By Barbara Mullan, Curtin University, Australia

Extent of the problem

Every year, one in 10 people worldwide (approximately 600 million people) become ill after eating contaminated food, and as many as 420,000 people die. There are vast geographical differences in where these instances occur, with African, South-East Asian, and Eastern Mediterranean regions bearing the highest burden of foodborne disease (further detail about the foodborne disease burden by region can be found here). In addition to these geographical differences, there are also vast differences in the types of agents that are responsible for foodborne disease (e.g., viruses, bacteria, parasites).

There are many links in the food safety chain from “farm to fork”. While there is a lot being done that is helping farmers, industries and restaurants manage their food safety, consumer involvement in safe food handling is often overlooked. Consumer safe food handling practices are vital as they represent the final stage of foodborne illness prevention. The estimates of what proportion of food poisoning originates in the home vary widely, ranging from 11 to 87%. As health psychology practitioners, there is a lot that we can do to help consumers minimise their risk of becoming ill with food poisoning in the home.

Practices contributing to outbreaks of food poisoning are variable, but the World Health Organisation has five key messages to keep food safe to eat. These are:

1. Keep hands and utensils clean,
2. Separate raw and cooked food (particularly when returning from the market/shop and when storing food in the refrigerator),
3. Cook food thoroughly,
4. Keep food at safe temperatures (i.e., keep hot food hot and keep cold food cold), and
5. Use safe water and raw materials.

Predicting consumer behaviour

Early research into the role of the consumer had concentrated on their knowledge as the primary influence on their behaviour. However, a systematic review found evidence that knowledge does not necessarily lead to safe food handling behaviour. This is also the case for other health behaviours, but knowledge is needed, even if not sufficient to change behaviour, as it helps build understanding of the ‘how’ and ‘why’ of the behaviour.

To help better understand what other influences may help consumers engage in safe food handling, researchers have used a variety of theories, mainly from psychology. These have included the theory of planned behaviour, protection motivation theory and the health belief model. A recent review of this research found that intention, social norms, self-efficacy and habit were important influences on consumer safe food handling, and concluded that interventions based on these constructs would likely be effective for improving their behaviour.

Food hygiene interventions

Another great review found some evidence that educational interventions were effective for improving food safety in the home. But there are also other effective interventions that target psychosocial constructs in addition to educating consumers. For example, one intervention based on the theory of planned behaviour was successful in changing safe food handling behaviour. This intervention provided undergraduate students with food safety information and used strategies, such as making specific plans and barrier identification, to help increase intention and perceived behavioural control (i.e., confidence to engage in the behaviour). The intervention increased both perceived behavioural control and safe food handling behaviour. These findings suggest that we can help our clients by educating them on how to perform safe food handling behaviours, and by encouraging them to make specific plans for doing so (e.g., help them formulate a plan to use separate chopping boards for meat and vegetables by discussing particular strategies).

Another successful intervention was based on habit theory. This intervention helped undergraduate students develop a habit of microwaving their dishcloth via providing an informational poster (i.e., a cue) and through providing reminders for performing the behaviour every three or five days. Behaviour significantly increased over the three-week testing period, and was maintained at three-week follow-up. Practically, these findings suggest that It would be useful to provide clients with food safety information, and also help them form habits for particular behaviours (e.g., encourage setting reminders in their phones for microwaving their dishcloth every week).

In sum, the above research indicates that there is a lot we as health psychology practitioners can do to help our clients to engage in this vital health behaviour. This starts with educating our clients about food safety, and then helping them to feel confident in their ability to engage in the behaviours as well as assisting them in building habits.

As a final note, while all consumers are at risk of becoming ill with foodborne illness, about 25% of the population are at higher risk, including pregnant women, children under 5, older adults, and people with compromised immune systems. Thus, it is important for health psychology practitioners to recognise particular opportunities for the interventions outlined above, such as when people present with chronic health conditions, when working with parents or older adults, and when women are considering pregnancy.

Practical recommendations

• Educate people that food safety starts in the home, and that important precursors of behaviour include intention, social norms, self-efficacy and habit.
• Do not underestimate the role of knowledge. Utilise national and global resources to educate consumers about the importance of food safety behaviours; once they have that information, certain simple behaviours can be easily adopted.
• Highlight the importance of food safety, by emphasising how safe cooking and food handling behaviours can affect health and can minimise the risk of food poisoning for individuals and their loved ones.
• Address both rational (e.g., intention) and automatic (e.g., habit) processes. Start with motivational strategies such as goal setting and planning, then encourage the use of cues (e.g., posters and reminders) to help people build food safety habits and routines.