scenario of COVID-19, social distancing, and business restrictions has increased food preparation and consumption at home. Food mishandling at home can significantly raise the risk of foodborne diseases. This study investigates food-mishandling behavior predictors by applying the extended theory of planned behavior (TPB), with the addition of knowledge and risk perception, to households during the COVID-19 pandemic. One thousand and sixty-eight consumers (n = 1068) in Brazil participated in this study before the COVID-19 vaccination period. Data were collected using an online questionnaire with 40 questions and different anchors; they were analyzed using structural equation modeling. The following original TPB factors positively affected the intention to implement safe food-handling practices: attitude (p < 0.001), perceived behavioral control (p < 0.001), and subjective norms (p < 0.001). More robust effects of attitude and perceived behavioral control on intention were also observed. Although food-safety knowledge did not affect intention (p = 0.30), it positively affected the other TPB factors. Perceived risk positively affected all TPB factors. The results of this study support the usefulness of TPB and its extension, providing evidence that public-health crises can contribute to changes in food-safety-related consumer behavior.

Food Hygiene Practices of Rural Women and Microbial Risk for Children: Formative Research in Nepal

Formative research was conducted in a rural hill setting in Nepal during April–June 2012 to inform the design of an intervention to promote safe food hygiene practices. A variety of methods underpinned by Behavior Centered Design theory and Hazard Analysis Critical Control Points was used to pinpoint key risk behaviors and their environmental and psychological determinants in 68 households with a mother having a child aged 6–59 months. These included video recordings, observation of daily routine, teach-the-researcher sessions, in-depth interviews, observations of actual behaviors, focus group discussions, motive mapping, microbiological assessment, and identification of critical control points. Physical settings, especially the kitchen, form a challenging environment for mothers, including family members in rural hill settings of Nepal to practice adequate food hygiene behaviors. Prevalent food hygiene practices of mothers were inadequate, leading to frequent exposure of young children to highly contaminated food, water, and milk. We identified six critical control points; of these, five needed improving. Determinants of these behaviors included physical and social environment as well as psychological brief and individual motives. Five key food hygiene risk behaviors are suggested for prioritization. While designing a food hygiene intervention package, consideration should be given to the physical, biological, and social environment, and immediate motives behind each practice should be taken into consideration while framing key messages. Creative and engaging activities should be designed around the motives of nurture, disgust, affiliation, and social status/respect.

Understanding the predictors of hand hygiene using aspects of the theory of planned behaviour and temporal self-regulation theory

OBJECTIVE

Adherence to proper hand hygiene practice is relatively low and is particularly salient in light of the current COVID-19 pandemic. Having a greater understanding of the psychosocial predictors of engaging in proper hand hygiene is warranted. One way to do this is through the application of a combined theory of planned behaviour and temporal self-regulation theory model.

DESIGN

A prospective two-part study was conducted between May - November 2020, with N = 232 Australians. At time one, variables from both the theory of planned behaviour (attitude, subjective norm, perceived behavioural control, and intention) and temporal self-regulation theory (habit, environmental cues, and planning) were completed.

MAIN OUTCOME MEASURES

One week later, engagement in proper hand hygiene behaviour over the previous week was assessed.

RESULTS

Two hierarchical multiple regressions were conducted, with 47% of variance accounted for in intention, with subjective norm being the strongest predictor, and 38% of variance accounted for in hand hygiene behaviour, with intention being the strongest predictor. Environmental cues also moderated the relationship between intention and behaviour.

CONCLUSIONS

To increase intention, incorporating subjective norm messages in advertisements may be helpful. Incorporating environmental cues in places where hand washing is recommended may assist in increasing hand hygiene.

Determinants of Food Thermometer Use and Poultry Washing among Canadian Consumers

ABSTRACT

Previous surveys have found that few Canadians report using a food thermometer to check cooking doneness, and many report rinsing or washing poultry prior to cooking. A cross-sectional survey study was conducted to investigate the sociodemographic and psychosocial determinants of the reported use of these behaviors among Canadians. A questionnaire was developed, guided by the Theoretical Domains Framework, and pretested through 10 cognitive interviews. The questionnaire was administered in English and French on 18 November 2019, to an online panel of 524 Canadian consumers. Logistic and ordinal regression models were constructed to evaluate determinants of consumers' reported thermometer ownership (yes or no) and thermometer use and poultry washing frequencies (each measured on a 5-point Likert scale). Nearly two-thirds of respondents (64%; n = 333) reported owning a food thermometer. Thermometer ownership was more common among males (odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.02, 2.15) and those with higher income categories. Nearly 45% of these respondents (n = 147) reported often or always using their thermometer to check cooking doneness. The frequency of engaging in this behavior was best determined by four psychosocial constructs: behavioral intentions, beliefs about consequences, self-efficacy, and habits. Nearly two-thirds of respondents (64%; n = 333) reported often or always washing their poultry before cooking it. This behavior was more frequently reported by males (OR = 1.51, 95% CI = 1.002, 2.28). It was also predicted by six psychosocial constructs: behavioral intentions, beliefs about consequences, self-efficacy, social influences, social responsibility, and habits. Habits had the largest influence on both behaviors. The study results can inform the development of more targeted food safety education and outreach initiatives to improve these behaviors among Canadians.

HIGHLIGHTS

A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers

Foodborne diseases are a significant cause of morbidity and mortality worldwide. Studies have shown that the knowledge, attitude, and practices of food handlers are important factors in preventing foodborne illness. The purpose of this research is to assess the effects of training interventions on knowledge, attitude, and practice on food safety and hygiene among food handlers at different stages of the food supply chain. To this end, we conducted a systematic review and meta-analysis with close adherence to the PRISMA guidelines. We searched for training interventions among food handlers in five databases. Randomized control trials (RCT), quasi-RCTs, controlled before-after, and nonrandomized designs, including pre-post studies, were analyzed to allow a more comprehensive assessment. The meta-analysis was conducted using the random-effects model to calculate the effect sizes (Hedges's g) and 95% confidence interval (CI). Out of 1094 studies, 31 were included. Results showed an effect size of 1.24 (CI = 0.89-1.58) for knowledge, an attitude effect size of 0.28 (CI = 0.07-0.48), and an overall practice effect size of 0.65 (CI = 0.24-1.06). In addition, subgroups of self-reported practices and observed practices presented effect sizes of 0.80 (CI = 0.13-1.48) and 0.45 (CI = 0.15-0.76) respectively.

Changes in Consumers' Food Purchase and Transport Behaviors over a Decade (2010 to 2019) Following Health and Convenience Food Trends

Although consumers’ food purchase/transport have been reported as causes of food safety risks, there is a lack of empirical data that are feasible to identify persistent and emerging risky behaviors of consumers. This longitudinal trend study consists of individual consumer surveys in 2010 (n = 609) and 2019 (n = 605) to analyze changes in risky behaviors linked to food purchase/transport over a decade. Overall, the results identified purchase/transport time and purchase order as the emerging and unchanged risk factors, respectively. Consumers’ preferences into channels for purchase (large discount stores rather than small/traditional markets) and transport (using cars or delivery) implied the convenience as the noticeable trend. Whereas, unexpected increases in purchase/transport time highlighted the underestimated risks in long-term exposure of foods under inadequate temperature. Food should not be exposed to danger zones > 1–2 h, but consumers might be unaware of the risk especially for preferred channels (e.g., 77 and 36 min. are required for purchase and transport from large discount stores, respectively). In the case of unchanged risky behavior, more than half of consumers in both surveys did not follow proper purchasing orders. Our findings highlight the necessity for novel countermeasures and the improvement of current consumer guidelines against emerging and unchanged risky behaviors, respectively.

M. Visschers V. Understanding the Underlying Psychosocial Determinants of Safe Food Handling among Consumers to Mitigate the Transmission Risk of Antimicrobial-Resistant Bacteria

In this study, we aimed to explore the psychosocial factors related to consumers’ safe food-handling behaviors to reduce the transmission risk of antimicrobial-resistant bacteria through food products. To this end, we investigated the extent to which the variables of the health action process approach (HAPA) and subjective norms can predict safe food handling by consumers. Data were collected from a representative sample of consumers belonging to the German-speaking part of Switzerland by administering a self-reporting questionnaire. The results showed that risk perception, self-efficacy, and positive outcome expectancy (i.e., the motivational phase of HAPA) were significant predictors of the intentions to handle food in a safe manner (see graphical abstract below). Additionally, in the volitional phase of HAPA, intention was found to be a significant predictor of safe food-handling behaviors. Contrary to expectations based on HAPA, action planning did not mediate the intention–behavior relationship. Only a small part of the variance in behavior was explained by coping planning and action control. The findings confirmed that the motivational phase of HAPA may be useful for determining safe food handling.

The role of Optimistic Bias in safe food handling behaviours in the food service sector

This study evaluates the influences on food handlers' intention to conduct safe handling behaviours in food service settings in Brazil and the United Kingdom, focusing on Optimistic bias (OB). Although OB has been identified in food handlers in other studies, this is the first study evaluating the role of OB in determining behavioural intention. Three hundred participants, from the United Kingdom (n = 150) and Brazil (n = 150), completed a Theory of Planned Behaviour - based questionnaire, including additional questions about OB. For Brazilian food handlers, Attitude had a significant influence on Behavioural Intention followed by Subjective Norm, while Perceived Behavioural Control and OB did not significantly influence Behavioural Intention. For the United Kingdom, Perceived Behavioural Control had the largest influence, followed by Attitude, and then OB. Results suggest that cultural differences may influence predictors of behavioural intention, and that OB can contribute to predicting engagement in safe handling behaviours. Results contribute to a better understanding of the influences on food safety related behaviours.

Predicting Hand Washing and Sleep Hygiene Behaviors among College Students: Test of an Integrated Social-Cognition Model

Objective: Hand washing and sleep hygiene are two important health behaviors. The purpose of the current study was to identify the motivational and volitional antecedents of college students’ hand washing and sleep hygiene behaviors based on an integrated model of behavior that combined social-cognition constructs from the Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA). Methods: Using a prospective design, college students (N = 1106) completed a survey assessing the motivational constructs of action self-efficacy, attitudes, subjective norm, perceived behavioral control, intentions, and behaviors of hand washing and sleep hygiene at Time 1. Demographic variables were also collected. One month later, at Time 2, college students (N = 524) self-reported on their volitional factors of maintenance self-efficacy, action planning, coping planning, and behaviors of hand washing and sleep hygiene. A further 2 months later, at Time 3, college students (N = 297) were asked to self-report on their hand washing and sleep hygiene behaviors over the past month. Findings: Data were analyzed using variance-based structural equation modelling. Results showed significant direct effects of attitudes, subjective norm, and perceived behavioral control on intentions; significant direct effects of action self-efficacy on maintenance self-efficacy; and significant direct effects of maintenance self-efficacy on action planning and coping planning. Significant direct effects of intention on action planning (sleep hygiene only), and significant direct effects of intention, maintenance self-efficacy (hand washing only), action and coping planning on behavior were also observed. Action planning also moderated the intention–behavior relationship, but only for hand washing. There were also significant total indirect effects of action self-efficacy on behavior mediated by maintenance self-efficacy, action planning, and coping planning for both behaviors, and significant total indirect effects of subjective norm and perceived behavioral control on behavior mediated by intention for sleep hygiene. When past behavior was included in the integrated model predicting all the psychological variables and behavior, all of the structural relations were attenuated. Discussion: Current findings indicate that college students’ hand washing and sleep hygiene behaviors are a function of both motivational and volitional factors. Findings also indicate that the TPB and HAPA pathways might differ for the two health behaviors. Implications of the current findings for future health interventions aimed at improving college students’ hand washing and sleep hygiene are discussed.

Modeling farmers' responsible environmental attitude and behaviour: a case from Iran

There is an increasing concern over the environmental degradation caused by agricultural activities especially in developing countries which mostly linked to farmer's behavior. Thus, this study aimed to model the responsible attitude and behavior of Iranian farmers in respect to environment. The Theory of Planned Behavior (TPB) was used as a basis for identification of the main determinants of the farmers' responsible environmental behavior. A survey of 400 farmers in the Hamedan Province, selected through a multistage stratified random sampling method. Data was gathered using a questionnaire which its validity and reliability were confirmed by a panel of agricultural and environmental experts and calculated Cronbach's alpha (0.65 ≤ α ≤ 0.80), respectively. Data were analyzed using structural equation modeling (SEM) to evaluate the strength of relationship between the constructs and test the overall model fit. Results of study showed that "using animal manure in the farms" was the most important behavior which farmers are responsibly doing to respect their environment but their least attention is given to "disposing cans and bottles after spraying." Also, the fitness indices of the model revealed that the TPB partially supported the farmers' responsible environmental behavior as perceived behavioral control and environmental attitude positively influenced the farmers' responsible environmental behavior but there was not observed any significant influence by subjective norm. Among the additional incorporated constructs, environmental awareness, ethical commitment, and environmental concern significantly had a positive influence on farmers' behavior by mediating role of the environmental attitude. The inclusion of new constructs in the TPB model was supported through improving the predictive power of the modified model in predicting farmers' responsible environmental behavior.

Wearable Technology Effects on Training Outcomes of Restaurant Food Handlers

Food safety training does not always result in behavior change, perhaps because of flaws inherent in traditional training designs. New technologies such as augmented reality headsets or head-mounted action cameras could transform the way food safety training is conducted in the food industry. Training conducted with wearable technology presents visual content in the first-person or actor's perspective, as opposed to the traditional third-person or observer perspective. This visual hands-on first-person perspective may provide an effective way of conveying information and encouraging behavior execution because it uses the mirror neuron system. There is little published literature about the impact of perspective on food safety training outcomes, such as motivation. The present study included a repeated-measures design to determine how first- and third-person camera angles affected hand washing training reactions among 108 currently employed restaurant food handlers. Participants were assessed on their posttraining compliance intentions, compliance self-efficacy, perceived utility of the training, overall satisfaction with the training, and video perspective preference. A significant proportion of food handlers (64%) preferred the first-person video perspective ( z = 5.00, P < 0.001), and a significant correlation was found between compliance intentions and compliance self-efficacy ( r(108) = 0.361, P < 0.001) for the first-person video. No significant differences in video preference were found for demographic variables, including age (χ² (2, n = 104) = 1.69, P = 0.430), which suggests that the first-person training format appeals to a diverse workforce. These findings support the application of wearable technology to enhance hand washing training outcomes across a wide range of demographic groups. This research lays the framework for future studies to assess the impact of instructional design on compliance concerning hand washing and other food handling behaviors.

Observation of High School Students' Food Handling Behaviors: Do They Improve following a Food Safety Education Intervention?

Youth are a key audience for food safety education. They often engage in risky food handling behaviors, prepare food for others, and have limited experience and knowledge of safe food handling practices. Our goal was to investigate the effectiveness of an existing food handler training program for improving safe food handling behaviors among high school students in Ontario, Canada. However, because no schools agreed to provide control groups, we evaluated whether behaviors changed following delivery of the intervention program and whether changes were sustained over the school term. We measured 32 food safety behaviors, before the intervention and at 2-week and 3-month follow-up evaluations by in-person observations of students ( n = 119) enrolled in grade 10 and 12 Food and Nutrition classes ( n = 8) and who individually prepared recipes. We examined within-student changes in behaviors across the three time points, using mixed effects regression models to model trends in the total food handling score (of a possible 32 behaviors) and subscores for "clean" (17 behaviors), "separate" (14 behaviors), and "cook" (1 behavior), adjusting for student characteristics. At baseline, students ( n = 108) averaged 49.1% (15.7 of 32 behaviors; standard deviation = 5.8) correct food handling behaviors, and only 5.5% (6) of the 108 students used a food thermometer to check the doneness of the chicken (the "cook" behavior). All four behavior score types increased significantly ∼2 weeks postintervention and remained unchanged ∼3 months later. Student characteristics (e.g., having taken a prior food handling course) were not significant predictors of the total number of correctly performed food handling behaviors or of the "clean" or "separate" behaviors, working or volunteering in a food service establishment was the only characteristic significantly associated with food thermometer use (i.e., "cook"). Despite the significant increase in correct behaviors, students continued to use risky practices postintervention, suggesting that the risk of foodborne disease remained.

Factors related to reduction in the consumption of fast food: application of the theory-based approaches

Background

The Trans-Theoretical model (TTM) and Theory of Planned Behaviour (TPB) may be promising models for understanding and predicting reduction in the consumption of fast food. The aim of this study was to examine the applicability of the Trans-Theoretical model (TTM) and the additional predictive role of the subjective norms and perceived behavioural control in predicting reduction consumption of fast food in obese Iranian adolescent girls.

Materials and Methods.

A cross sectional study design was conducted among twelve randomly selected schools in Sabzevar, Iran from 2015 to 2017. Four hundred eighty five randomly selected students consented to participate in the study. Hierarchical regression models used to predict the role of important variables that can influence the reduction in the consumption of fast food among students. using SPSS version 22.

Results

Variables Perceived behavioural control (r=0.58, P<0.001), Subjective norms (r=0.51, P<0.001), self-efficacy (r=0.49, P<0.001), decisional balance (pros) (r=0.29, P<0.001), decisional balance (cons) (r=0.25, P<0.001), stage of change (r=0.38, P<0.001), were significantly and positively correlated while experiential processes of change (r=0.08, P=0.135) and behavioural processes of change (r=0.09, P=0.145), were not significant.

Conclusions

The study demonstrated that the TTM (except the experiential and behavioural processes of change) focusing on the perceived behavioural control and subjective norms are useful models for reduction in the consumption of fast food.

Breakfast consumption determinants among female high school students of Yazd Province based on Pender's Health Promotion Model

BACKGROUND AND AIM

Despite the importance of breakfast, especially for students, unfortunately, this meal is usually ignored in daily routine. The aim of this study was to identify determinants among female high school students of Yazd province based on the Pender Health Promotion Model.

METHODS

This was a cross-sectional study conducted to examine 200 female high school students of Yazd, selected by cluster sampling method in 2016. A researcher-made questionnaire, based on Pender's Health Promotion Model, was used as a data collection tool. A panel of experts and Cronbach's alpha coefficient were used to confirm the questionnaire validity and reliability. In order to analyze descriptive data, SPSS version 22 was used. AMOS software (v.23) was employed for path analysis.

RESULTS

Direct impact of activity -related affect (0.300), interpersonal influences (0.276), and perceived barriers to eating breakfast (-0.223) were approved at significance level p<0.000. By influencing perceived barriers, perceived self-efficacy and previous related behavior indirectly affected breakfast consumption. These components determined 33% of breakfast consumption.

CONCLUSION

By planning to create a positive feeling in students to have breakfast, to involve family and friends to encourage students to eat breakfast, to reduce barriers to have breakfast by increasing students' self-efficacy, the behavior of having breakfast among students can be improved.

Explaining Consumer Safe Food Handling Through Behavior-Change Theories: A Systematic Review

Consumers often engage in unsafe food handling behaviors at home. Previous studies have investigated the ability of behavior-change theories to explain and predict these behaviors. The purpose of this review was to determine which theories are most consistently associated with consumers' safe food handling behaviors across the published literature. A standardized systematic review methodology was used, consisting of the following steps: comprehensive search strategy; relevance screening of identified references; confirmation of relevance and characterization of relevant articles; risk-of-bias assessment; data extraction; and descriptive analysis of study results. A total of 20 relevant studies were identified; they were mostly conducted in Australia (40%) and the United States (35%) and used a cross-sectional design (65%). Most studies targeted young adults (65%), and none focused on high-risk consumer groups. The outcomes of 70% of studies received high overall risk-of-bias ratings, largely due to a lack of control for confounding variables. The most commonly applied theory was the Theory of Planned Behavior (45% of studies), which, along with other investigated theories of behavior change, was frequently associated with consumer safe food handling behavioral intentions and behaviors. However, overall, there was wide variation in the specific constructs found to be significantly associated and in the percentage of variance explained in each outcome across studies. The results suggest that multiple theories of behavior change can help to explain consumer safe food handling behaviors and could be adopted to guide the development of future behavior-change interventions. In these contexts, theories should be appropriately selected and adapted to meet the needs of the specific target population and context of interest.

Mothers' intentions to vaccinate their teenaged children against human papillomavirus, as predicted by sex in South Korea: An application of the theory of planned behavior

AIM

This study was conducted in order to examine the intention of mothers to vaccinate their teenaged children against human papillomavirus (HPV) infection, according to the children's sex. Based on the theory of planned behavior, the study identified the sex-specific predictors of mothers' intention to vaccinate their teenaged children against HPV.

METHODS

This was a descriptive survey study that included, as participants, 200 mothers whose teenaged children were not vaccinated against HPV.

RESULTS

The mothers' experience with HPV vaccination was a significant predictor of their childrens' HPV vaccination status. For the mothers of sons, subjective norms, attitudes, and perceived behavioral control were found to be significant predictors of intention of HPV vaccination, with an explanatory power of 69.5%. For those with daughters, only attitudes and subjective norms were significant predictors, with an explanatory power of 79.6%.

CONCLUSION

The application of the theory of planned behavior is an effective method to determine the predictors of children's HPV vaccination status. In order to improve the HPV vaccination rate of teenaged children, strategies for education and effective promotion that involve mothers should be developed.

Barriers and Facilitators to Safe Food Handling among Consumers: A Systematic Review and Thematic Synthesis of Qualitative Research Studies

Foodborne illness has a substantial health and economic burden on society, and most cases are believed to be due to unsafe food handling practices at home. Several qualitative research studies have been conducted to investigate consumers' perspectives, opinions, and experiences with safe food handling at home, and these studies provide insights into the underlying barriers and facilitators affecting their safe food handling behaviours. We conducted a systematic review of previously published qualitative studies in this area to synthesize the main across-study themes and to develop recommendations for future consumer interventions and research. The review was conducted using the following steps: comprehensive search strategy; relevance screening of abstracts; relevance confirmation of articles; study quality assessment; thematic synthesis of the results; and quality-of-evidence assessment. A total of 39 relevant articles reporting on 37 unique qualitative studies were identified. Twenty-one barriers and 10 facilitators to safe food handling were identified, grouped across six descriptive themes: confidence and perceived risk; knowledge-behaviour gap; habits and heuristics; practical and lifestyle constraints; food preferences; and societal and social influences. Our overall confidence that each barrier and facilitator represents the phenomenon of interest was rated as high (n = 11), moderate (11), and low (9). Overarching analytical themes included: 1) safe food handling behaviours occur as part of a complex interaction of everyday consumer practices and habituation; 2) most consumers are not concerned about food safety and are generally not motivated to change their behaviours based on new knowledge about food safety risks; and 3) consumers are amenable to changing their safe food handling habits through relevant social pressures. Key implications and recommendations for research, policy and practice are discussed.

Control beliefs and engagement in hygienic and safety behaviours: the case of foodborne illness

Foodborne illness is an ever-growing concern in public health. Studies found that conventional training is not enough to cause employees to apply the hygiene and safety measures. The present study explores control and fatalistic beliefs as potential factors for explaining engagement in preventive actions. Two-hundred and seventeen employees of a fast-food restaurant (75 % of all staff) answered a questionnaire assessing their control beliefs, fatalistic beliefs, risk perception, and engagement in hygienic and safety behaviours. The results validated our hypotheses. Control beliefs were positively related to engagement in hygienic and safety behaviours (b = 0.43, p < 0.001). The inverse relation was observed for fatalistic beliefs (b = - 0.24, p < 0.001). The perceived effectiveness of the prescribed measures seems to be the best predictor of engagement in preventive behaviours, followed by perceived self-efficacy. To increase adherence to preventive measures, it is recommended to enhance staff's self-efficacy and perceived effectiveness of these measures.

The extended Theory of Planned Behavior in explaining exclusive breastfeeding intention and behavior among women in Kelantan, Malaysia

BACKGROUND/OBJECTIVES

The purpose of this study is to utilize an extended Theory of Planned Behavior in identifying predictors of exclusive breastfeeding intention and behavior among women in Kelantan, Malaysia.

SUBJECTS/METHODS

A prospective cohort study was conducted, recruiting pregnant womenthrough two-stage cluster sampling. Their exclusive breastfeeding intention, attitude, perceived norm, perceived behavioral control and past behavior were obtained at baseline through interviewer-guided questionnaire. At one month after delivery, another interview was conducted to determine the two additional variables in the extended theory, which were their postpartum support and breastfeeding difficulty. The behavior, which was the actual duration of exclusive breastfeeding, was obtained from the second follow-up at six months. Pearson correlation and two hierarchical regression analyses were conducted.

RESULTS

A total of 200 women completed the study follow-up. Their median intended exclusive breastfeeding duration was 4.0 (IQR 5) months, and the median actual duration was 1.0 (IQR 4) month. The Theory of Planned Behavior explained 51.0% of the variance in intention, with perceived behavioral control and attitude were the significant predictors. It also explained 10.0% of the variance in behavior, but the addition of postpartum support and breastfeeding difficulty increased the amount of explained variance in behavior by 6.0%. The significant predictors of exclusive breastfeeding behavior were intention, postpartum support and breastfeeding difficulty.

CONCLUSION

The extended Theory of Planned Behaviorhad a good predictive ability in explaining exclusive breastfeedingintention and behavior. The women's intention to practice exclusive breastfeeding may be improved by improving their perceived behavioral control and attitude. Providing correct postpartum support and skills to handle breastfeeding difficulties after delivery will improve their exclusive breastfeeding behavior.

Developing and testing a measurement tool for assessing predictors of breakfast consumption based on a health promotion model

OBJECTIVE

To develop an instrument for measuring Health Promotion Model constructs in terms of breakfast consumption, and to identify the constructs that were predictors of breakfast consumption among Iranian female students.

DESIGN

A questionnaire on Health Promotion Model variables was developed and potential predictors of breakfast consumption were assessed using this tool.

PARTICIPANTS

One hundred female students, mean age 13 years (SD ± 1.2 years).

SETTINGS

Two middle schools from moderate-income areas in Qom, Iran.

VARIABLES MEASURED

Health Promotion Model variables were assessed using a 58-item questionnaire. Breakfast consumption was also measured.

ANALYSIS

Internal consistency (Cronbach alpha), content validity index, content validity ratio, multiple linear regression using stepwise method, and Pearson correlation.

RESULTS

Content validity index and content validity ratio scores of the developed scale items were 0.89 and 0.93, respectively. Internal consistencies (range, .74-.91) of subscales were acceptable. Prior related behaviors, perceived barriers, self-efficacy, and competing demand and preferences were 4 constructs that could predict 63% variance of breakfast frequency per week among subjects.

CONCLUSIONS AND IMPLICATIONS

The instrument developed in this study may be a useful tool for researchers to explore factors affecting breakfast consumption among students. Students with a high level of self-efficacy, more prior related behavior, fewer perceived barriers, and fewer competing demands were most likely to regularly consume breakfast.

Food safety in home kitchens: a synthesis of the literature

Although foodborne illness is preventable, more than 56,000 people per year become ill in the U.S., creating high economic costs, loss of productivity and reduced quality of life for many. Experts agree that the home is the primary location where foodborne outbreaks occur; however, many consumers do not believe the home to be a risky place. Health care professionals need to be aware of consumers' food safety attitudes and behaviors in the home and deliver tailored food safety interventions that are theory-based. Thus, the purpose of this paper is to synthesize/summarize the food safety literature by examining the following: consumers' perceptions and attitudes towards food safety and their susceptibility to foodborne illness in the home, work, and school; common risky food safety practices and barriers to handling food safely; and the application of theory-based food safety interventions. Findings will help healthcare professionals become more aware of consumers' food safety attitudes and behaviors and serve to inform future food safety interventions.