Dr. Patricia Borrusso is an ORISE Fellow in the Office of Analytics and Outreach at the FDA’s Center for Food Safety and Applied Nutrition. Dr. Borrusso earned her Bachelor’s degree in Nutrition Science from Russell Sage College and her Ph.D. in Biological Sciences from Drexel University where her research focused on food microbiology and consumer food safety.

Q: Why does your research focus on reviewing consumer food safety education campaigns and research from the last 20 years?

A: Since the early 1990’s there have been efforts to improve consumer food safety knowledge and food-handling behavior, yet there haven’t been recent attempts to look at the effectiveness of these efforts. The purpose of my project is to systematically review the body of research that describes how and why consumers handle food and the results from consumer intervention studies. I use my findings to highlight areas where we’ve seen significant improvements in consumer behavior and identify problem areas. We’re working on a set of recommendations that provide specific suggestions about how to improve consumer knowledge and behavior.

Q: Many educators are concerned that self-reported consumer survey data is not very useful for improving food safety education. What did you learn in your review about self-reported verses observational data?

A: Most of what we know about consumer food handling behavior comes from self-reported data. Generally when you compare the self-reported and observed data for a given behavior, both provide consistent conclusions. However, there are far fewer observational studies than self-reported, survey-based studies so it’s possible that as more observational behavior research is completed new patterns will emerge.

There are advantages and disadvantages associated with both collection methods. Studies that use self-reported survey data can include a larger, more diverse sample. Thus, researchers can make population level estimates of food safety behavior and track trends over time. However, if survey responses are inaccurate, then the data may not represent true behavior. Observational studies rely on objective evidence which is considered a more accurate representation of true behavior. However these studies often have small samples and complex designs which make it difficult to generalize results. Overall, regardless of the study type, the quality of the results is related to the quality of the measurement tools and research design.

Q: Last year the Partnership commissioned an environmental scan of consumer food safety education and learned that only about 50% of people who conduct consumer education programming are performing any form of evaluation. What did you learn in your research about how evaluations are being conducted and how they can be improved?

A: My review uncovered several of the problems associated with the evaluation of intervention studies. For example, few studies compare treatments with a control group. Thus only weak inferences could be made as to whether observed changes were actually caused by the intervention. Furthermore, intervention studies should use theoretical frameworks to guide development and evaluation. Yet my review showed that only 37% of intervention studies were informed by a theory of behavior change or learning. Theories provide a framework to help recognize underlying causes of unsafe behaviors and understand how other factors impact the said behavior. Not knowing what to measure can be a waste of time or conceal effects of intervention.                        

Intervention studies could also be improved by bettering the accuracy of reported information. For example, retrospective data is sometimes used to assess outcomes. However, this is not ideal because it diminishes the ability of the researchers to observe actual changes. Collecting pre-test data before the study begins is the better option.

Q: Can you summarize the recommendations that emerged from your work that might be helpful to people designing and conducting consumer education programming?

A: The following two suggestions were developed based on research findings and gaps identified from the literature review; however they are still only suggestions and not currently endorsed by the FDA.

First, consumer education programming could better align with the specific needs of a target audience. Many of the programs I reviewed used findings from previous research to justify the need to develop a new campaign to target consumer behavior, but failed to identify underlying causes of unsafe behaviors. As a result many existing programs and campaigns provide only general information, such as “wash all produce thoroughly under running water before eating, cutting or cooking.” These instructions may not be helpful to people who think produce is already clean and don’t understand why washing is necessary or to people with limited mobility who struggle to hold heavy items while cleaning.

Second, health care providers are a trusted source of information about food and health. However, many health care providers do not provide food safety information to their patients. This is problematic because consumers may not know who else to go to for credible information and may assume food safety is not important because it was not brought up by their physician. In general, health care providers may not address food safety because they don’t believe it’s important or as important as other advice they need to give in a short period of time or because they lack adequate knowledge about how consumers should handle food at home.

Q: Where can your research be accessed?

A: My research has not been published yet, but it will be soon! I will be presenting at the NACCHO and IAFP conferences (summer of 2015) and possibly will be conducting other webinars as well. 

Dr. Jennifer Quinlan is Associate Professor, Nutrition Sciences Department at Drexel University. Dr. Quinlan’s research focuses on identifying food safety risks for minority and low income populations. Her work uses focus groups and surveys to explore differences in handling of food by consumers from different demographic groups. Through her research, she identified the common practice of incorrectly washing raw poultry by consumers of all demographics which lead to the “Don’t Wash Your Chicken” campaign. The focus group research behind “Don’t Wash Your Chicken” was published in the Journal of Food Protection and the research regarding the larger survey is under peer review currently.

Listen to the full recording of the BAC Fighter Knowledge Exchange conference call with Dr.Quinlan and Dr. Bruhn.

Q:  Tell me about the methods you used in your research that led to the discovery that consumers of ALL demographics are still rinsing their chicken? How was the study funded?

A: Our formative research regarding egg and poultry handling by consumers utilized a combination of focus groups and surveys.  We conducted a total of 9 focus groups with consumers of different demographics to discuss practices with these consumers in a more “casual” and “exploratory” setting.  Focus groups are a great tool because they allow researchers to get feedback from participants that they don’t ask about directly.  This allows themes and practices to emerge that researchers may not be aware of to even ask about.  This is essentially what happened with our focus groups.  Participants expressed to us unique pork and poultry purchasing and handling practices that we hadn’t anticipated, one of these was the apparently widespread nature of washing raw poultry among participants.  A limitation of focus groups is that because findings are based on such a small number of people it can’t be assumed that they can be extrapolated to a larger population.  For this reason we conducted a larger telephone survey among approximately 400 consumers in the Philadelphia area.  This survey included questions related to the unique practices we had identified in the focus groups including practices like washing raw poultry, cooking a turkey overnight and purchasing live birds.

Q: So why is it a bad practice to rinse poultry before cooking it? What does the science tell us?

A:  The science tells us that when you’re dealing with raw poultry there’s a chance that it will have either Salmonella or Campylobacter on it, or both.  The science also tells us that cooking poultry to 165 ° F will kill those pathogens.  Simply rinsing with water is not an effective way to eliminate pathogens. The risk associated with rinsing raw poultry is that you increase the chances for cross contamination to occur in the kitchen.  The water used to rinse the poultry can serve as a vehicle to allow the bacteria from the poultry to spread both in the sink and in areas around the sink.

Q: Did people in the focus groups explain why they believed it was a good idea to wash chicken?

A: We heard a number of reasons why people believed they should rinse raw poultry both from focus groups as well as through feedback on social media.  Some people said “I just thought I was supposed to” – either because that’s what they had learned in their home or they had seen it on TV or read it in a recipe or even just because they thought they should because it was raw. Another group of people felt strongly that they needed to rinse raw poultry to remove either blood or just stickiness associated with raw poultry.  Others felt that because the poultry had been processed there was some type of residue from processing that they needed to remove.

Q: I’m sure a great deal of research went into developing the materials for the “Don’t Wash Your Chicken” campaign. As you started the process, did you have a clear idea of how you would motivate people to change behavior? How many different ideas did you have?

A:  The Transtheoretical Model (TTM) played a role in how we approached the development of the materials. The TTM identifies stages where people are in their willingness and ability to carry out a desired behavior ranging from pre-contemplative – that is not even knowing what the proper desired behavior is – all the way to maintenance, which would include regularly performing the desired behavior.  From our results, as well as some results that were coming out of Australia and the UK around that time, we predicted that most consumers were at the pre-contemplative stage – that is, they weren’t even aware that washing raw poultry was an incorrect behavior.  Based on this we felt that the first need was simply to get the message out in a captivating and appealing way to tell consumers not to wash their raw poultry, and therefore at least start to “move” consumers to the next stages of the TTM to either contemplate or prepare to perform the desired behavior of not washing raw poultry.  We recognized that it was unlikely that one initial campaign would address all of the barriers to getting some consumers to adopt this food handling practice. 

We also knew that we wanted to develop a multi-media campaign that would include not only print materials but also internet videos, cartoons, etc. and thanks to USDA funding, we had the resources to do so.  Photo novellas are essentially “picture stories” that aim to teach a lesson through a storyline.  We decided early on that we wanted to use this format in the research.  We really worked as a team with our colleagues at New Mexico State University to develop storylines that would be culturally diverse as well as include a range of chicken recipes and cuts of chicken.

Q: Most of your photo novellas and videos focus on a specific chicken preparation technique, stir fry, oven fried, etc. Do you find that people are equally inclined to rinse their chicken when they’re cooking whole vs chicken parts and chicken breasts?

A:  From our data, it was difficult to tell if people are equally inclined to rinse their chicken when cooking whole vs. parts. It was a small sample and the numbers were very close.  I think that is a question that still needs to be answered with a larger sample of the consumers.  We developed the materials to include in the message that NO type or cut of poultry should be washed, which is why we included a number of different cuts in the different photo novellas.  At the same time, in order to make the materials as culturally diverse as possible we wanted to include a range of recipes and actors/actresses so that educators might be able to use a particular video or photo novella that would be more appealing or easily accepted by their particular audience.

The development of the “germ-vision” really came about through discussions as a group and wondering if there was a way to visualize for consumers the data from a report out of the UK in 2003 that had shown with dye that aerosolization of spray off poultry could travel up to 2.3 feet. This is what the germ-vision was based on.

Interestingly, when the message and campaign of “Don’t Wash Your Chicken” gained such national media and social media attention last year, it wasn’t our culturally appropriate photo novellas and videos that gained the most attention, but the 14 second “germ-vision”.  I think this was a lesson for us and should be a lesson for other public health and food safety educators about the limitations of getting a public health message across in the age of social media and short attention spans.  While to date our videos have been viewed between 1500-5,000 times, depending on the video, the 14 second germ vision has been viewed almost 470,000 times!

Q: Let’s talk about results of your outreach effort.  What can you share in the way of evaluation data?

A: Prior to the press release about the availability of the materials last August, we did a controlled piloting of the materials in Philadelphia, PA. The materials were made available over a 4 week period in a number of libraries and one grocery store. We used a post-test only design to avoid raising the question of washing raw poultry before exposing consumers to the materials. Consumers were surveyed over a 3 week period following exposure to the materials and those who were exposed to the materials were statistically significantly more likely to report not washing poultry. However the number of consumers in both groups that reported not washing raw poultry were still very low – in the 10-25% range, so it also reconfirmed our belief that many consumers are still at the pre-contemplative stage and don’t even know the correct behavior.  We felt the large amount of “discussion” that arose in the media and social media last fall after the materials were released also reconfirmed this idea with many consumers “surprised” to find out this was the proper and recommended handling practice for raw poultry.  While feedback has been that some consumers have been happy to stop the practice of washing raw poultry once they heard the message, it’s clear that there are barriers for other consumers to not wash raw poultry.  Now that the message of not washing raw poultry has become part of the discussion and more widely disseminated, we believe there is a need for more research to better understand the barriers for those consumers who are not accepting of the message and determine how to tailor additional consumer education messages to address those barriers.

No other factor is as critical to the Partnership for Food Safety Education’s commitment to excellence as is structuring opportunities for input and engagement of our public and private sector stakeholders.

The Partnership’s process for content development relies heavily on collaborative input to ensure accuracy, a strong basis in science, and comprehension by consumers.

The Partnership engages people in a way that allows for confirming facts, as well as for gathering experiences and challenges related to communicating with the public on health and food safety topics.

As we work now on a refreshed effort to communicate with consumers about safe handling of fresh produce, the Partnership has structured a process that allowed us to hear from food safety educators in the field, from scientists, and from communications and consumer affairs professionals.  This input is forming our approach to developing a new outreach campaign.

An online survey helped us learn how 550 BAC Fighters have used the Six Steps to Safer Fresh Fruits and Vegetables and their use of various media in getting out their messages.  Convenings of science experts, communications experts and retailers have led to specific recommendations for updates to basic safe handling practices and identified how important information might be made more accessible to consumers.

Collaboration among stakeholders from inside and outside government was the basis of the Partnership’s creation in 1997, and remains fundamental to its mission.

If you are interested in getting involved in efforts to protect consumers of all ages from foodborne illness please contact us at fightbac.org.

In early 2010, following substantial discussion with our current Contributing Partners and Federal liaisons, the Partnership Board of Directors launched a needs analysis process designed to identify areas where the Partnership could add the most value in efforts to educate the public about safe food handling. When we started we didn’t have the resources to “go national” with our conversation on the future of the Partnership.

This changed when our partners in the FDA, in September, 2010, supported the Partnership with a grant that allowed us to engage a great many more stakeholders and also to contract for a multi-year resource development plan so we could grow the Partnership’s operational capacity commensurate with its national mission.

I am very pleased to say that the Partnership’s Board of Directors, on June 7, approved the new national action plan after it was discussed with a leadership steering committee in late May. The plan is envisioned as a three-year plan with three primary focus areas:

1. Leading efforts to evaluate the impact of consumer food safety education;
2. Convening and supporting practitioners inside and outside government to work together to improve outcomes; and
3. Helping to tell the story of the impact thousands of food safety educators have on the health of people in their communities.

I am proud to have had the opportunity to Chair the Partnership’s Board during this exciting time. There are great challenges ahead, also, including the need for a concerted and sustained effort to raise the money necessary to allow the Partnership to execute this important leadership role.

If you are an existing contributing partner or corporate donor to the Partnership– thank you very much for your support!

If you are not yet a contributing partner or donor, I sincerely hope you will consider joining us. We will have an event in the fall with our partners to celebrate the new strategic direction. For now I just want to thank all the stakeholders who were involved in the planning process for your time and effort. It was a job extremely well done and we are grateful to you. Please stay involved as we move the new Partnership forward.

-SHELLEY FEIST, EXECUTIVE DIRECTOR, PARTNERSHIP FOR FOOD SAFETY EDUCATION