Access to sufficient safe and nutritious food is critical to sustaining human life and promoting good health (World Health Organization [WHO], 2020). Unsafe food creates a vicious cycle of disease and malnutrition, especially among vulnerable populations such as infants, young children, elderly and immunocompromised individuals (WHO, 2020). Foodborne diseases also put a strain on health care systems and harm national economies (WHO, 2020). It is therefore important to promote food safety practices to safeguard the health system and national economies. Food safety is crucial not only in the domestic environment, but also in commercial food establishments such as restaurants, institutional kitchens and grocery stores which serve a wide range of individuals, including vulnerable populations. Given the complex nature of worker-related food contamination, food safety programs and interventions must consider comprehensive approaches that account for a broad set of factors, and should therefore adopt an ecological orientation that addresses these factors at multiple levels (Clayton et al., 2015).
Social Ecological Models are used in Public Health to better understand various factors that influence the health status and behaviour of individuals and populations (American College Health Association [ACHA], 2020). The Centers for Disease Control and Prevention (CDC) uses a four-level social-ecological model which considers the complex interplay between individual, relationship, community, and societal factors, to better understand violence and the impact of potential prevention strategies (CDC, 2020). This model can be adapted, as shown in Figure 1, to better understand food safety behaviours in the context of commercial food establishments, and to develop targeted interventions in these settings. In this blog, I will explain how individual, relationship, community and societal factors impact food safety behaviour of food service workers in commercial food establishments and highlight some key target points for effective interventions.
Figure 1
Social Ecological Model for Food Safety
Individual Level
Factors such as age, education, income/financial resources, attitudes, knowledge and skills influence individual behaviours and access to tools and resources required for developing a culture of food safety (CDC, 2020; Clayton et al., 2015). The first level of the model identifies intrapersonal factors (CDC, 2020), some of which can be targeted for interventions.
Research has shown a significant association between educational level, for instance, and food safety knowledge score (Zyoud et al., 2019). Clayton et al. (2015) also found that limited financial and hygiene-related resources, such as a lack of personal washer and dryer, were perceived to complicate compliance with personal hygiene requirements. Targeted intervention strategies to address barriers at this level could therefore include: identifying and connecting financially-challenged workers to community supports/financial assistance to increase access to hygiene resources; increasing access to affordable food safety certification training; access to better education to promote an understanding of food safety concepts, change attitudes and facilitate accurate documentation of food safety practices; and dissemination of food safety information in languages and visual formats (Haque & Kohda, 2020) that cater to people of diverse backgrounds .
Relationship Level
The second level explores close relationships that may influence a worker’s food safety behaviour. Family members, peers, mentors, and close friends contribute to an individual’s experiences (CDC, 2020), and therefore influence a worker’s behaviour. Research has shown that parents with good knowledge are more likely to have good attitudes to food safety concerns such as food poisoning, which in turn translates into practice (Zyoud et al., 2019). Research has also shown that relationships with co-workers and management influence the food safety behaviours of food service workers (Clayton et al., 2015). Managers’ leadership style, including the ability to make team members feel valued, motivate food service workers to practice positive food safety behaviours (Clayton et al., 2015). Targeted interventions, to improve management leadership styles in the workplace, and to educate family members and peers can change attitudes and beliefs, thereby promoting good food safety behaviour at multiple levels of the social ecological model.
Community Level
The third level explores settings such as schools or vocational institutions, food service workplace characteristics, policies and procedures, and community groups or community centres, where social relationships occur (CDC, 2020; Clayton et al., 2015). Food safety culture in these environments can influence or shape a worker’s attitudes.
According to Clayton et al. (2015), some workers indicate that they cannot afford to stay home when sick or feel that staying home when ill would harm their reputation with supervisors. The workers’ concerns may be related to their personal financial responsibilities (individual level), their lived experiences in the workplace (community level), and/or beliefs that have been passed on from their close social networks (relationship level). This perception presents a significant barrier to compliance with food handler health and hygiene requirements, and highlights an interaction between the individual, relationship, and community levels of the social ecological model. Interventions to address this barrier must therefore be targeted across all relevant levels.
One strategy to address this barrier could involve interventions such as: introducing food safety into institutional curricula or community centre activities; enacting labour laws that improve food service workers’ wages; establishing public policies or programs that encourage employers to offer paid sick leave; building capacity within commercial food establishments to integrate food safety in all aspects of their operations; and increasing access to food safety resources and tools that improve behaviours.
Societal Level
The fourth level explores broad factors such as social and cultural norms, public policies, and regulations (CDC, 2020; Clayton et al., 2015) that influence food safety behaviours. Education and regulatory enforcement are commonly used to promote good food safety behaviours within commercial food establishments. However, some cultural norms surrounding how food is sourced and prepared could sometimes present barriers to food safety practices in establishments, as these methods have been passed on for generations. A strong understanding of the value of certain cultural norms can therefore inform the work of policymakers and regulators during the development and implementation of policies and regulatory changes. Stakeholders can then be engaged to determine ways to safely adapt or modify cultural norms involving food handling to meet the intent of the regulations, whilst respecting the culture of the target population. This approach can improve buy-in from communities.
Haque & Kohda (2020) proposed the provision of educational information at schools and places of worship to promote further dissemination of information within the wider population, as a strategy to promote food safety at the community level. To build on this strategy, leaders in these settings could also be mobilized to take on food safety advocacy roles, and influence policy and regulatory changes at the societal level.
Conclusion
The overlapping rings of the Social Ecological Model illustrate how factors at the various levels influence each other (CDC, 2020).This model therefore highlights the fact that a holistic approach to promoting food safety in commercial food establishments must apply interventions across all levels, from the individual to the societal level, to assimilate a culture of good food safety behaviour. Improving food safety practices in commercial food establishments would reduce the burden of food-borne diseases on families, communities, healthcare systems and national economies.
References
American College Health Association. (2020). Ecological Model. ACHA.
Centres for Disease Control and Prevention. (2020). The Social-Ecological Model: A
Framework for Prevention. CDC.
Clayton, M. L., Smith, K. C., Neff, R. A., Pollack, K. M., & Ensminger, M. (2015). Listening to
food workers: Factors that impact proper health and hygiene practice in food service.
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https://doi.org/10.1179/2049396715Y.0000000011
Haque, I. T., & Kohda, Y. (2020). Understanding the impact of social determinants of health
in street food safety: a qualitative study in Bangladesh. International Journal of Health
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https://doi.org/10.1080/14635240.2020.1719860
Zyoud, S., Shalabi, J., Imran, K., Ayaseh, L., Radwany, N., Salameh, R., Sa’dalden, Z., Sharif,
L., Sweileh, W., Awang, R., & Al-Jabi, S. (2019). Knowledge, attitude and practices
among parents regarding food poisoning: a cross-sectional study from Palestine. BMC
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