Participant knowledge gain
Results of knowledge questions showed an increase in immediate knowledge gain between pretest and posttest, suggesting that the educational program was successful in improving food safety knowledge of participants (Table 2). At program entry, only 24.4% of the participants answered all 3 items correctly. After the program, 75.6% of the same participants answered the questions correctly (P < 0.001).
Participant improvement in attitudes
Overall, participants' attitudes regarding fresh produce food safety were statistically and practically significantly different between the time points, with an average attitude rating of 4.29 (SD = 0.52), 4.78 (SD = 0.33), and 4.39 (SD = 0.41) on the retrospective pretest, posttest, and follow-up, respectively (Table 3). Post hoc analysis indicated that attitudes were statistically (P < 0.001) and practically (η2= 0.49) significant. However, at the 3-mo follow-up, gains above pretest levels were modest (P = 0.005, η2= 0.02). Specifically, there were improvements in attitudes related to safe handling of fresh produce at the grocery store or market and proper storage and washing of fresh fruits and vegetables (Table 3).
Participants' improvement in behavior
At follow-up, participants' overall food safety behaviors significantly improved compared to retrospective pretest levels, being both statistically (p<.001) and practically (η2= 0.16) significant. Improvements in behaviors were found related to all areas. Table 4 indicates participants' reported behaviors before the program and at the 3-mo follow-up.
Table 4—. Mean retrospective pretest and 3-mo follow-up scores for participants' behavior related to fresh fruit and vegetable food safety (n = 426).
|Separate fresh fruits and vegetables from raw meat in the shopping cart.||3.97 ± 1.22||4.52 ± 1.06||<0.001|
|Bag fresh fruits and vegetables separate from raw meat at grocery checkout.||4.28 ± 1.08||3.56 ± 1.71||<0.001|
|Keep fruits and vegetables separate from raw meat in the refrigerator.||4.66 ± 0.71||4.91 ± 0.46||<0.001|
|Use a thermometer to check refrigerator temperatures.||2.97 ± 1.64||3.90 ± 1.46||<0.001|
|Wash fresh fruits and vegetables even if the skin or rind is not eaten.||3.89 ± 1.21||4.54 ± 0.84||<0.001|
|Use a fruit/vegetable brush to scrub skins and rinds of firm fruits and vegetables.||3.51 ± 1.39||3.70 ± 1.37|| 0.042|
|Wash fresh fruits and vegetables just before cooking or eating them.||4.47 ± 0.84||4.76 ± 0.68||<0.001|
|Refrigerate fresh fruits and vegetables that have been cut within 2 h.||4.17 ± 0.94||4.49 ± 1.00||<0.001|
|Wash and sanitize food preparation areas in the kitchen.||4.40 ± 0.84||4.65 ± 0.68||<0.001|
|Wash hands before handling fresh fruits and vegetables.||4.35 ± 0.93||4.77 ± 0.60||<0.001|
|Wash and sanitize cutting boards/utensils before preparing fresh fruits and vegetables.||4.33 ± 0.97||4.69 ± 0.77||<0.001|
|Total behavior scale mean||4.10 ± 0.68||4.42 ± 0.48||<0.001|
Consumers often fail to recognize their home environment as a potential source of foodborne disease and underestimate the frequency of serious consequences related to foodborne disease (Bruhn 1997). This may serve as a barrier to consumers making recommended behavior changes (Sammarco and others 1997; Redmond and Griffith 2003).
However, it is interesting to note that in our study consumers reported long-term improvement of behaviors but not attitudes. It is possible that this lack of change in consumer attitudes may be due to a ceiling effect, since most participants reported positive attitudes toward produce food safety before the program. Perhaps consumers felt overall that fruits and vegetables were safe to eat before the program and therefore this topic was not a high priority for them. However, one could surmise that consumer attitudes might change if an outbreak of foodborne illness linked to produce was noted in their community or if they were exposed to repeated and specific news and media messages about a produce outbreak. Although participants' overall attitudes related to the risks of foodborne illness remained practically unchanged in our study several months after the program, improvements in food safety behaviors were realized, and changes in these behaviors (USFDA 2000, 2005) are crucial to reducing the risk of foodborne illness from fresh produce regardless of lack of change in attitudes among consumers.
One objective of this educational program was to improve safe handling of fresh produce at the grocery store or market. Results indicated that participants reported separating fresh produce from raw meats in their grocery cart as well as bagging fresh produce separate from raw meat at the checkout counter. Other studies have shown that half of consumers surveyed report “no special requirements” for bagging fresh produce at the grocery store (Li-Cohen and Bruhn 2002).
Proper home storage of fruits and vegetables is an important topic related to both quality and safety. For purposes of this study, storage recommendations were targeted toward increasing the safety of produce items via prevention of cross-contamination of fresh produce in the refrigerator, as suggested by previous research (Li-Cohen and Bruhn 2002). We noted significant, long-term behavior changes in this area. Consumers reported positive changes in use of a refrigerator thermometer in the home (Table 4) and also reported long-term knowledge gains related to the proper temperature of the refrigerator (Table 2) which are important for safe storage of foods.
Participants in our study reported a significant increase in washing fresh produce, including washing fresh fruits and vegetables with running water even if the skin or rind is not eaten (Table 4). In a previous study, 60% of consumers reported that they washed fruits and vegetables to remove germs and bacteria to improve their safety. In the same survey, 6% of consumers reported that they did not wash fruits and vegetables because these foods were safe without washing (Li-Cohen and Bruhn 2002). Medeiros and others (2001) suggest that messages concerning washing of fresh produce should be included in food safety education programs as “it is the only method to reduce pathogen load on fresh produce.” Additionally, washing fresh produce before eating was identified as an important behavior to prevent cross-contamination (Hillers and others 2003) although it cannot guarantee prevention of foodborne illness.
While participants in our study reported changing behaviors related to use of a vegetable brush to scrub firm produce, this was the smallest increase noted in behaviors, even though participants were given this item as an incentive for completion of the surveys (Table 4). Previous results indicate that only 4% of consumers use a vegetable brush to scrub whole melons and only 17% use a brush to wash whole carrots (Li-Cohen and Bruhn 2002). Similarly, data from the Partnership for Food Safety Education indicated that 49% of surveyed individuals were aware of the recommendation to use a vegetable brush, but only 42% reported always or usually using a scrub brush (PFSE 2006). These results suggest that additional innovative educational strategies beyond demonstrating how to scrub produce and providing a vegetable brush may be necessary to motivate consumers to use this food safety tool.
Proper washing of cutting boards, utensils, and food preparation areas after contact with raw foods such as meat, poultry, and fish is a key consumer behavior to the prevention of cross-contamination (Medeiros and others 2001). In an earlier study, 24% of consumers reported using only water to clean food preparation surfaces, with 5% reporting dry wiping with no water or solution (Li-Cohen and Bruhn 2002). Nearly 20% of respondents in the same study indicated rinsing knives with water only after cutting meat and before slicing fresh produce and 8% reported simply dry wiping the knife between foods. All of these behaviors could cause cross-contamination and result in foodborne disease. Consumers in our study reported improvements in behaviors related to washing and sanitizing food preparation areas and washing/sanitizing cutting boards/utensils before preparing fresh fruits and vegetables (Table 4).
If used properly, sanitizing solutions offer an added level of protection against the risk of foodborne disease (USDA/FSIS 2006a). Consumers reported knowledge gain (Table 2) related to identification of a mixture of bleach and water as a sanitizing method as suggested by the U.S. Food and Drug Administration (USFDA 2000, 2005). Given that over 40% of participants in this study could be considered at increased risk of foodborne illness, use of a sanitizing solution could be a valuable skill for them to adopt. At posttest, 77% of consumers were able to answer correctly as to what constitutes a sanitizing solution (Table 2). Furthermore, they reported washing and sanitizing food preparation areas, cutting boards, and utensils in their home kitchens (Table 4). However, no data were available on whether or not consumers in our study actually knew how to prepare the sanitizing solution correctly.
A unique food safety recommendation included in our educational program was to refrigerate fresh fruits and vegetables that have been cut within 2 h. According to survey data from the Partnership for Food Safety Education, 61% of consumers reported hearing or seeing this recommendation, with 75% reporting that they always or usually followed the 2-h rule for cut fruits and vegetables (PFSE 2006). Forty-four percent of participants in our study reported that they always followed this recommendation at pretest with a significant increase to 73% at the 3-mo follow-up.
Hand washing is another key behavior in the prevention of foodborne disease (Medeiros and others 2001). Long-term improvements related to washing hands before handling fresh fruits and vegetables were realized among participants. Forty-two percent of our study participants indicated that, before the program they did not always wash their hands before handling fresh produce. This is similar to other data showing 47% of individuals failed to wash their hands every time before handling fresh produce (Li-Cohen and Bruhn 2002). Following participation in our educational program, 84% of individuals at the 3-mo follow-up indicated that they always washed their hands before preparing fresh produce.
This study has several limitations. First, this study included the use of self-reported data in which participants may have over-reported behaviors perceived as positive (Stanton and others 1987). Additionally, participants answered the knowledge questions immediately before and after the program which may have influenced participant knowledge gain scores. Finally, there may have been a ceiling effect in regard to attitude measures as mentioned previously.