EAL

MHFS: Food Safety (2012-2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To identify key behaviors associated with major food safety pathogen control factors.

Inclusion Criteria:

Professionals nationally recognized for their expertise in food safety
Names of epidemiologists and food microbiologists obtained by compiling a list of the authors of books and other published literature in the area of food safety
Educators selected from a nationwide listing of cooperative extension specialists with responsibility for food safety education
Policy makers identified from listings of persons with leadership responsibility for food safety policy within federal or state government agencies.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

Via electronic mail and continued until a convenience sample of 10 epidemiologists, 11 microbiologists, 10 food safety educators and 10 policy makers from throughout the United States agreed to participate
A sufficient number of experts were recruited to ensure that at least 15 to 20 persons completed all four rounds, as required by Delphi process methodology
Expert participation was voluntary and no incentives were provided.

Design

Descriptive study.

Statistical Analysis

Descriptive statistics and sum of observation data were used to determine rank order and validity.

Data Collection Summary:

Timing of Measurements

The experts went through four rounds, each of which had a specific purpose:
- Round One: To edit the list of food-handling behaviors for completeness and to judge appropriateness of the behaviors to each pathogen
- Round Two: To rank order each revised list of behaviors according to its importance in preventing illnesses caused by that specific pathogen
- Round Three: To place behaviors with their primary pathogen control factor
- Round Four: To rank behaviors within each pathogen control factor by importance in preventing food-borne illness and to seek comments on non-validated behaviors
Ranking information from Round two along with validation information and wording suggestions from Round three were used to compile and edit the list of behaviors in Round four within each pathogen control factor.

Dependent Variables

Data available on food-borne illness was reviewed for incidence by pathogen, severity and cost per case and by types of food and behaviors associated with outbreaks
13 pathogens with relevance to consumer food-handling behavior were selected for study
Food safety pathogen control factors were measured using the Delphi process, in which food safety experts put the revised list of behaviors in rank order according to its importance in preventing illness caused by that specific pathogen.

Independent Variables

Key consumer food-handling behaviors identified by literature sources were consulted to construct a primary list of food-handling behaviors.

Description of Actual Data Sample:

Initial N: 41 (10 epidemiologists, 11 microbiologists, 10 food safety educators, 10 policy makers from throughout the United States)
Attrition (final N): 41 (10 epidemiologists, 11 microbiologists, 10 food safety educators, 10 policy makers from throughout the United States)
Location: Ohio State University, Ohio.

Summary of Results:

Key Findings

29 key food-handling techniques for maintaining the safety of food and reducing the number of cases and outbreaks of food-borne illness were identified
These techniques were rank-ordered within five pathogen control factors:
- Practice personal hygiene
- Cook foods adequately
- Avoid cross-contamination
- Keep foods at safe temperatures
- Avoid foods from unsafe sources.

Author Conclusion:

The list of rank-ordered behaviors grouped by pathogen control factor should help dietitians and educators confidently teach food safety guidance that will be most effective in preventing illness.

Funding Source:

Government:

USDA CSREES National Research Initiatives Grant no. 99352018126

Reviewer Comments:

Sample was not well described.

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?		Yes
	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?	No
	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?		N/A
	4.1.	Were follow-up methods described and the same for all groups?	N/A
	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%.)	N/A
	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?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
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