Food Safety Behavior of Nutrition Program Graduates: Do They Do… What They Say They Do?

Patricia Kendall, PhD, RD
Colorado State University

Lydia C. Medeiros, PhD, RD
The Ohio State University

Virginia N. Hillers, PhD, RD
Washington State University

Context of Data

Part of larger study to:

• Gain consensus among food safety experts on most important behaviors to reduce risks of foodborne illness from home food preparation
• Develop and validate a food safety behavior questionnaire
• Identify high risk behaviors that should be further targeted for food safety education

Medeiros, Hillers, Kendall 1999-2001
USDA grant #99-35201-8126

Identification of Food Safety Behaviors Most Important in Preventing Foodborne Illness

Using web-based Delphi process, food safety experts (n=24) identified 29 food safety behaviors as being most important in home food preparation

Behaviors ranked within 13 pathogens and 5 pathogen control factors and for importance to high risk audiences

Medeiros, Hillers, Kendall
J. Amer. Dietetic Assoc., 101:1326;2001

Development & Validation of a Behavior Questionnaire

Expert Panel led process:

• Panelists (n=6) reviewed results of Delphi process & made final recommendations for behavior list.
• Worked in small groups to develop questions to assess the 29 behaviors
• Evaluated content & face validity of questions

Questionnaire further shortened & revised based on feedback from target audience and project team

Behavioral Question Bank

Reliability and validity testing performed on 52-item question bank:

• Practice personal hygiene (5 questions)
• Cook foods adequately (12)
• Avoid cross contamination (7)
• Keep foods at safe temperatures (12)
• Avoid foods from unsafe sources (16)

Recruitment

Targeted EFNEP/FSNEP classes with 30-60 minute food safety education component

Classes took food safety behavior questionnaire, then recruited to take part in a cooking methods study

• Primary food preparer
• Limited income household

Kitchen Activity Session

• Cooking observation in Community Kitchen:
  • Cooked a chicken breast to desired doneness
  • Sliced an apple to garnish the chicken
  • Cooked a hamburger to desired doneness
  • Sliced a tomato to go with the hamburger
• In-depth interview
  • Asked same questions on questionnaire in conversational, open-ended manner
• 50 graduates completed sessions

Observable Behaviors

• Wash hands before food preparation
• Avoid cross contamination:
  • Thoroughly rinse fruits and vegetables
  • Wash hands and utensils with soap and hot water after contact with potentially hazardous foods
  • Clean food preparation surfaces with hot soapy water before and after meal preparation
• Cook foods adequately:
  • Use a thermometer to ensure meat/poultry are adequately cooked

How Safe are their Practices? Do they do what they say they do?

Wash hands with soap and water before preparing food (n=50)

Observation

• 92% did correctly
• 4% did incorrectly
  • Included rinse only, wipe with dishcloth or paper towel
• 4% did not do

Validation with Questionnaire

• 92% agreement

Wash hands with soap & water between working with raw chicken and continuing cooking

Observation

• 24% did correctly
• 74% did incorrectly
  • Included rinse only, wipe with dishcloth or paper towel; clean as part of dishwashing
• 2% did not do

Agreement with Questionnaire

• 94% agreement (correct & incorrect behaviors)
• 18% agreement (correct only)

Wash cutting board after preparing chicken and before cutting apple

Observation:

• 76% did correctly
• 21% did incorrectly
• 2% not at all

Validation with Questionnaire:

• 83% agreement (correct & incorrect behaviors)
• 64% agreement (correct only)

Thoroughly rinse fresh vegetables under running water before eating

Observation

• 74% rinsed tomato before slicing
• 26% did not

Validation with Questionnaire

• 68% agreement

Clean countertops with hot, soapy water Before preparing food

Observation

• 2% did correctly
• 98% not at all

Validation with Questionnaire

• 12% agreement

Clean countertops with hot, soapy water After preparing food

Observation

• 6% did correctly
• 76% did incorrectly
  • Included wiping with sponge, cloth or paper towel
• 18% not at all

Validation with Questionnaire

• 76% agreement (correct & incorrect behaviors)
• 28% agreement (correct only)

Use thermometer to determine if a chicken breast has been cooked enough

Observation:

• 18% used thermometer
• 82% did not
• Still, 90% cooked to 160°F

Validation with Questionnaire:

• 67% agreement

Results similar for hamburger patty

Conclusions

Handwashing:

• Message learned
• Skills need improving, esp. to prevent cross-contamination

Cleaning utensils/cutting boards to prevent cross-contamination:

• Message learned
• Skills need improvement

Cleaning food preparation surfaces before/after food preparation:

• Message not well learned
• Skills lacking

Use thermometer to ensure adequate cooking:

• Message not learned, but most cooked to adequate temperatures
• Skills lacking in use of thermometer

Recommendations

Emphasis should be placed on:

• Correct handwashing after contact with potentially hazardous foods
• Cleaning of countertops before meal preparation
• Correct methods for cleaning countertops after meal preparation
• Correct methods for cleaning utensils, cutting boards
• Thermometer use

Acknowledgments

Ohio State University

• Dr. Gang Chen

Colorado State University

• Mary Schroeder
• Anne Elsbernd
• Kelly Sinclair

Washington State University

• Verna Bergmann