EAL

MHFS: Food Safety (2012-2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

This study is part of a larger project aimed at designing more effective messages to encourage safe home food-handling. A survey explored some of the predictors of two important safe home food-handling practices, using a food thermometer and appropriate hand-washing. Guiding this study is a general structure based on the theory of planned behavior, but the goal is also to explore issues that emerged from focus groups conducted by the research team, namely that impression management concerns about presenting oneself as a safe and competent cook could encourage hand-washing and discourage food thermometer use. Another factor that emerged was concern about the ease and convenience of performing the behaviors.

Inclusion Criteria:

Informed consent provided
Cooked regularly for friends and or family and who at least sometimes started meals with raw meat, poultry or fish.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment: Participants were volunteers recruited at three shopping malls and one commuter airport in New York State, in exchange for $5 cash
Design: Cross-sectional survey
Statistical analysis: Data was analyzed using SPSS 17 for Windows.

Data Collection Summary:

Timing of Measurements

Timing of survey not reported.

Dependent Variables

Home food preparation practices measured by a questionnaire that contained three sections:
- The first contained demographic questions, including age, gender, education level, household income and whether there were children younger than five years old or between five and 18 years in the household
- In the second section, the participants were asked questions about either hand-washing or using food thermometers
- The third section asked questions about smoking and advertising, as part of a different study.
The theory was developed based on planned behavior and preliminary results from focus group interviews
The questionnaire directly measured six components in the TPB model: Behavioral belief, outcome evaluation, normative beliefs, motivation to comply, perceived behavioral control and behavioral intention. The other two components, attitude and subjective norm, were calculated based on other measures.
All items were developed based on a published guideline for measuring the theory of planned behavior constructs and modified to refer to the targeted food-handling procedures
All the measures were presented as five-point Likert scales (1=strongly disagree and 5=strongly agree).

Independent Variables

Home cooks.

Description of Actual Data Sample:

Initial N: 605 participants were approached, but 61 participants indicated that they never prepared the main meal for their families or never prepared the main meal beginning with raw meat, chicken or fish, leaving 544 participants
Attrition (final N): 544 participants, 45% female
Age: 18 to 92 years (mean, 35.88±13.99)
Ethnicity: Not reported
Other relevant demographics: 49% had a college degree, 31% attended some college or equivalent education, 15% completed high school and 5% did not complete high school
Anthropometrics: Not reported
Location: Cornell University, Ithaca, NY.

Summary of Results:

Key Findings

Out of 544 participants, about 45% (N=247) reported preparing the main meal in their household all or nearly all of the time and 55% (N=297) reported preparing the main meal only some of the time
48% reported preparing meals that begin with raw meat, chicken or fish all or nearly all of the time
39% (N=211) began with raw meats only some of the time and 13% (N=71) only seldom began with raw meats
The main TPB measures significantly differed across the two different food safety practices
Respondents had more positive attitudes towards proper hand-washing behaviors than towards using food thermometers when handling meat or chicken for hand-washing: Mean, 12.92±7.32. For thermometer use: Mean, 11.30±6.95, t(542)=2.64, P<0.01.
They were more concerned with subjective norms associated with proper hand-washing behaviors than those associated with using food thermometers (mean, 27.04±11.59 for hand-washing; mean, 3.47±7.67 for thermometer use)
The regression model explained about 42% of the variance of the intent to wash hands F(9,261)=20.56, P<0.01
Perceived behavioral control was the strongest predictor of behavioral intentions for both hand-washing and food thermometer use, while subjective norm was the next strongest predictor for thermometer use and attitude towards the behavior was the next strongest predictor for hand-washing.

Author Conclusion:

This study explains the knowledge-compliance gap in home food safety practices that educating home cooks about the proper practices does not lead to behavior changes. These understandings highlight some social and cognitive processes in food-handling and have practical values in attempting to change malpractices in home food safety.

Funding Source:

Government:

USDA (CSREES/NIFA) under award no. 2007-51110-03814

Reviewer Comments:

Statistical analysis was not well described
The authors did identify some limitations:
- Limits on the number of questions that could be asked made it necessary to use single-item measures
- Single-item measures can be associated with more errors, although the measures in the present study were consistent with previous measures used by the theory of planned behaviors and were developed based on the focus group results.

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?	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?	Yes
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?	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?	Yes
	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?	No
	8.2.	Were correct statistical tests used and assumptions of test not violated?	???
	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