EAL

MHFS: Food Safety (2012-2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To identify and assess the opportunities and challenges for food safety education in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

Inclusion Criteria:

WIC clinic in a Midwestern state with urban and rural areas.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

All WIC clinics in a Midwestern state with urban and rural areas.

Design

Cross-sectional study.

Statistical Analysis

SPSS version 10.1 was used for all analysis
Initial analysis included calculations of frequencies, means and standard deviations
Cronbach's alpha was used to measure the reliability of the safety and risk scale
A knowledge score was calculated from the safety and risk scales by coding responses as correct if the respondent identified a safe practice as "safe" or "could be safe" and likewise for the risky practices
Skipped questions or responses of unsure or don't know were scored as incorrect
X²analysis was used to compare the knowledge groups and respondents' professional credentials with other discrete variables.

Data Collection Summary:

Timing of Measurements

79 WIC clinic directors were sent cover letters, a brief director questionnaire, and five health professional questionnaires with individually attached cover letters and return envelopes
The health professional questionnaire was developed in a two-stage process. A registered dietitian with a Master of Science degree and extensive experience with WIC programs and statistician provided initial reviews of the questionnaire.

Dependent Variables

Food safety education measured by the health professional questionnaire and director questionnaire
The health professional questionnaire had four sections:
- Client food safety education
- Perception of safety or risk of food-handling practices
- Demographic information
- Open-ended questions about the need for and challenges of food safety education in the clinic setting.

Independent Variables

The director questionnaire was composed of three items:
- Number of health professional questionnaires distributed
- Number of health professionals supervised
- Approximate clinic caseload
Directors were also invited to complete the health professional questionnaire if their position included nutrition counseling.

Description of Actual Data Sample:

Initial N: 79 WIC clinic directors were initially sent cover letters
Attrition (final N): 57 clinics actually participated
Age: Age of WIC health professionals:
- 18.2% were less than 30 years
- 28.2% were between the ages of 31 and 40 years
- 30.6% were between the ages of 41 and 50 years
- 21.2% were between the ages of 51 and 60 years
- 1.8% were at or above the age of 61
Location: Kent State University, Kent, Ohio.

Summary of Results:

Key Findings

57 out of 79 clinics (72%) participated in the study
48 director questionnaires (61%) and 170 health professional questionnaires were returned
Among the 48 clinics that reported the distribution of 182 health professional questionnaires, 150 (82%) were returned
The mean caseload number was 2,230 clients
72% reported offering food safety advice to 20% or more of their WIC clients during the course of the day
No significant differences were found using a X² analysis in the frequency that respondents shared food safety information with their clients based on professional credentials
Significant differences were found for the most important issues, preventing sharing of food safety information based on credentials (P<0.05)
90% identified food safety knowledge of their clients to be fair to very poor and stated in open-ended questions that the need for education among WIC clients was high, especially in the areas of infant formula use, breast milk storage, fish consumption and general food preparation skills
In addition, respondents reported that clients:
- Lack automotive transportation and carry groceries home in hot weather
- Avoid discarding unused formula in bottles due to cost
- Lack of refrigeration or electricity in the home
- Cannot afford food thermometers
The need for food safety handouts targeted for WIC clients was identified by 27% of the respondents.

Author Conclusion:

WIC professionals are promoting safe food handling among a high-risk population group. Expansion of current food-safety education efforts with WIC clients is encouraged with emphasis on methods to effectively overcome barriers to safe food handling.

Funding Source:

University/Hospital:

Kent State University Faculty Grant

Reviewer Comments:

A limitation to this study is that data were collected in only one state in the United States. Future research could assess if these results are comparable to other regions.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		N/A
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		No
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	No
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	No
3.	Were study groups comparable?		N/A
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	N/A
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	N/A
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	N/A
	4.4.	Were reasons for withdrawals similar across groups?	N/A
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	Yes
	7.5.	Was the measurement of effect at an appropriate level of precision?	Yes
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		No
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	No
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	No
	8.6.	Was clinical significance as well as statistical significance reported?	No
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	No
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes