EAL

MHFS: Food Safety (2012-2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To conduct focus groups among WIC clients to determine what beliefs they had regarding food safety and what barriers they encounter when practicing food safety.

Inclusion Criteria:

WIC client or provide care for a WIC client
Speak English
At least 18 years of age
Provided informed consent.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

Participants were recruited through a flyer handed out by research staff to women who came to the clinic during the study period.

Design

Descriptive study.

Statistical Analysis

Main findings were organized in a table that included the focus group questions and probes
The participants comments were categorized into themes independently by three researchers using theme categories based on the questions and probes that were in the discussion guide
94 themes were identified, with 45 classified as recurring, 20 as extensive and 29 as infrequent
Five focus groups were deemed sufficient because, by the fifth focus group, only two new themes were identified.

Data Collection Summary:

Timing of Measurements

Five audiotaped focus groups were conducted.

Dependent Variables

Beliefs about, barriers to and motivators for good food safety practices.

The same moderator was used for all 5 focus groups
The moderator provided an introduction, answered questions and conducted the focus group using a discussion guide to structure the discussion
The discussion guide is based on the Health Belief Model, and a co-moderator took notes and operated the tape recorder. Each session lasted about an hour.
The discussion began with questions and probes regarding beliefs and attitudes, specifically those regarding the participants' perceptions of their susceptibility to and the seriousness of food-borne illnesses.
Participants were then asked to read the Partnership for Food Safety Educations's Fight BAC Pamphlet and discuss each of its four main content areas (clean, separate, cook, chill)
They discussed which recommendations they and their peers generally followed which they did not, and barriers to following the recommendations
Participants also discussed what may motivate WIC clients to practice good food safety behavior and effective ways to deliver food safety education including interactive multimedia.

Independent Variables

WIC program participants in Miami, Florida.

Description of Actual Data Sample:

Initial N: 32 women
Attrition (final N): 32 women
Age: Range 18 to 55 years
Ethnicity:
- 53% non-Hispanic and non-Haitian blacks
- 22% Haitian blacks
- 19% Hispanic whites
- 3% Hispanic Blacks
- 3% non-Hispanic Whites
Other relevant demographics:
- 19% had not graduated from high school
- 37.5% had graduated from high school
- 31% had at least one year of education beyond college
- 13% had graduated from college
Location: Miami, Florida.

Summary of Results:

Key Findings

Participants did not perceive food-borne illnesses as a major problem or believe that food-borne illnesses usually resulted from poor food handling practices at home
The hardest practice for them to follow was using a thermometer since most clients did not own one
Additional problems reported included leaving perishable foods and bottles of baby formula outside of refrigeration for more than two hours
Many clients could not afford to buy multiple shallow containers for storage or throw away unfinished formula or leftovers
In addition, clients did not always wash their hands, particularly after changing their children's diapers, or clean baby bottles between uses
Participants reported that their babies' health was the most important motivator to good food safety practices and that women may be the most receptive to food safety education during their first pregnancy.

Author Conclusion:

Overall, WIC clients have gaps in their knowledge and practices when it comes to food safety. The WIC program is in a position to help its clients to learn more about food safety practice and handling procedures.

Funding Source:

Government:

National Integrated Food Safety Initiative of the Cooperative State Research, Education and Extension Service of USDA, No. 51110-02166

Reviewer Comments:

Several limitations were discussed, including:

Small focus groups
Self-selected groups of volunteers
The study was conducted in one WIC clinic that serves a predominantly African-American community.

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?		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?		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?	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?	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?	Yes
	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