Knowledge and risk perceptions of foodborne disease by consumers and food handlers at restaurants with different food safety profiles

Influence of age, gender, and willingness to adopt former foodstuffs on the perception of Italian farm animal veterinarians

Background

Veterinarians play an essential role in improving animal care, as they are often viewed as trusted advisors, particularly in relation to disease control and management; however, little is known about veterinarians' perceptions and attitudes toward alternative feeds. The aim of this study was to investigate the influence of age, gender, and willingness to adopt on the attitudes of livestock veterinarians toward the use of alternative feeds in farm animals.

Methods

A total of 136 active veterinarians completed the online survey, distributed through the main veterinary associations in Italy. The questionnaire contained items on dietary recommendation, awareness, benefit and safety perceptions, and a willingness to adopt former foodstuffs (FFs), complemented with socio-demographic questions.

Results

Almost 90% of the population reported a willingness to adopt FFs as feed. Men and women did not share the same perceptions of the nutritional composition of FFs, while the importance of product availability was found to be a key factor driving the age difference. Participants willing to adopt FFs as feed linked positive attitudes to attributes such as digestibility, energy intake, and positive social implications.

Conclusion

Our findings provide a basic background on the current use of the FFs in Italy and suggest the need for the development of educational programs and marketing strategies to enhance the acceptability of FFs in farm animals to ultimately promote the transition toward more sustainable animal production. This study has limitations, including the number of recorded responses and reliance on national estimates. Future research is needed to investigate the perceptions of farmers and animal nutritionist from different countries. This could provide a more detailed picture of the current situation in Europe about the potential of using FFs in farm animals' feed, thus further contributing toward a greener and safer livestock production sector.

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.

Reproducibility and Validity of a Self-Administered Food Safety Assessment Tool on Children and Adolescent's Risk Perception, Knowledge, and Practices

The present study aimed to verify the instrument's reliability and validity for assessing children and adolescents' risk perception, knowledge, and food safety practices in the school context. Moreover, it aimed to test the hypothesis that both application methods (paper and pencil (PAPI) and online) are valid. The instrument comprised three questionnaires and followed a strict protocol to combine online and PAPI models, resulting in five application forms. The sample consisted of 439 Brazilian students from 10 to 14 years old (y/o). The results related to reliability and validity indicated that the knowledge questionnaire presented adequate stability and discriminant validity coefficients. The self-reported practices questionnaire obtained acceptable coefficients of stability and internal consistency. Regarding risk perception data, it was observed that students attribute a low probability of Foodborne Diseases (FBD) outbreaks occurrence and low severity of possible symptoms. In addition, students demonstrated insufficient knowledge and inadequate practices on issues related to failures associated with the time and temperature of preparation, storage, and exposure of food, contamination of food, and consumption of unsafe food. In this context, the reproducibility and validity indices need to be interpreted and discussed correctly, and young people in food safety actions are a priority in facing FBD.

Job Crafting and Burnout as Predictors of Food Safety Behaviors in the Foodservice Industry

This study aimed to investigate whether job crafting, burnout, and work engagement predict food safety behaviors in the foodservice industry. It was a cross-sectional study conducted in Cuiabá (Brazil) among foodservice workers. Four instruments were used among foodservice workers for the examination: (a) job demands and resources, (b) job satisfaction, (c) burnout, and (d) work engagement. Food safety practices were measured using a validated risk-based checklist. Partial least squares structural equation modeling was used to test the hypothesis model. In this study, 22 restaurants and 302 foodservice workers were examined. It was found that the “job demands-resources” model was valid for foodservice workers, i.e., burnout was strongly predicted by job demands (β = 0.550; p < 0.001); job resources were a positive predictor of work engagement (β = 0.258; p < 0.001); and burnout was a negative predictor of work engagement (β = −0.411; p < 0.001). Food safety violations were predicted by job crafting (β = −0.125; p = 0.029) and burnout (β = 0.143; p = 0.016). The results indicate that mitigating burnout and increasing job crafting can be important supporting strategies to improve food safety behaviors.

Impact of COVID-19 Outbreak Risk Perception on Willingness to Consume Products from Restaurants: Mediation Effect of Risk Attitude

The COVID-19 outbreak caused huge losses for the catering industry. The outbreak’s influence on consumers’ risk perception and risk attitude was an important factor for these heavy losses. The aim of this study was to investigate the change in epidemic risk perception, risk attitude, and the consumers’ willingness to consume products from restaurants during the spread of the COVID-19 epidemic. The study collected 502 questionnaires at the end of 2021, and structural analysis was conducted using SPSS 26.0 and AMOS 20.0 statistical programs. The results showed that consumers’ awareness of the coronavirus pandemic (consumers’ epidemic risk perception) had a significant positive effect on their decision-making behavior under uncertain conditions (risk attitude); consumers’ decision-making behavior under uncertain conditions (risk attitude) had a significant negative effect on their willingness to purchase from restaurants; consumers’ awareness of the coronavirus pandemic (consumers’ epidemic risk perception) had a significant negative effect on their willingness to consume products from restaurants; and risk attitude played a mediating role in the influence of consumers’ epidemic risk perception on their willingness to consume products from restaurants. This study can provide guidance and reference for restaurants on how to deal with the epidemic situation, help them undertake risk prevention work and reduce losses, and promote the healthy and sustainable development of the restaurant.

Development, Validation, and Testing of a Self-Assessment Tool to Measure Food Safety Beliefs, Attitudes, and Behaviors in Health Care Food Service Operations

ABSTRACT

The neutropenic diet has long been a dietary prescription for immunocompromised patients. However, its effectiveness and consistency have been constantly challenged. Researchers and health care policymakers call for liberalization of the neutropenic diet, which shifts risk management strategies from excluding "high-risk" food items to focus on safe food handling. The responsibility of food safety falls on food service workers in a health care setting. The objective of the present study was to develop and conduct psychometric testing to determine the validity and reliability of a self-assessment survey instrument tool targeting beliefs, attitudes, and behaviors of health care food service workers regarding safe food handling practices. This survey validation study was conducted in four phases. First, the tool was developed based on the Theory of Planned Behavior. After the initial draft, the survey was tested to establish face validity and test-retest reliability to measure temporal stability. The 40-item survey was then pilot tested to assess internal consistency and construct validity. Pilot testing was conducted over a 16-month period on 211 health care food service workers across six acute care hospitals that serve immunocompromised people. The original survey comprised 46 items. Six items were removed due to low content validity scores and temporal instability. Pilot testing revealed acceptable internal consistency (Cronbach's alpha = 0.79). The linear regression model was a good fit (P ≤ 0.0001) after assumptions were tested and met to predict behavior from attitude. A reliable and valid self-assessment survey instrument tool was developed for use in a health care food service operation. Results of this tool can help organizations pinpoint areas in which they can improve food safety practices of food service workers who serve immunocompromised people.

HIGHLIGHTS

What Motivates Consumer Food Safety Perceptions and Beliefs? A Scoping Review in BRICS Countries

This scoping review aimed to map the main evidence in the existing literature regarding consumer perceptions and beliefs regarding food safety in the context of BRICS (Brazil, Russia, India, China, and South Africa) countries. Articles were searched in the Web of Science, Scopus, and SciELO databases. The last search was performed on November 2021. Only the studies conducted within BRICS countries were included. The synthesis aimed to group similarities in consumer beliefs and perceptions of food safety. After screening, 74 eligible articles were included in the study. Of the 74 studies analyzed, 49 (66.2%) were carried out in China, 14 (18.9%) in Brazil, 5 (6.8%) in India,4 (5.4%) in South Africa, and 2 (2.7%) in Russia. Thirty-three motivators of perceptions and beliefs regarding food safety were identified. Food safety motivators were grouped into three categories: (1) sociodemographic characteristics, (2) cognitive aspects, and (3) other. In the "sociodemographic characteristics" category, the motivator with the highest number of corresponding results was education level (results = 22), followed by income (results = 22), both positive drivers for food safety perceptions. The "cognitive aspects" category comprised the majority of the identified motivators. Concern for food safety (results = 32) and risk perception (results = 30) were the motivators with the highest number of results among all categories and motivators. Finally, the main motivator in the "other" category was place of consumption/purchase (results = 8), focusing on consumers underestimating the risk of having a foodborne disease when eating away from home. China and Brazil are leading the way in studies on this topic. Consumers' perceptions are influenced by socioeconomic characteristics (e.g., age, gender, education level, income), cognitive aspects (e.g., knowledge, risk perception, food concerns, previous experience with food safety incidents) and other situational factors (e.g., price, place of purchase, traceability).

Measuring customer satisfaction on the cleanliness of food premises using fuzzy conjoint analysis: A pilot test

Determining the level of customer satisfaction in cleanliness regarding a product or service is a significant aspect of businesses. However, the availability of feedback tools for consumers to evaluate the cleanliness of a restaurant is a crucial issue as several aspects of cleanliness need to be evaluated collectively. To overcome this issue, this study designed a survey instrument based on the standard form used for grading the food premises and transformed it into a seven Likert scale questionnaire and consists of seven questions. This study employed fuzzy conjoint analysis to measure the level of satisfaction in cleanliness in food premises. This pilot study recruited 30 students in Universiti Teknologi MARA (UiTM) Seremban 3. The student's perception was represented by the scores calculated based on their degree of similarities and corresponding levels of satisfaction, whereby, only scores with the highest degree of similarity were selected. Furthermore, this study identified the aspects of hygiene that assessed based on the customers' satisfaction upon visiting the premises. The results indicated that the fuzzy conjoint analysis produced a similar outcome as the statistical mean, thus, was useful for the evaluation of customer satisfaction on the cleanliness of food premises.

Customers' risk perception and dine-out motivation during a pandemic: Insight for the restaurant industry

The restaurant industry is one of the most affected businesses during the outbreak of COVID-19. The customer choice regarding whether or not to dine in a restaurant have changed due to this unprecedented global pandemic. Integrated with the affective decision-making framework, meta-theoretic model of motivation (3M), and optimistic bias theory, this conceptual paper proposes a theoretical scheme for understanding constructs that affect consumer motivation while considering the significance of consumers' risk perceptions of the novel coronavirus disease. This research aims to delineate the role of loyalty, trust, and transparency on resuming in-restaurant dining during and after the pandemic. By identifying the link between each construct and addressing the unparalleled food-/health related risks, this study suggests that restaurants who accumulated more customer trust by fostering transparency are likely to have more business and quickly recover from the shock.

Should I stay, or should I go? Consumers' perceived risk and intention to visit restaurants during the COVID-19 pandemic in Brazil

This study aimed to verify how consumers’ intention to visit restaurants during the pandemic is affected by consumers’ risk perception and different types of trust. The sample was composed of 546 consumers from 89 different cities in Brazil. An adapted 43 items questionnaire with 5-point scales was administered, and analyzed using structural equation modeling. The results indicate that consumers' trust in a restaurant and brand, fair price, solidarity with the restaurant sector, disease denial, and health surveillance trust predict intention to visit a restaurant during the COVID-19 pandemic. Age has significant moderated effects, reducing disease denial effects. The trust in restaurants and brands was the factor with the largest effect size. In a multigroup analysis, it was found that solidarity with the sector does not affect the intention to visit restaurants for consumers without formal work. It is discussed the implications of an increased consumers' risk perception, directly affecting their intentions. Special attention to consumers’ trust and fair price perception is fundamental, given consumers’ solidary inclination toward helping the restaurant sector. These aspects must be recognized by restaurant owners and managers to be improved and be used to attract consumers.

Design and Development of an Instrument on Knowledge of Food Safety, Practices, and Risk Perception Addressed to Children and Adolescents from Low-Income Families

In the fight against foodborne diseases, expanding access to information for different groups is needed. In this aspect, it is crucial to evaluate the target audience’s particularities. This study constructed and validated an instrument containing three questionnaires to identify the level of knowledge, practices, and risk perception of food safety by low-income students between 11 and 14 years old. The following steps were used: systematic search of the databases; conducting and analyzing focus groups; questionnaires development; and questionnaires analysis. After two judges’ rounds, the final version was reached with 11 knowledge items, 11 practice items, and five risk perception items. The content validation index values were higher than 0.80. The adopted methodology considered the students’ understanding and perceptions, as well the appropriate language to be used. Besides, it allowed the development of questionnaires that directly and straightforwardly covers the rules set by the World Health Organization for foodborne disease control called Five Keys to Safer Food (keep clean; separate raw and cooked; cook thoroughly; keep food at safe temperatures; and use safe water and raw materials). Its use can result in a diagnosis for elaborating educational proposals and other actions against foodborne illness in the most vulnerable population.

Brazilian Community Restaurants’ Low-Income Food Handlers: Association between the Nutritional Status and the Presence of Non-Communicable Chronic Diseases

This cross-sectional study aimed primarily to determine the association between the nutritional status and the presence of non-communicable chronic diseases (NCDs) among community restaurants’ food handlers, since their access to food can influence their body mass index (BMI). The study discusses the socio-demographic status of participants, dietary intake, the prevalence of overweightness/obesity, and self-reported diagnosed NCDs. In 36 Community Restaurants (CRs) from all of the Brazilian regions, we collected data from 559 food handlers. We used a questionnaire to collect socio-demographic data and the reported diagnosed chronic diseases. For the anthropometric evaluation with Body Mass Index calculation, we measured the weight and the height of the individuals. They were all weighed before having lunch at the CR, without shoes and coats. Associations between variables were analyzed by the chi-square test and Poisson regression at a significance level of 5%, considering health as the outcome variable. Most of the food handlers were female (63.1%), married or with a partner (51.7%), and overweight (59.9%). Among the food handlers that presented diagnosed NCDs (n = 96, 17.2% of food handlers), 45.8% (n = 44) presented hypertension and 12.5% (n = 12) type 2 diabetes mellitus. There was a significant association between BMI and NCD status in the studied population. The total daily sodium intake of food handlers was higher than the recommendations of the World Health Organization (WHO), especially from the CR lunch, which may raise the risk of chronic diseases such as hypertension (the most prevalent non-communicable disease found in our study). Despite that, in general, the CRs provide access to cheap and adequate meals to their workers, considering energy intake and the proportion of macronutrients. In this population, overweightness and obesity were prevalent; there was an association of obesity with chronic disease in the study population. Therefore, it is necessary for better menu planning for CRs to guarantee sodium reduction throughout time.

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.

Association of Internet Use with Attitudes Toward Food Safety in China: A Cross-Sectional Study

A growing body of research has shown that people’s attitudes toward food safety is affected by their availability and accessibility to food risk information. In the digital era, the Internet has become the most important channel for information acquisition. However, empirical evidence related to the impact of Internet use on people’s attitudes towards food safety is inadequate. In this study, by employing the Chinese Social Survey for 2013 and 2015, we have investigated the current situation of food safety perceptions and evaluations among Chinese residents and the association between Internet use and individuals’ food safety evaluations. Empirical results indicate that there is a significant negative correlation between Internet use and people’s food safety evaluation in China. Furthermore, heterogeneity analysis shows that Internet use has a stronger negative correlation with food safety evaluation for those lacking rational judgment regarding Internet information. Specifically, the negative correlation between Internet use and food safety evaluations is more obvious among rural residents, young people, and less educated residents. Finally, propensity score matching (PSM) is applied to conduct a robustness check. This paper provides new evidence for studies on the relationship between Internet use and an individuals’ food safety cognition, as well as additional policy enlightenment for food safety risk management in the digital age.

The differences between observed and self-reported food safety practices: A study with food handlers using structural equation modeling

Every year, studies about food handlers' food safety knowledge, attitudes, and practices are published. Some results of these papers have been rather controversial, especially those related to food safety practices. The two most common methods for evaluating food safety practices - self-assessment and observation - are generally treated as interchangeable, but they can have different meanings. The objective of this study was, therefore, to differentiate between the observed and self-reported food safety practices of food handlers, verifying the effect of different variables in these food safety indicators through structural equation modeling, and examining the relationship between cognitive factors and these practices. A questionnaire with 37 questions was given to 183 food handlers to evaluate their food safety knowledge, attitudes, self-reported practices, and risk perceptions. For the observed assessment method of evaluating the food handlers' practices (observed practices), a checklist was developed, and food handlers were observed during one workday. Two models were developed based on the results of these two assessment methods. In the first model a significant positive effect of knowledge and a negative effect of risk perception on self-reported practices were observed. Food handlers with high risk-perception about their practices reported less adequate practices. Positive food safety attitudes acted as a moderator dampening the positive effect between knowledge and self-reported practices. In the second model a significant positive effect of knowledge on observed practices. Attitudes strengthened the positive effect between knowledge and observed practices. On the other hand, a direct effect of attitude on observed practices was not observed. In conclusion, self-reported practices and observed practices are different and should be used and discussed properly.