Food Safety Education in the 21st Century: Understanding and Improving Food Handling Knowledge and Behavior among Hard-to-Reach Audiences

NON-TECHNICAL SUMMARY: The proportion of food handling data collected on diverse, low-income populations and those with limited formal education is limited. In the past decade, U.S. cities have witnessed an increasing number of refugees and other minorities escaping political and social oppression in Bosnia, Iraq, Somalia, Sudan, etc. Fargo-Moorhead and other cities in the upper Midwest have witnessed an increasing number of refugees and other minorities. In 1999 and 2000 alone, over 1,000 new refugees resettled to Fargo. According to 2003 data, over 11,000 refugees live in Fargo-Moorhead. In addition, there has also been an increase in secondary migration (refugees initially resettled in other parts of the US moving to the Fargo-Moorhead area). The five largest groups resettling to North Dakota are Bosnian, Sudanese, Somali, Albanian and Kurdish. In a pilot food safety education study with refugees and new Americans in Fargo, ND, many gaps in safe food handling knowledge, skills, and current practices were noted. The overall purpose is to reduce the risk of foodborne illness outbreaks among consumers, especially hard-to-reach and at-risk audiences through preventive education and community outreach.

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APPROACH: Assessment activities comprise the use of interviews and focus groups. Interviews will be conducted with four to six members of each of six designated ethnic/language groups. An interpreter will be used as necessary. Interviewees will be selected based on their previous work in an on-going health mentoring program or by their perceived status as an opinion leader of their ethnic group. An interview question guide will be designed to gather culturally relevant information related to food acquisition, preparation, storage, and re-use. Interviews will be electronically recorded and transcribed for later analysis. Six focus groups with each of the designated ethnic/language groups will be conducted to broaden project understanding of diversity over the spectrum of food handling practices. While members of each focus group will be able to communicate with each other, language specific interpreters will be included to assure communication between focus group members and project personnel. A question guide will be constructed based on prior analysis of interview data. Focus group sessions will be electronically recorded and transcribed. Preliminary data analysis of the transcripts of each interview using the methods derived from grounded theory analysis will be conducted to identify relevant food safety themes and issues. This analysis will be used in turn to design culturally appropriate question guides for each of the focus groups. Transcriptions of the focus groups will be analyzed to generate understanding of issues and target areas to be integrated into the food safety educational materials and workshops. Results of interview and focus group data analysis will comprise an extensive formative evaluation, which will be used to develop appropriate food safety education materials including content of the on-line modules and ways to best disseminate the information. Such an in-depth process will enable us to tailor programming to meet the needs and cultural diversity of our audiences. Data analysis of the quantitative survey data will be conducted in consultation with a statistical research analyst. Using the results of focus groups, high-quality educational modules in six languages (in print/audio/interactive slide show) will be developed/adapted. A "gateway" multilingual food safety Web site will be created, including all materials and links (with permission) to multilingual food safety resources in other states. Health mentors from the respective populations will be trained, and community and school-based education using the trained health mentors, extension agents and a variety of community partners will disseminate the information and technology broadly in schools and numerous community settings.