Media Analysis

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Beyond self reporting Exploration of food safety
behaviours through observation
Dr. Ben Chapman Food safety extension
specialist North Carolina State
University benjamin_chapman_at_ncsu.edu
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What is safe food?
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Retail and food service
Transport
In-the-home
Processors
Farmers
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WHO factors contributing to foodborne illness

• Improper cooking procedures
• Temperature abuse during storage
• Lack of hygiene and sanitation by food handlers
• Cross-contamination between raw and ready-to-eat
  foods
• Foods from unsafe sources
• All human factors, behaviour based
• WHO, 2002

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Background - communication

• If you think the 10 commandments being posted in
  a school is going to change behavior of children,
  then you think Employees Must Wash Hands is
  keeping the piss out of your happy meals. It's
  not.
• Source Jon Stewart, Saturday Night Live
  monologue, 2002

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Food safety communication philosophy

• Anyone who tries to make a distinction between
  education and entertainment doesnt know the
  first thing about either
• Marshall McLuhan, 1967
• Disconnect between knowledge and food handler
  practices
• Green et al., 2006 Green and Selman, 2005
  Pragle et al., 2007 Redmond et al., 2004

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Where it all began

• MSc project (on-farm food safety)
• Put information into context (Chapman, 2004)
• Began to shift to food service food handlers
  (restaurant inspection interest)
• Post at urinals?
• From Chapman, MacLaurin and Powell, 2009. BFJ (in
  press)
• and
• Chapman, Eversley, Filion, MacLaurin and Powell.
  JFP (in review)

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www.foodsafetyinfosheets.com
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Sample

• 8 sites in Ontario (out of 13 possible)
• Stations
• Grill/fryer
• Deli and salad
• Preparation areas
• Similar menus
• Burgers, chicken, sandwiches, salads, specials
• 47 food handlers

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Methodology

• Baseline practices recorded
• Food safety infosheets were designed (to be
  current) and provided weekly for 7 weeks
• Posted by researcher/assisstants
• 5 highly visible areas
• May have been integrated into on-going training
• Rerecorded

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Data collection

• 174 hours of video on each occasion (pre and post
  food safety infosheet introduction)
• 348 total hours
• On-camera for a mean of 13.43 hours of actual
  food handling pre-food safety infosheet
  introduction and
• 13.55 hours post-infosheet introduction.
• Recording commenced 30 minutes prior to the first
  scheduled employees start time and end 30
  minutes after

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Results Mean events per food handler
Event Pre Post Change percentage
Handwashing attempts 21.09 22.51 1.42 6.7
Correct handwashing events 2.38 4.02 1.64 68.9
Indirect cross-contamination 15.70 13.13 -2.57 -19.6
Direct cross-contamination 1.89 1.04 -0.85 -81.7
Significance level (p lt.05, 95 CI)
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Did your microwave nuke the bacteria?
DeDonder, S., Wilkinson, C., Surgeoner, B.,
Phebus, R, Chapman, B. and Powell, D. 2009.
Direct Observation of Meal Preparation by
Consumers. British Food Journal (in press).
Source NYT (14.oct.07
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Cause for consumer confusion?
Similar appearance of fully cooked and uncooked
breaded products
Product packaging of fully cooked vs. uncooked
products
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N.Y. Times, May 15, 2009
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Methods

• Convenience sample
• 21 Primary meal preparers
• 20 Adolescents
• Direct Observation
• Meal preparation in model kitchen
• Trained scorers and predetermined scale
• Self-report survey
• Data analysis
• Descriptive and frequency statistics (SPSS 15.0)

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Handwashing
Primary Meal Preparers Primary Meal Preparers Primary Meal Preparers
Behavior Self-report Direct Observation
Before food preparation 90 90.5
After handling raw poultry 90 52.4
Adolescents Adolescents Adolescents
Behavior Self-report Direct Observation
Before food preparation 90.5 55
After handling raw poultry 85 10
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Read/apply label instructions

• Reading Little time spent reading
• Applying Only 7 of all participants followed
  directions precisely

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Food Thermometer Use
Primary Meal Preparers Primary Meal Preparers Primary Meal Preparers
Behavior Self-report Direct Observation
Owns a food thermometer 80.9 ---
Uses a food thermometer while cooking 9.5 ---
Used a food thermometer while cooking raw breaded chicken 19 (4) 19
Adolescents Adolescents Adolescents
Behavior Self-report Direct Observation
Owns a food thermometer 68.4 ---
Uses a food thermometer while cooking 0 ---
Used a food thermometer while cooking raw breaded chicken 20 5
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Objectives

• To investigate compliance to hand hygiene at the
  peak of an outbreak investigation
• To assess cognitive factors related to hand
  hygiene
• From Surgeoner, Chapman and Powell, University
  Students Hand Hygiene Practice During a
  Gastrointestinal Outbreak in Residence What They
  Say They Do and What They Actually Do. Journal of
  Environmental Health, September 2009, Volume 72,
  No. 2.

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Methodology

• Combination of different research methodologies
• Provides more illuminating evidence of
  intervention impact and/or effects
• Covert observations (n357)
• Self-report surveys (n100)
• Long interviews (n6)

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Covert observations
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Observation results
Used hand sanitizer Used hand sanitizer Total
Yes No Total
Gender Male Count 16 97 113
within gender 14.2 85.8 100
Female Count 46 198 244
within gender 18.9 81.1 100
Total Count 62 295 357
within gender 17.4 82.6 100
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Key survey results contd

• Beliefs toward hand hygiene
• Most respondents considered they knew recommended
  guidelines on hand hygiene (mean 5.8)
• Perceived adherence
• 64 of respondents ALWAYS perform hand hygiene as
  recommended (another 20 usually did)
• Butonly 20 of their peers ALWAYS performed hand
  hygiene as recommended

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Conclusions

• Human behavior is key
• Education alone ? application of knowledge gained
• Re-evaluate sanitized messages
• Providing easy access to tools does not
  necessarily improve desired practices
• Improving safety culture at societal level,
  merits emphasis

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• Prayer is antiseptic

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Methods

• June and July 2007
• 3 Communities
• Region of Waterloo, City of Toronto, Haiburton
  Kawartha Pine Ridge
• Catalogue practices
• Trained to write down everything, risk or not,
• gleaned from past studies with food handlers,
  health inspections
• Exploratory
• sense of frequency

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Observation results

• Proper handwashing was problematic
• Not consistent, tools not there in one dinner
• Cross-contamination
• Tongs and platters raw meat to RTE burgers
• Dirty equipment used
• No thermometer usage at any of the CMEs
• Despite participants discussions
• Refrigerators over-packed, out of temperature
• To conserve energy, fridge not turned on until
  morning of event

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Observation results
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Have the tools
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Dishwashing (hand towels -- everyone uses towel
dry)
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So What?

• Measuring behaviour methodologies
• What do people actually do?
• Observation has limitations, but better than self
  report or others
• Secret peers/shoppers
• Understanding and tailoring information to target
  audiences
• Moms-to-be
• Menu builders at long term care homes
• On-farm

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So What? (cont)

• Learning from outbreaks
• Storytelling
• Moving beyond traditional training
• Risk identification, other dialogue enriching
  tools
• Food safety culture creation, evaluation and
  enhancement

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bites.ksu.edu
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• Dr. Ben Chapman
• benjamin_chapman_at_ncsu.edu
• Follow me on twitter _at_benjaminchapman
• 919 809 3205
• www.foodsafetyinfosheets.com
• www.bites.ksu.edu
• www.barfblog.com