EAL

MHFS: Food Safety (2012-2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

The purpose of this study was to assess the food safety informational needs of cancer patients and to determine the factors that could influence prospective educational interventions to foster behavior change
The study was divided into two phases: Educational needs of cancer patients and educational resource development.

Inclusion Criteria:

For the food safety needs assessment study: Cancer patients who were undergoing chemotherapy or had completed chemotherapy in the last six months
Physicians, nurses, dietitians and social workers who worked with cancer patients in a comprehensive cancer center were included.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

For the food safety needs assessment study, cancer patients were recruited through flyers placed in hospitals, cancer clinics and outpatient centers to participate in focus groups designed to assess food safety attitudes, practices and educational needs
For the educational resources development study, cancer patients who were currently undergoing chemotherapy treatments or who had completed their treatment in the last six months were recruited from a comprehensive cancer center to evaluate the prototypes
For the safety needs assessment study, physicians, nurses, dietitians and social workers who worked with cancer patients in a comprehensive cancer center were sent an introductory letter describing the study and interview.

Design

Descriptive study.

Statistical Analysis

Responses to attitude and food preference surveys were converted to percentages using SPSS
Means and standard deviations of data from the cognitive response forms were calculated.

Data Collection Summary:

Timing of Measurements

Focus groups with cancer patients were formed and interviews with health professionals working with cancer patients were conducted.

Dependent Variables

Cancer participants were asked to complete a food safety attitude and food preference questionnaire before the focus group discussions began. The survey had three sections including demographics and background information as well as a 10-item food safety attitude scale and a nine-item food preference questionnaire.
For the cancer patient's focus groups, the moderator's script was adapted from the Health Belief Model and consisted of five sections: A brief introduction, general questions about participants concerns about food, foodborne illness, food safety and changes made in food-handling practice after diagnosis
Health care providers were asked to complete a background questionnaire and were then interviewed using a previously reported protocol. The questionnaire assessed occupation, length of time working with cancer patients, location of employment, number of days per week working with patients, number of patients seen per day, number of times each patient was seen during the total period of care and length of time spent with patients per visit.
Food safety informational needs. Three prototypes were drafted for the educational resources development study: The first prototype described various types of foodborne diseases and how cancer patients can reduce their risk of infection. The second prototype focused on behaviors and methods to minimize exposure to foodborne pathogens. The third prototype was specifically written to discuss Listeria monocytogenes and ready-to-eat foods.

Independent Variables

Cancer patients
Health professionals working with cancer patients.

Description of Actual Data Sample:

Initial N: 49 total: 31 cancer patients participated in a needs assessment study and 18 health care providers participated in the needs assessment study with health care providers
Attrition (final N): 49 total: 31 cancer patients participated in a needs assessment study and 18 health care providers participated in the needs assessment study with health care providers
Age: 45 to 64 years for cancer patients
Ethnicity: Not described
Other relevant demographics: Most cancer patients shopped for their own food and prepared their own food. Overall, the group was well educated.
Anthropometrics: Not reported
Location: Ohio State University.

Summary of Results:

Key Findings

There was a general awareness among focus group participants that chemotherapy increased their susceptibility to foodborne illness and infections
Participants had a basic knowledge of safe food-handling practices, but did not necessarily link their awareness of increased susceptibility for infection with their routine food-handling practices
Most cancer patients expressed attitudes toward food safety that were consistent with professionally accepted food safety guidance, with the exception of lack of interest in using a meat thermometer, lack of concern about consuming unheated hot dogs and raw sprouts and ambivalence toward thawing perishable food at room temperature
When informed of specific high-risk foods, there was skepticism about compliance due to disbelief of the risk, personal preferences for the high-risk food and lack of information about how to use the recommendation
Results from the needs assessment study with cancer patients: Two major themes emerged when the cancer patients were asked what additional food safety information they wanted to know; they wanted information specifically aimed toward cancer patients (three of six groups) that was up to date, accurate and scientifically-based
They also wanted the food safety information to be available at treatment facilities (five or six groups) or delivered through food safety classes or in support groups
The cancer patients felt they needed food safety information early after diagnosis and as soon as the first oncology appointment (two of six groups)
Result from the needs assessment study with health care providers: Nine of the 18 health care providers (one physician, four nurses, two dietitians and two social workers) believed that all or most of the recommendations addressed potential problem areas for their clients and that if the recommendations were not followed, the risk of infections would increase (especially for patients with low white blood cell counts)
13 of the health care providers said that written materials were the most effective way to educate their clients on food safety and 10 providers said that all health care providers should verbally review the written information with their clients
Participants were asked which educational resource they would prefer if only one were available. The majority of participants selected the prototype titled Food-borne Disease and Cancer Patients because it contained the most information they needed and the title was appealing to them as cancer patients.
Most of the health care providers agreed that food safety information should be provided by dietitians, physicians and nurses, but physicians stated they had little time to do so
The top motivator for following the risk reduction recommendations was having scientific proof of why cancer patients should follow the recommendation.

Author Conclusion:

The results of this study suggest that even though both health care providers and cancer patients are aware of the susceptibility of patients to opportunistic infections while neutropenic and the potential consequences of a severe infection, safe food-handling remains the personal choice of the patient
The food safety educator can devise information-providing strategies that are credibly informed and sensitive to the perceptions and modifying factors that should influence the likelihood that an individual will act on the information and behave in the desirable manner.

Funding Source:

Government:	US Department of Agriculture Cooperative State Research, Education and Extension Service
Other:	National Integrated Food Safety Institute projects

Reviewer Comments:

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)	N/A
	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)	N/A

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?		Yes
	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?	Yes
	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?	???
3.	Were study groups comparable?		Yes
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	Yes
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	Yes
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	Yes
	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?	Yes
	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?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	Yes
	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?	N/A
	8.2.	Were correct statistical tests used and assumptions of test not violated?	N/A
	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)?	No
	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