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Sousa IC, Mucinhato RMD, Prates CB, Zanin LM, da Cunha DT, Capriles VD, de Rosso VV, Stedefeldt E. Do Brazilian consumers intend to use food labels to make healthy food choices? An assessment before the front-of-package labelling policy. Food Res Int 2023; 172:113107. [PMID: 37689875 DOI: 10.1016/j.foodres.2023.113107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 09/11/2023]
Abstract
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.
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Affiliation(s)
- Isabel Costa Sousa
- Food Labeling Observatory, Nutrition and Food Service Research Center (CPPNAC), Federal University of São Paulo (UNIFESP), Santos, SP, Brazil.
| | - Raísa Moreira Dardaque Mucinhato
- Postgraduate Program in Nutrition - Federal University of São Paulo - UNIFESP, 862, Botucatu St, Vila Clementino, São Paulo, SP 04024-002, Brazil.
| | - Carolina Bottini Prates
- Postgraduate Program in Nutrition - Federal University of São Paulo - UNIFESP, 862, Botucatu St, Vila Clementino, São Paulo, SP 04024-002, Brazil.
| | - Laís Mariano Zanin
- Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo - USP, 3900 Bandeirantes Av., Monte Alegre, Ribeirão Preto, SP 14049-900, Brazil.
| | - Diogo Thimoteo da Cunha
- Multidisciplinary Laboratory of Food and Health, School of Applied Sciences - State University of Campinas - UNICAMP - SP, 1300, Pedro Zaccaria St., Limeira, SP 13484-350, Brazil.
| | - Vanessa Dias Capriles
- Food Labeling Observatory, Nutrition and Food Service Research Center (CPPNAC), Federal University of São Paulo (UNIFESP), Santos, SP, Brazil; Federal University of São Paulo (UNIFESP), Institute of Health and Society (Campus Baixada Santista), Department of Biosciences, Silva Jardim st, 136, 11015-020, Santos, SP, Brazil.
| | - Veridiana Vera de Rosso
- Food Labeling Observatory, Nutrition and Food Service Research Center (CPPNAC), Federal University of São Paulo (UNIFESP), Santos, SP, Brazil.
| | - Elke Stedefeldt
- Food Labeling Observatory, Nutrition and Food Service Research Center (CPPNAC), Federal University of São Paulo (UNIFESP), Santos, SP, Brazil; Department of Preventive Medicine - Federal University of São Paulo - UNIFESP, 740, Botucatu St, fourth floor, Vila Clementino, São Paulo, SP 04024-002, Brazil.
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Charlesworth J, Mullan BA. Examining Safe Food-Handling Knowledge, Behaviour, and Related Psychological Constructs among Individuals at Higher Risk of Food Poisoning and the General Population. Foods 2023; 12:3297. [PMID: 37685229 PMCID: PMC10487084 DOI: 10.3390/foods12173297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Safe food-handling knowledge and behaviour are low across the general population. This raises concerns about whether individuals at higher risk of food poisoning have sufficient safe food-handling knowledge and engage in safe food-handling practices. The aim of this study was to explore safe food-handling knowledge, behaviour, and related psychological constructs among individuals at higher risk of food poisoning and compare the results to the general population. Participants (N = 169) completed measures of safe food-handling knowledge, intention, habit strength, perceived risk, self-efficacy, subjective norms, and behaviour. A series of multivariate analyses of variance were conducted to determine differences in these measures between participants at higher risk of food poisoning and the general population. No significant differences in knowledge, intention, habit strength, self-efficacy, subjective norms, and behaviour were found between individuals at higher risk of food poisoning and the general population. However, individuals at higher risk of food poisoning appeared to have stronger risk perceptions across safe food-handling behaviours compared with the general population. This study demonstrated that individuals at higher risk of food poisoning do not have higher safe food-handling knowledge than the general population, and despite having higher risk perceptions around some safe food-handling behaviours, they do not differ in engagement in safe food-handling behaviours or the majority of related psychological constructs. Implications of these findings relate to the need to target other psychological constructs, not just risk perceptions, in order to see safer food-handling behaviours in high-risk populations.
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Affiliation(s)
- Jessica Charlesworth
- enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
- School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Barbara A. Mullan
- enAble Institute, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
- School of Population Health, Curtin University, Kent Street, Bentley, WA 6102, Australia
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Jevšnik M, Kirbiš A, Vadnjal S, Jamnikar-Ciglenečki U, Ovca A, Kavčič M. Food Safety Knowledge among Professional Food Handlers in Slovenia: The Results of a Nation-Wide Survey. Foods 2023; 12:2735. [PMID: 37509827 PMCID: PMC10379724 DOI: 10.3390/foods12142735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The authors present and discuss the results of a nation-wide survey on food safety knowledge among professional food handlers in Slovenia. The data were collected via a telephone survey using a well-established questionnaire adapted to the Slovenian context. Altogether, 601 respondents from hotels, restaurants, catering, and confectionery units completed the questionnaire. To assess food safety knowledge among food handlers in both general and specific domains, three indexes (a General Knowledge Index, a Personal Knowledge Index, and a Temperature Knowledge Index) were created. Among them, the Temperature Knowledge Index revealed the largest gaps in knowledge. An insufficient transfer of food safety knowledge from managers and chefs to assistant chefs and kitchen assistants in establishments where more persons handle food was evident, while a course titled "Hygiene Minimum" of standardised training from the past still significantly contributes to food safety knowledge. The results suggest a need for improvement in the current system of food safety training courses for professional food handlers in Slovenia. The human factor in the food supply chain still has a significant role in ensuring food safety culture, and therefore must become a more important part of the food safety management system.
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Affiliation(s)
- Mojca Jevšnik
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Andrej Kirbiš
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
| | - Stanka Vadnjal
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
| | - Urška Jamnikar-Ciglenečki
- Institute of Food Safety, Feed and Environment, Veterinary Faculty, University of Ljubljana, Gerbičeva 60, 1000 Ljubljana, Slovenia
| | - Andrej Ovca
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Matic Kavčič
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
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Low M, Scharff R, Tang J, Grasso-Kelley E, Feng Y. Food Handling Practices for Apple Drying in Home Kitchens in the United States: A Survey. J Food Prot 2022; 85:1418-1430. [PMID: 35723543 DOI: 10.4315/jfp-22-106] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/16/2022] [Indexed: 11/11/2022]
Abstract
ABSTRACT Fruit drying has traditionally received little food safety attention in spite of Salmonella outbreaks and recalls involving low-moisture foods. This study was conducted to assess the food safety implications during the home drying process, with dried apples as an example. A cohort of home apple dryers (n = 979) participated in an online survey through Qualtrics XM in May 2021. The results showed that participants' knowledge of safe food handling practices regarding dried fruit was low. On average, participants used only 8 of 18 identified food safety practices during apple drying. The survey revealed inadequate frequency of hand washing during apple preparation, potential points of cross-contamination from kitchen tools, lack of hurdle technology without a pretreatment step, failure to incorporate a thermal kill step during drying, and a lack of objective measurements to ensure that target parameters are attained. Participants mainly pretreated apples for sensory improvement instead of microbial reduction. When presented with some benefits of pretreatment, participants who did not pretreat their apples considered doing so to kill bacteria. The use of safe food handling practices differed within demographic groups. Participants 18 to 39 years old (mean = 7.47; 95% confidence interval [CI] = 7.26, 7.67) and 40 to 59 years old (mean = 7.43; 95% CI = 7.16, 7.70) reported using fewer safe practices than did those >60 years old (mean = 8.49; 95% CI = 8.22, 8.75), and participants who identified as male (mean = 7.38; 95% CI = 7.16, 7.60) reported using fewer safe practices than did those identifying as female (mean = 7.92; 95% CI = 7.74, 8.11). The findings of this study provide food handling data to support the development of more accurate food safety risk assessment models and to guide the development of food safety education for consumers who dehydrate produce in the home. HIGHLIGHTS
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Affiliation(s)
- Megan Low
- Department of Food Science, Purdue University, West Lafayette, Indiana 47907
| | - Robert Scharff
- Department of Human Sciences, Ohio State University, Columbus, Ohio 43210
| | - Juming Tang
- Department of Biological Systems Engineering, Washington State University, Pullman, Washington 99164
| | | | - Yaohua Feng
- Department of Food Science, Purdue University, West Lafayette, Indiana 47907
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Soon JM, Vanany I, Abdul Wahab IR, Abdullah Sani N, Hamdan RH, Jamaludin MH. Protection Motivation Theory and consumers' food safety behaviour in response to COVID-19. Food Control 2022; 138:109029. [PMID: 35449723 PMCID: PMC9009582 DOI: 10.1016/j.foodcont.2022.109029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/23/2022] [Accepted: 04/09/2022] [Indexed: 12/23/2022]
Abstract
The threat of COVID-19 has altered consumers shopping behaviour and increased consumers' willingness to purchase food using online food delivery services. Consumers were more likely to practice strict hand hygiene measures and were concerned with food safety. Such behaviours were likely driven by the fear and threat of contracting COVID-19. This study aims to use Protective Motivation Theory (PMT) to investigate how COVID-19 affects food shopping and food safety behaviour. An online, cross-sectional study was conducted in Indonesia and Malaysia to determine the protective motivation to engage in three food shopping and hygiene practices such as i) Safe food shopping behaviour; ii) Hand hygiene and avoiding cross contamination; and iii) Use of online food delivery services. Data were analysed using descriptive statistics, Spearman rho's correlation and binary logistic regression. A total of 1180 responses were received of which 1129 were valid. Gender was identified as a significant predictor across all food safety behaviours during COVID-19. Response efficacy and self-efficacy were significant predictors for food shopping behaviour while perceived severity significantly predicted hand hygiene practices after shopping. Age, frequency of food preparation and shopping, perceived severity, perceived vulnerability, response efficacy and self-efficacy were significant predictors for use of online food delivery services. Our findings suggest that women were more likely to engage in protective measures during food shopping, carry out hand hygiene practices after shopping and use online food delivery services during COVID-19. Participants with higher response and self-efficacy scores were more likely to shop from markets or shops with high hygiene standards while participants who perceived COVID-19 as a serious threat were more likely to clean and sanitise their hands after shopping. Participants also believed that the use of online food delivery services helps to reduce the risk of COVID-19 infection. However, foods should be purchased from trusted restaurants or takeaways. This is the first study to use Protection Motivation Theory to explore consumers' food shopping, hand hygiene and online food delivery practices during COVID-19.
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Affiliation(s)
- Jan Mei Soon
- Faculty of Allied-Health and Wellbeing, University of Central Lancashire, Preston, PR1 2HE, UK
| | - Iwan Vanany
- Department of Industrial Engineering, Sepuluh Nopember Institute of Technology, Surabaya, 60111, Indonesia
| | | | - Norrakiah Abdullah Sani
- Department of Food Science, Faculty of Science and Technology, National University of Malaysia, 43600, UKM Bangi, Selangor, Malaysia
| | - Ruhil Hayati Hamdan
- Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, 16100, Kota Bharu, Kelantan, Malaysia
| | - Mohd Hafiz Jamaludin
- Faculty of Agro-Based Industry, Universiti Malaysia Kelantan, 17600, Jeli, Kelantan, Malaysia
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6
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Charlesworth J, Mullan B, Howell J, Tan H, Abbott B, Potter A. Exploring the role of perceived risk and habit in safe food-handling behaviour change. Food Control 2022. [DOI: 10.1016/j.foodcont.2021.108754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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8
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Wang M, Huang L, Pan C, Bai L. Adopt proper food-handling intention: An application of the health belief model. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.108169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Charlesworth J, Mullan B, Howell J, Tan H, Abbott B, Potter A. Evaluating the impact of a pilot safe food-handling media campaign among consumers in Western Australia: Implications for public health messaging. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.108070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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11
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Kuo SC, Weng YM. Food safety knowledge, attitude, and practice among elementary schoolchildren in southern Taiwan. Food Control 2021. [DOI: 10.1016/j.foodcont.2020.107818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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12
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Wang M, Bai L, Gong S, Huang L. Determinants of consumer food safety self-protection behavior-- an analysis using grounded theory. Food Control 2020. [DOI: 10.1016/j.foodcont.2020.107198] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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13
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Predicting intention on safe food handling among adult consumers: A cross sectional study in Sibu district, Malaysia. Food Control 2019. [DOI: 10.1016/j.foodcont.2019.06.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Hunter CM, Williamson DHZ, Gribble MO, Bradshaw H, Pearson M, Saikawa E, Ryan PB, Kegler M. Perspectives on Heavy Metal Soil Testing Among Community Gardeners in the United States: A Mixed Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2350. [PMID: 31277219 PMCID: PMC6651326 DOI: 10.3390/ijerph16132350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/29/2019] [Accepted: 06/30/2019] [Indexed: 02/06/2023]
Abstract
Community gardens offer numerous benefits, but there are also potential risks from exposure to chemical contaminants in the soil. Through the lens of the Theory of Planned Behavior, this mixed methods study examined community gardeners' beliefs and intentions to conduct heavy metal soil testing. The qualitative component involved five focus groups of community garden leaders in Atlanta, Georgia. Qualitative analysis of the focus group data revealed that heavy metal soil contamination was not frequently identified as a common gardening hazard and several barriers limited soil testing in community gardens. The focus group results informed the development of a questionnaire that was administered to 500 community gardeners across the United States. Logistic regression analysis revealed that the soil testing intention was associated with attitude (aOR = 2.46, 95% CI: 1.34, 4.53), subjective norms (aOR = 3.39 95% CI: 2.07, 5.57), and perceived behavioral control (aOR = 1.81, 95% CI: 1.10, 2.99). Study findings have implications for interventions involving community garden risk mitigation, particularly gardens that engage children and vulnerable populations.
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Affiliation(s)
- Candis M Hunter
- Department of Environmental Health, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA.
| | - Dana H Z Williamson
- Department of Behavioral Health Sciences and Education, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
| | - Matthew O Gribble
- Department of Environmental Health, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
- Department of Epidemiology, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
| | - Halle Bradshaw
- Department of Environmental Health, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
| | - Melanie Pearson
- Department of Environmental Health, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
| | - Eri Saikawa
- Department of Environmental Health, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
| | - P Barry Ryan
- Department of Environmental Health, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
| | - Michelle Kegler
- Department of Environmental Health, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
- Department of Behavioral Health Sciences and Education, Emory University, 1518 Clifton Rd. Atlanta, GA 30322, USA
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Young I, Reimer D, Greig J, Turgeon P, Meldrum R, Waddell L. Psychosocial and health-status determinants of safe food handling among consumers: A systematic review and meta-analysis. Food Control 2017. [DOI: 10.1016/j.foodcont.2017.03.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Young I, Reimer D, Greig J, Meldrum R, Turgeon P, Waddell L. Explaining Consumer Safe Food Handling Through Behavior-Change Theories: A Systematic Review. Foodborne Pathog Dis 2017; 14:609-622. [PMID: 28719239 DOI: 10.1089/fpd.2017.2288] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Ian Young
- 1 School of Occupational and Public Health, Ryerson University , Toronto, Canada
| | - Danielle Reimer
- 1 School of Occupational and Public Health, Ryerson University , Toronto, Canada
| | - Judy Greig
- 2 National Microbiology Laboratory, Public Health Agency of Canada , Guelph, Canada
| | - Richard Meldrum
- 1 School of Occupational and Public Health, Ryerson University , Toronto, Canada
| | - Patricia Turgeon
- 3 National Microbiology Laboratory, Public Health Agency of Canada , St-Hyacinthe, Canada
| | - Lisa Waddell
- 2 National Microbiology Laboratory, Public Health Agency of Canada , Guelph, Canada
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Hsieh HL, Kuo YM, Wang SR, Chuang BK, Tsai CH. A Study of Personal Health Record User's Behavioral Model Based on the PMT and UTAUT Integrative Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 14:E8. [PMID: 28025557 PMCID: PMC5295259 DOI: 10.3390/ijerph14010008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 11/17/2022]
Abstract
The personal health record (PHR) is a system that enables borderless medical care services by combining technological innovation and human consideration. This study explored factors affecting the adoption of PHR from technical, medical, and social perspectives according to the Protection Motivation Theory (PMT) and Unified Theory of Acceptance and Use of Technology (UTAUT) model. A survey using a structured questionnaire was subsequently conducted, which produced the following results: (1) The PMT and UTAUT were effective at predicting PHR usage behaviors; (2) Perceived ease-of-use was the most decisive factor influencing the use of PHR, followed by self-efficacy and perceived usefulness; and (3) Behavioral intention for PHR was significantly and positively correlated with usage behavior. From the obtained results, this study recommends that health authorities and medical institutions promote self-efficacy in the use of PHR to improve the levels of behavioral intention and usage behavior among the people. Additionally, medical care institutions are recommended to promote health management and preventive healthcare concepts to help improve public acceptance of the PHR system as a means to self-manage their health. Finally, community centers, medical institutions, and health authorities are urged to work together to enhance public medical knowledge and pool resources for the PHR system, both of which are essential for improving the popularity of the PHR, public quality of life, and the effectiveness of health management.
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Affiliation(s)
| | - Yu-Ming Kuo
- Department of Marketing and Distribution, Tzu Chi University of Science and Technology, Hualien 970, Taiwan.
| | - Shiang-Ru Wang
- Department of Business Administraiton, National Dong Hwa University, Hualien 974, Taiwan.
| | | | - Chung-Hung Tsai
- Department of Health Administration, Tzu Chi University of Science and Technology, Hualien 974, Taiwan.
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