Abstract
The determinants of food safety knowledge and practices of the Iranian consumers were investigated. The questionnaires was designed, validated and applied to 1500 participants from capital city and regional area of East-Azarbaijan–Iran. Overall percentage mean score for knowledge and practice was 77.66% and 70.77% respectively. There was low level of awareness and practice with respect to optimal heating/cooling temperature, proper thawing techniques and eating raw egg. Female and married respondents had significantly higher mean knowledge score than males (p<0.001) and singles (p=0.04). Residents of regional areas act more safely than capital city residents (p=0.01). In conclusion, the mean food safety knowledge and practice of Iranian consumers were good yet there is lack of knowledge and practice on some important factors. According to lower food safety knowledge and practice of low educated, single and male respondents, the educational programs should mainly focus on these groups.
Key words: Food safety; knowledge; practice, Education, Iranian consumer
Introduction:
Food related disease is an important health problem worldwide. According to WHO (2010) report, food borne disease were found to affect more than 30% of the population in developed countries and the problem is more sever in developing countries. Moreover, studies have estimated that between 50% and 87% of reported food borne disease outbreaks have been associated with the home (Redmond and Griffith 2003). Although the public is progressively more concerned about food-related risks, the rise in food related disease cases suggests that people still make decisions of food consumption, food storage and food preparation that are less ideal from a health and safety perspective (McCarthy et al. 2007). The lack of hygiene education; contaminated waters; inappropriate food storage conditions; lack of cleaning and inadequate reheating of cooked food are the main causes of food related illness (Eves and Kipps 1995, Medeiros et al. 2004).
There are a number of literatures reporting the food safety knowledge of consumers in different countries and they showed many gaps that have an impact on food-borne diseases at home (Garayoa et al. 2005, Kendall et al. 2004, Kennedy et al. 2005, Redmond and Griffith 2003, Unusan 2007). The effect of demographic characteristics on consumer's food safety knowledge and practices were also investigated and generally found that the food safety knowledge and practice were more likely to increase with age and the level of education (Bruhn and Schutz 1999, Roseman and Kurzynske 2006, Van Kleef et al. 2006). Females were also found to be more familiar with safe food-handling practice than males (Albrecht 1995, Altekruse et al. 1996, Altekruse et al. 1999, Jevšnik et al. 2008, Li-Cohen and Bruhn 2002, Meer and Misner 2000). Respondents who lived within the city tend to have lower scores compared with those who lived in rural areas (Albrecht 1995).
Although, there have been numerous studies investigating the food safety knowledge and practice in different countries, there is limited data that directly tackles this issue in Iran. Moreover, to the best of our knowledge, there is no education program in Iran to enhance food safety knowledge and practices of consumers in any age group. Since for the development of effective food safety education programs in each region, learning about the basic knowledge and practice of consumers is essential; this study was conducted with the aim of determining food safety knowledge and practices of the Iranian consumers and also investigating their association with various social-demographic characteristics and residential area.
Method and materials
The data for this study were collected in 2015 as a part of the major lifestyle promotion project conducted in the districts of East Azarbaijan (urban and regional parts), one of the large province of Iran. The sampling method of this study is the probability proportional to size (PPS) multistage stratified cluster sampling. One hundred fifty clusters were selected. The updated postal code was used as a sampling frame of this study. In urban areas, clusters include one to numerous blocks or parts of blocks. Generally, blocks were attached buildings. In each cluster, 10 participants (5 females and 5 males) were enrolled (1500 participants). The start point of sampling was determined and sampling began from that point and continued toward to the right-hand side of each building. Exclusion of incomplete questionnaires yielded 2135 final sample, subjected to statistical analysis. The final sample consists of 916 the capital city (Tabriz) residents and 1219 regional areas residents (including Marand, Mianeh, Varzegan, Khodafarin, Bonab, Osku and Ilkhichi).
All procedures performed in this study were in accordance with the ethical standards of the Ethics Committee of Tabriz University of Medical Science and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Also, Informed consent was obtained from all individual participants included in the study.
Instrumentation
The research data was collected by two questionnaires through face-to-face interviews. The first questionnaire included questions regarding the socio-demographic characteristics including age, gender, educational level, marriage status and residential area. The second questionnaire is consist of two parts: the first part including 18 questions regarding food safety knowledge of and the second part including 14 questions regarding self-reported practice of participants. The food safety knowledge and practice questionnaire was a modified from other researchers (Unusan, 2007, Sharif & Al-Maleki, 2010, Hajimohammadi et al, 2014).
The food safety questionnaire was pilot tested, resulting in minor modifications. Cronbach alpha coefficient of internal consistency was used to estimate the reliability of the questionnaire. Alpha coefficient of 0.71 and 0.77 were considered to be acceptable for food safety knowledge and practice respectively.
Statistical analysis
SPSS v18 Statistical computer software was used for all statistical analyses. Normal distribution was assessed using Kolmogrov-Smirnov test. The demographic characteristics represented the independent variables. Each multiple-choice question had one correct answer that was assigned the score of 1 point; whereas, 0 point was assigned to all wrong answers. Student t test and Analysis of Variance (ANOVA) was conducted to compare the mean sum of correct responses of every section by gender, age, residential area. For the cor¬relates analyses, linear regression was used for investigating the association between independent variables and food safety knowledge and practice. Significance level of .05 was used.
Results:
Table 1 outlines the demographic characteristics of 1373 Iranian adult consumers. Mean age of the participants was 35.77±15.86 years. Approximately 19.7% of subjects had a college degree and 69% were undergraduated. About 86% of subjects were married and 47 % of them lived in the capital city (Tabriz). .
Table 2 summaries the correct responses of participant to knowledge questions. About 56.1% of participants stated that chilling or freezing could not eliminate harmful germs in food. Respectively, 89.1%, 73.3% and 68.2% of participant truly knew that “milk left in the counter over night”, “Cooked food left out of the refrigerator more than 2 hours” and “leftover meat” had higher risk to cause food poisoning. About 95.2% of consumers knew that they should not drink unpasteurized milk, 81.6% of them confirmed that grilled steak should not served on the same plate that held raw steak without washing the plate. However, only 37% of participant truly knew that left over food should be reheated until boiling and also only 46.1% of them knew that they should not eat raw or undercooked egg.
Table 3 summarizes the safe food practice of Iranian consumers. About 93% of respondents regularly checked the expiry date written on the food packages and about 67% of them checked the label of the product for any storage instructions. About 93% of them washed their hands before preparing and eating food. Fifty nine percent of the respondents always left cooked food at room temperature until cool before placing it in the refrigerator and 17% of them put the frozen foods under the running water for thawing. Moreover, 93% of the respondents usually place leftover foods in the refrigerator in no later than two hours of consumption. More than half of the respondents heated leftover foods until they are boiling hot. About 88% of respondents check food cans for buckling or bulging, about 52% of respondents boil the canned foods, 40% of them never eat raw eggs or foods made from raw eggs, and 82% of them put the raw meat sprats from cooked foods in refrigerator.
The mean scores of knowledge and practice of respondents in different age, sex, marital status and residential area are shown in table 4. There was no difference between youth and adults in the case of food safety knowledge and practice. Knowledge score of females was significantly higher than males (p<0.001); however, in the case of practice score, there was significant differences between two genders regarding both mean knowledge (p=0.04) and practice (p= 0.02) scores. Although the knowledge scores of respondents with different educational level were not significantly different, the respondents who had university education had better food safety practice in comparison with other ones. Besides, the mean knowledge scores of respondents who lived in capital city were significantly more than respondents who lived in regional areas. However, there was no difference between these two residency areas regarding food safety practice.
The regression models for the association between the mean knowledge and practice scores and independent variables (age, sex, marital, educational and residency status were shown in Table 5. After adjusting for independent variables, females (versus males) and respondents with higher education (compared with illiterate/read and write and diploma) had higher mean knowledge scores. On the other hand, after adjusting for independent factors, married (versus single), respondent with diploma and higher studies (versus illiterate/read and write) and regional areas residents (compared with capital city resents) significantly had more mean practice scores.
Discussion:
It is of great importance for consumers to develop food safety knowledge and practices and the role of educational programs in this regard of great importance. However, there are only a few studies conducted on food safety knowledge and the practice of Iranian consumers. As for the development of effective food safety education programs, learning about the basic knowledge and practice of consumers is essential; this study was conducted to determine the food safety knowledge and practices of the Iranian consumers and also investigating its correlates in this population
The results of current study indicated that the overall percentage mean score for knowledge and practice was 77.66% and 70.77% respectively that were considered good. Approximately, similar results of knowledge score was reported in studies from Iran (Hajimohammadi et al. 2014) and Saudi Arabia (Sharif and Al-Malki 2010). In a study conducted by Hajimohammadi et al. (2014) about food safety knowledge and practice of females from Yazd-Iran, the results showed that the majority of respondents (69.2%) had good knowledge about food safety (Hajimohammadi, Ehrampoush, Khalatbari-limaki, Amiri, Gerayllo and Hosseini 2014). Based on the results of this study, the majority of consumers were aware of food safety rules, although there were many gaps in their knowledge and practices that might lead to food-borne illnesses. According to the results, although the participants had high level of knowledge in the case of self hygiene (about 87%), there was low level of awareness and also poor practice with respect to optimal heating/ cooling temperature and proper thawing techniques. These results are consistent with the results of other studies conducted in Turkey (Unusan 2007), Saudi Arabia (Sharif and Al-Malki 2010) and Iran (Hajimohammadi, Ehrampoush, Khalatbari-limaki, Amiri, Gerayllo and Hosseini 2014). The mean percent of knowledge about foods that increase food poisoning was low (about 50%). Similar to findings of earlier studies (Alrabadi et al. 2013, Hajimohammadi, Ehrampoush, Khalatbari-limaki, Amiri, Gerayllo and Hosseini 2014, Sharif and Al-Malki 2010, Unusan 2007), there was lack of knowledge and poor practice regarding eating raw egg. It seems that people in many parts of the world think that there is no risk of disease from eating half-cooked or raw egg eating. Studies conducted in USA have reported that about 40–50% of the people consume raw egg (Byrd-Bredbenner et al. 2008, Patil et al. 2005). Sharif & Al-Malki (2010) showed that about 34% of the Taif University students have believed that raw eggs are more healthy and nutritious than cooked ones (Sharif and Al-Malki 2010).
In accordance with the results of other studies (Angelillo et al. 2001, Langiano et al. 2012, Unusan 2007), female respondents in present study had significantly higher mean knowledge score than males. After adjusting for age, sex, marital, educational and residency status, female responders still had significantly higher knowledge. As in Iranian community, most food are prepared and cooked at homes and females are traditionally being the responsible for the nutrition of the whole family and feeding the children, this issue is so important.
In contrast to earlier findings (Albrecht 1995, Unusan 2007), the results of current study signified that there was no significant difference between knowledge score of participant with different educational level; however, after adjusting for different covariates, the respondents with university education level and married ones had significantly higher mean practice score. This may be due to the fact that educated and married people are often better recognized the importance of food safety and more concern on personal hygiene and avoiding risky practice of food borne disease.
Another important finding was that the urban (capital city) residents significantly had more food safety knowledge than respondents from regional cities but the there were no significant differences between their practices. After adjusting for other variables such as age, sex and educational and marital status, there was no significant correlation between residency area and knowledge score; however, residents of regional areas act more safely than capital city residents. These findings do not support the previous research. Albrecht (1995) showed that US respondents who lived within the city tend to have lower knowledge scores compared with those who lived in rural areas (Albrecht 1995). A possible explanation for our findings might be that the urban residences had high access to food safety information; however, they did not put their knowledge into practice. On the other hand, studies showed that the people with more experience of food preparation had more safe practices. As people in regional areas more often prepared meals at homes so certain food safety related practices may be traditionally practiced and passed on by the mothers of young girls.
The main strength of this study was a large sample size from different urban and regional areas that serve quite different populations. However; as the current study measured the self-reported practice which is prone to bias by subjects, the results should be interpreted considering this limitation.
In conclusion, the above results revealed that the mean knowledge and practice regarding food safety of Iranian consumers was good yet there is lack of knowledge and practice on some important factors related to food poisoning such as eating raw or lightly cooked egg or improper heating/thawing practices. These findings have important implications for developing proper food safety education programs in Iran which should mostly emphasize on these important issues. According to lower knowledge and practice of low educated, single and male respondents about food safety, it seems that these groups may benefit more from educational programs. Moreover, it should be noted that despite the good knowledge of some respondents regarding food safety, their food safety practices were poor. It can thus be suggested that the future studies had better focus on investigating the perceived barriers of consumers about food safety practices.
Acknowledgments
This study was funded by the East Azarbaijan Provincial Health Center, Tabriz Health Services Management Research Center at Tabriz University of Medical Sciences and Eastern Azarbaijan Governor General for financial support.