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Cited by 83Food Safety and HygieneSalmonella and Campylobacter epidemiologyNutrition, Health and Food Behavior

A systematic review and meta-analysis of the effectiveness of food safety education interventions for consumers in developed countries

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Young, Ian, Waddell, Lisa, Harding, Shannon, Greig, Judy, Mascarenhas, Mariola, Sivaramalingam, Bhairavi, Pham, Mai T., Papadopoulos, Andrew·2015·BMC Public Health
DOI 10.1186/s12889-015-2171-xPMC PMC4548310
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Abstract

BACKGROUND: Foodborne illness has a large public health and economic burden worldwide, and many cases are associated with food handled and prepared at home. Educational interventions are necessary to improve consumer food safety practices and reduce the associated burden of foodborne illness. METHODS: We conducted a systematic review and targeted meta-analyses to investigate the effectiveness of food safety education interventions for consumers. Relevant articles were identified through a preliminary scoping review that included: a comprehensive search in 10 bibliographic databases with verification; relevance screening of abstracts; and extraction of article characteristics. Experimental studies conducted in developed countries were prioritized for risk-of-bias assessment and data extraction. Meta-analysis was conducted on data subgroups stratified by key study design-intervention-population-outcome categories and subgroups were assessed for their quality of evidence. Meta-regression was conducted where appropriate to identify possible sources of between-trial heterogeneity. RESULTS: We identified 79 relevant studies: 17 randomized controlled trials (RCTs); 12 non-randomized controlled trials (NRTs); and 50 uncontrolled before-and-after studies. Several studies did not provide sufficient details on key design features (e.g. blinding), with some high risk-of-bias ratings due to incomplete outcome data and selective reporting. We identified a moderate to high confidence in results from two large RCTs investigating community- and school-based educational training interventions on behaviour outcomes in children and youth (median standardized mean difference [SMD] = 0.20, range: 0.05, 0.35); in two small RCTs evaluating video and written instructional messaging on behavioural intentions in adults (SMD = 0.36, 95% confidence interval [CI]: 0.02, 0.69); and in two NRT studies for university-based education on attitudes of students and staff (SMD = 0.26, 95% CI: 0.10, 0.43). Uncontrolled before-and-after study outcomes were very heterogeneous and we have little confidence that the meta-analysis results reflect the true effect. Some variation in outcomes was explained in meta-regression models, including a dose effect for behaviour outcomes in RCTs. CONCLUSIONS: In controlled trials, food safety education interventions showed significant effects in some contexts; however, many outcomes were very heterogeneous and do not provide a strong quality of evidence to support decision-making. Future research in this area is needed using more robust experimental designs to build on interventions shown to be effective in uncontrolled before-and-after studies.

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  • The summarized effect size for attitude was SMD = 0.28, suggesting a moderate effect for positive attitude of food handlers.

    “Considering the summarized effect size, a SMD = 0.28 suggests a moderate effect for the positive attitude of food handlers; this is similar to previous studies [57,58,66].”

    From A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers (2020) · cites this paper as [66]

    The Results (Meta-analysis results; page unavailable) report a positive adult attitude effect of SMD = 0.26, close to the citing paper’s 0.28. The Discussion identifies the participants in that analysis as university students and staff, not food handlers. Its “moderate” rating describes GRADE certainty, not the size of the effect. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Self-reported data are usually susceptible to social desirability bias, so respondents tend to overestimate their food safety practices.

    “However, this is contrary to expected, since self-reported data are usually susceptible to social desirability bias [112], i.e., the tendency of respondents to give socially desirable responses in such a way as to be viewed favorably by others [113]. Thus, respondents tend to overestimate their food safety practices as being higher than their actual practices deserve [38,66,114,115].”

    From A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers (2020) · cites this paper as [66]

    The Discussion (page not available in our copy) says self-reported food-safety behaviours can be subject to social desirability bias and can be overestimated relative to observed practices. It does not establish that respondents usually overestimate their practices; it also notes studies finding agreement between self-reported and observed behaviours. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Behavior outcomes provide a more direct measure of intervention effectiveness compared to knowledge and attitudes.

    “Behavior outcomes provide a more direct measure of intervention effectiveness compared to knowledge and attitudes [66]; however, food safety practices were measured in only 16 out of the 31 studies.”

    From A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers (2020) · cites this paper as [66]

  • Food safety practices were measured in only 16 out of the 31 studies.

    “Behavior outcomes provide a more direct measure of intervention effectiveness compared to knowledge and attitudes [66]; however, food safety practices were measured in only 16 out of the 31 studies.”

    From A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers (2020) · cites this paper as [66]

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Research works printed but not linked: 59

  1. [1]Scallan E Griffin PM Angulo FJ Tauxe RV Hoekstra RM Foodborne illness acquired in the United States—unspecified agents Emerg Infect Dis 2011 17 16 22 10.3201/eid1701.P21101 21192849 PMC3204615 · DOI
  2. [3]Hoffmann S Batz MB Morris JG Jr Annual cost of illness and quality-adjusted life year losses in the United States due to 14 foodborne pathogens J Food Prot 2012 75 1292 1302 10.4315/0362-028X.JFP-11-417 22980013 · DOI
  3. [4]Thomas MK, Murray R, Flockhart L, Pintar K, Pollari F, Fazil A, et al. Estimates of the burden of foodborne illness in Canada for 30 specified pathogens and unspecified agents, circa 2006. Foodborne Pathog Dis. 2013;10:639–48. PMC3696931 23659355
  4. [5]Thomas MK Majowicz SE Pollari F Sockett PN Burden of acute gastrointestinal illness in Canada, 1999–2007: interim summary of NSAGI activities Can Commun Dis Rep 2008 34 8 15 18800412
  5. [6]Vrbova L Johnson K Whitfield Y Middleton D A descriptive study of reportable gastrointestinal illnesses in Ontario, Canada, from 2007 to 2009 BMC Public Health 2012 12 970 10.1186/1471-2458-12-970 23145487 PMC3503727 · DOI
  6. [7]Keegan VA, Majowicz SE, Pearl DL, Marshall BJ, Sittler N, Knowles L, et al. Epidemiology of enteric disease in C-EnterNet’s pilot site - Waterloo region, Ontario, 1990 to 2004. Can J Infect Dis Med Microbiol. 2009;20:79–87. PMC2770317 20808465
  7. [8]Redmond EC Griffith CJ Consumer food handling in the home: a review of food safety studies J Food Prot 2003 66 130 161 12540194
  8. [10]Redmond EC Griffith CJ Consumer perceptions of food safety risk, control and responsibility Appetite 2004 43 309 313 10.1016/j.appet.2004.05.003 15527934 · DOI
  9. [11]Nesbitt A, Thomas MK, Marshall B, Snedeker K, Meleta K, Watson B, et al. Baseline for consumer food safety knowledge and behaviour in Canada. Food Control. 2014;38:157–73.
  10. [12]Patil SR Cates S Morales R Consumer food safety knowledge, practices, and demographic differences: findings from a meta-analysis J Food Prot 2005 68 1884 1894 16161688
  11. [13]Fein SB Lando AM Levy AS Teisl MF Noblet C Trends in U.S. consumers’ safe handling and consumption of food and their risk perceptions, 1988 through 2010 J Food Prot 2011 74 1513 1523 10.4315/0362-028X.JFP-11-017 21902921 · DOI
  12. [14]Haines RJ Report of the Meat Regulatory and Inspection Review. Farm to Fork: A Strategy for Meat Safety in Ontario 2004 Toronto Queen’s Printer for Ontario
  13. [16]Munro D Le Vallée J-C Stuckey J Improving Food Safety in Canada: Toward a More Risk-Responsive System 2012 Ottawa The Conference Board of Canada
  14. [19]Milton A Mullan B Consumer food safety education for the domestic environment: A systematic review Br Food J 2010 112 1003 1022 10.1108/00070701011074363 · DOI
  15. [20]Jacob C Mathiasen L Powell D Designing effective messages for microbial food safety hazards Food Control 2010 21 1 6 10.1016/j.foodcont.2009.04.011 · DOI
  16. [21]Campbell ME Gardner CE Dwyer JJ Isaacs SM Krueger PD Ying JY Effectiveness of public health interventions in food safety: A systematic review Can J Public Health 1998 89 197 202 9654807 PMC6990163
  17. [23]Sivaramalingam B, Young I, Pham MT, Waddell L, Greig J, Mascarenhas M, et al. Scoping review of research on the effectiveness of food-safety education interventions directed at consumers. Foodborne Pathog Dis. 2015;12:561–70. 26135891
  18. [25]Arksey H O’Malley L Scoping studies: towards a methodological framework Int J Soc Res Methodol 2005 8 19 32 10.1080/1364557032000119616 · DOI · Paper page
  19. [27]Keown K Van Eerd D Irvin E Stakeholder engagement opportunities in systematic reviews: Knowledge transfer for policy and practice J Contin Educ Health Prof 2008 28 67 72 10.1002/chp.159 18521874 · DOI
  20. [31]Borenstein M Hedges LV Higgins JPT Rothstein HR Introduction to meta-analysis 2009 Chichester UK John Wiley & Sons, Ltd.
  21. [34]DerSimonian R Laird N Meta-analysis in clinical trials Control Clin Trials 1986 7 177 188 10.1016/0197-2456(86)90046-2 3802833 · DOI · Paper page
  22. [35]Lathyris DN Trikalinos TA Ioannidis JP Evidence from crossover trials: empirical evaluation and comparison against parallel arm trials Int J Epidemiol 2007 36 422 430 10.1093/ije/dym001 17301102 · DOI
  23. [36]Medeiros LC Hillers VN Chen G Bergmann V Kendall P Schroeder M Design and development of food safety knowledge and attitude scales for consumer food safety education J Am Diet Assoc 2004 104 1671 1677 10.1016/j.jada.2004.08.030 15499353 · DOI
  24. [37]Kendall PA, Elsbernd A, Sinclair K, Schroeder M, Chen G, Bergmann V, et al. Observation versus self-report: validation of a consumer food behavior questionnaire. J Food Prot. 2004;67:2578–86. 15553645
  25. [38]Abrams KR Gillies CL Lambert PC Meta-analysis of heterogeneously reported trials assessing change from baseline Stat Med 2005 24 3823 3844 10.1002/sim.2423 16320285 · DOI
  26. [39]Zou GY One relative risk versus two odds ratios: implications for meta-analyses involving paired and unpaired binary data Clin Trials 2007 4 25 31 10.1177/1740774506075667 17327243 · DOI
  27. [40]Fraser AM An evaluation of safe food handling knowledge, practices and perceptions of Michigan child care providers. PhD thesis. Michigan State University, Department of Food Science and Human Nutrition 1995
  28. [41]Byrd-Bredbenner C Wheatley V Schaffner D Bruhn C Blalock L Maurer J Development of food safety psychosocial questionnaires for young adults J Food Sci Educ 2007 6 30 37 10.1111/j.1541-4329.2007.00021.x · DOI
  29. [42]Townsend MS Johns M Shilts MK Farfan-Ramirez L Evaluation of a USDA nutrition education program for low-income youth J Nutr Educ Behav 2006 38 30 41 10.1016/j.jneb.2005.11.014 16595276 · DOI
  30. [43]Peters JL Mengersen KL Meta-analysis of repeated measures study designs J Eval Clin Pract 2008 14 941 950 10.1111/j.1365-2753.2008.01010.x 19018929 · DOI
  31. [44]Higgins JPT Thompson SG Deeks JJ Altman DG Measuring inconsistency in meta-analyses BMJ 2003 327 557 560 10.1136/bmj.327.7414.557 12958120 PMC192859 · DOI · Paper page
  32. [45]Higgins JP Thompson SG Quantifying heterogeneity in a meta-analysis Stat Med 2002 21 1539 1558 10.1002/sim.1186 12111919 · DOI · Paper page
  33. [47]Thompson SG Higgins JPT How should meta-regression analyses be undertaken and interpreted? Stat Med 2002 21 1559 1573 10.1002/sim.1187 12111920 · DOI · Paper page
  34. [48]Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction - GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64:383–94. 21195583
  35. [49]Bhattacharyya OK Estey EA Zwarenstein M Methodologies to evaluate the effectiveness of knowledge translation interventions: a primer for researchers and health care managers J Clin Epidemiol 2011 64 32 40 10.1016/j.jclinepi.2010.02.022 21130349 · DOI
  36. [52]Dollahite JS Pijai EI Scott-Pierce M Parker C Trochim W A randomized controlled trial of a community-based nutrition education program for low-income parents J Nutr Educ Behav 2014 46 102 109 10.1016/j.jneb.2013.09.004 24268300 · DOI
  37. [53]Montgomery P Mayo-Wilson E Hopewell S Macdonald G Moher D Grant S Developing a reporting guideline for social and psychological intervention trials Am J Public Health 2013 103 1741 1746 10.2105/AJPH.2013.301447 23947317 PMC3780746 · DOI
  38. [54]Hovis A Harris KK O27 A WIC internet class versus a traditional WIC class: lessons in food safety education and evaluation [abstract] J Nutr Educ Behav 2007 39 S101 10.1016/j.jneb.2007.04.282 · DOI
  39. [55]Fajardo-Lira C Heiss C Comparing the effectiveness of a supplemental computer-based food safety tutorial to traditional education in an introductory food science course J Food Sci Educ 2006 5 31 33 10.1111/j.1541-4329.2006.tb00079.x · DOI
  40. [56]Kosa KM Cates SC Godwin SL Ball M Harrison RE Effectiveness of educational interventions to improve food safety practices among older adults J Nutr Gerontol Geriatr 2011 30 369 383 10.1080/21551197.2011.623943 22098179 · DOI
  41. [58]Nauta MJ Fischer ARH Van Asselt ED De Jong AEI Frewer LJ De Jonge R Food safety in the domestic environment: the effect of consumer risk information on human disease risks Risk Anal 2008 28 179 192 10.1111/j.1539-6924.2008.01012.x 18304115 · DOI
  42. [61]Quick V Corda KW Chamberlin B Schaffner DW Byrd‐Bredbenner C Ninja kitchen to the rescue Br Food J 2013 115 686 699 10.1108/00070701311331481 · DOI
  43. [62]Engel DA Applying dialogical design methods to video: enhancing expert food safety communication. PhD thesis. Cornell University 2003
  44. [63]Trifiletti E Crovato S Capozza D Visintin EP Ravarotto L Evaluating the effects of a message on attitude and intention to eat raw meat: salmonellosis prevention J Food Prot 2012 75 394 399 10.4315/0362-028X.JFP-11-120 22289604 · DOI
  45. [65]DeDonder S Jacob CJ Surgeoner BV Chapman B Phebus R Powell DA Self‐reported and observed behavior of primary meal preparers and adolescents during preparation of frozen, uncooked, breaded chicken products Br Food J 2009 111 915 929 10.1108/00070700910992844 · DOI · Paper page
  46. [66]Abbot JM Byrd-Bredbenner C Schaffner D Bruhn CM Blalock L Comparison of food safety cognitions and self-reported food-handling behaviors with observed food safety behaviors of young adults Eur J Clin Nutr 2009 63 572 579 10.1038/sj.ejcn.1602961 18000516 · DOI
  47. [67]Milton AC Mullan BA An application of the theory of planned behavior – a randomized controlled food safety pilot intervention for young adults Health Psychol 2012 31 250 259 10.1037/a0025852 22059618 · DOI
  48. [68]Unusan N E‐mail delivery of hygiene education to university personnel Nutr Food Sci 2007 37 37 41 10.1108/00346650710726931 · DOI
  49. [69]Mayer AB Harrison JA Safe eats: an evaluation of the use of social media for food safety education J Food Prot 2012 75 1453 1463 10.4315/0362-028X.11-551 22856569 · DOI
  50. [71]Cragun EC The number of lessons needed to maximize behavior change among Community Nutrition Education Program (CNEP) participants 2006 MSc thesis Oklahoma State University, Graduate College
  51. [72]Dharod JM Perez-Escamilla R Bermudez-Millan A Segura-Perez S Damio G Influence of the Fight BAC! food safety campaign on an urban Latino population in Connecticut J Nutr Educ Behav 2004 36 128 132 10.1016/S1499-4046(06)60149-8 15202988 · DOI
  52. [73]Lynch RA Dale Steen M Pritchard TJ Buzzell PR Pintauro SJ Delivering food safety education to middle school students using a web-based, interactive, multimedia, computer program J Food Sci Educ 2008 7 35 42 10.1111/j.1541-4329.2007.00046.x · DOI
  53. [74]Redmond EC Griffith CJ A pilot study to evaluate the effectiveness of a social marketing‐based consumer food safety initiative using observation Br Food J 2006 108 753 770 10.1108/00070700610688386 · DOI
  54. [75]Dwan K Gamble C Williamson PR Kirkham JJ Reporting Bias Group Systematic review of the empirical evidence of study publication bias and outcome reporting bias - an updated review PLoS One 2013 8 10.1371/journal.pone.0066844 23861749 PMC3702538 · DOI · Paper page
  55. [76]O’Mara-Eves A, Brunton G, McDaid D, Oliver S, Kavanagh J, Jamal F, et al. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Res. 2013;1:1–525. 25642563
  56. [77]Byrd-Bredbenner C Abbot JM Quick V Food safety knowledge and beliefs of middle school children: implications for food safety educators J Food Sci Educ 2010 9 19 30 10.1111/j.1541-4329.2009.00088.x · DOI
  57. [78]Medeiros L Hillers V Kendall P Mason A Evaluation of food safety education for consumers J Nutr Educ 2001 33 Suppl 1 S27 S34 10.1016/S1499-4046(06)60067-5 12857542 · DOI
  58. [80]Shapiro MA Porticella N Jiang LC Gravani RB Predicting intentions to adopt safe home food handling practices, applying the theory of planned behavior Appetite 2011 56 96 103 10.1016/j.appet.2010.11.148 21115082 · DOI
  59. [81]Takeuchi MT Edlefsen M McCurdy SM Hillers VN Educational intervention enhances consumers’ readiness to adopt food thermometer use when cooking small cuts of meat: an application of the transtheoretical model J Food Prot 2005 68 1874 1883 16161687

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Authors
Young, I., Waddell, L., Harding, S., Greig, J., Mascarenhas, M., Sivaramalingam, B., Pham, M. T., & Papadopoulos, A.
Affiliations
  • Public Health Agency of Canada (CA)
  • University of Guelph (CA)
Corresponding author
Papadopoulos, Andrew
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2015-08-26
Volume
15
Issue
1
Pages
822-822
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-015-2171-x
PMC
PMC4548310
OpenAlex
W1951751055
Cited by
83
References
14
Citations by year
2026: 9 · 2025: 7 · 2024: 9 · 2023: 5 · 2022: 11 · 2021: 11 · 2020: 10 · 2019: 4 · 2018: 7 · 2017: 3 · 2016: 5 · 2015: 1
FWCI
0.68
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Public Health Agency of Canada
  • Public Health Agency
Topics
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Food Safety and Hygiene
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
foodborne illness prevention, home food handling, educational intervention, school education, community-based education, behavioral intention, attitudes, risk of bias, dose-response relationship
MeSH terms
Adolescent, Adult, Child, Child, Preschool, Health Education, Humans, Outcome Assessment, Health Care, Developed Countries, Food Safety

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