Application of a five-step message development model for food safety education materials targeting people with HIV/AIDS.

Individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome have an increased risk of contracting foodborne illnesses and need to take special precautions regarding food safety. We implemented a five-step model to assess the needs of people with HIV, develop education materials targeted to their needs, and evaluate acceptance of the materials. Needs assessment focus groups (n=8) with HIV-infected people (n=65) and interviews with health care providers (n=18) were conducted to determine motivators and barriers to adopting food safety recommendations. Education materials were developed using needs assessment data, literature on foodborne illnesses, and the Health Belief Model. Acceptability of materials was evaluated by focus groups (n=4) with HIV-infected people (n=32) and a survey of health care providers (n=25). Needs assessment focus group participants expressed resistance to and confusion about many recommendations. Prototype materials were designed to address barriers and motivators. HIV-infected people who reviewed the prototype materials in evaluation focus groups expressed positive attitudes about the materials, and most indicated willingness to follow recommendations. Health care providers were interested in distributing the education materials to their clients. Carefully listening to HIV-infected people and their health care providers, as well as detailed investigation of the literature on foodborne illnesses, contributed to acceptance of the education materials.

Observation versus self-report: validation of a consumer food behavior questionnaire.

A reliable and validated set of food safety behavior questions that could be used with confidence when evaluating food safety education programs was identified in this study. A list of 29 food-handling and consumption behaviors rank-ordered within five pathogen control factors by nationally recognized food safety experts was the basis for the development of the behavior questions. Questions were evaluated for reliability and several forms of validity. During a kitchen activity session, 70 graduates of a nutrition education program completed four food preparation tasks while being observed and videotaped. The individuals also participated in an in-depth interview to validate behaviors that could not be observed during the food preparation activity, e.g., refraining from preparing food for others when experiencing diarrhea. Criterion validity was established by comparing questionnaire responses to observed behavior and interview responses. Twenty-eight questions met the validity criterion (> or = 70% agreement between observed and interviewed responses and self-reported responses), with three or more questions from each of five pathogen control factor areas. Observation assessments revealed that hand washing was more likely to be performed prior to beginning food preparation than between working with raw meats and fresh produce. Errors in methods of washing hands, utensils, and preparation surfaces between food preparation tasks were common. Most participants did not use thermometers to evaluate doneness but still cooked to safe internal temperatures. The results provide a tool that educators can use to evaluate food safety programs and will help guide the development of more effective food safety education programs targeting needed improvements in behavioral skills.

Awareness and acceptance of current food safety recommendations during pregnancy.

OBJECTIVES: To better understand pregnant women's food safety attitudes and beliefs that affect food selection, preparation and handling behaviors, sources of food safety information, motivators and barriers to adopting current recommendations, and preferences for receiving food safety materials. METHODS: Eleven focus groups were conducted with 69 women (57 pregnant and 12 less than 6 months postpartum). The Health Belief Model guided development of the moderator's guide. In the presence of each focus group, participants completed a food safety attitude/behavior questionnaire. Sessions were audiotaped, transcribed, and analyzed for common themes across and within groups. RESULTS: Most participants indicated moderate concern about food safety and had made some food handling or consumption changes since becoming pregnant; however, many were not following 7 of the 12 specific recommendations discussed. Further, there was resistance to change habits, especially for less well-known recommendations. The women assumed their food is safe, and wanted strong evidence regarding why they should change current practices. Common barriers included lack of prior awareness of most recommendations, no prior illness from implicated foods and the convenience, perceived health benefits of, and personal preference for many risky foods discussed. Participants wanted food safety information that was quick and easy to read, sufficiently thorough, and specifically targeted to pregnant women. CONCLUSIONS: The women studied had not internalized the connection between risky food consumption during pregnancy and risk to the unborn child, but expressed interest in valid information that might cause them to change their behaviors. The information gained will be useful in developing food safety educational materials for pregnant women.

Design and development of food safety knowledge and attitude scales for consumer food safety education.

OBJECTIVE: The objective of this study was to design and develop food safety knowledge and attitude scales based on food-handling guidelines developed by a national panel of food safety experts. DESIGN: Knowledge (n=43) and attitude (n=49) questions were developed and pilot-tested with a variety of consumer groups. Final questions were selected based on item analysis and on validity and reliability statistical tests. SUBJECTS/SETTING: Knowledge questions were tested in Washington State with participants in low-income nutrition education programs (pretest/posttest n=58, test/retest n=19) and college students (pretest/posttest n=34). Attitude questions were tested in Ohio with nutrition education program participants (n=30) and college students (non-nutrition majors n=138, nutrition majors n=57). STATISTICAL ANALYSES PERFORMED: Item analysis, paired sample t tests, Pearson's correlation coefficients, and Cronbach's alpha were used. RESULTS: Reliability and validity tests of individual items and the question sets were used to reduce the scales to 18 knowledge questions and 10 attitude questions. The knowledge and attitude scales covered topics ranked as important by a national panel of experts and met most validity and reliability standards. The 18-item knowledge questionnaire had instructional sensitivity (mean score increase of more than three points after instruction), internal reliability (Cronbach's alpha >.75), and produced similar results in test-retest without intervention (coefficient of stability=.81). Knowledge of correct procedures for hand washing and avoiding cross-contamination was widespread before instruction. Knowledge was limited regarding avoiding food preparation while ill, cooking hamburgers, high-risk foods, and whether cooked rice and potatoes could be stored at room temperature. The 10-item attitude scale had an appropriate range of responses (item difficulty) and produced similar results in test-retest ( P