A Study to Assess Basic Food Safety Knowledge among University Students ()
1. Introduction
Insufficient education, practice, and knowledge regarding food safety pose significant risks for the transmission of food borne illnesses. Annually, an estimated 76 million individuals fall ill due to food-related diseases, with 325,000 hospitalizations and 5000 deaths occurring in the United States alone [1] . Evidence suggests that the number of foodborne disease outbreaks and concomitant illnesses has increased globally in recent years [2] . Therefore, ensuring food safety is not only crucial for maintaining people’s health but also for promoting social stability and better health outcomes. University students are in a prime learning stage where developing good nutritional habits can enhance their educational performances and overall learning. Analyzing university students’ food safety knowledge and identifying any factors that may hinder their ability to maintain food quality can be beneficial in reducing the incidence of foodborne illnesses during both early and later stages of life [3] . Furthermore, this information can aid in launching targeted health education campaigns to spread awareness about food safety and influence the population’s behavior and attitudes towards it [4] . Ultimately, gaining knowledge about food safety can lead to positive behavior changes, fewer food poisoning incidents, and improve overall quality of life [5] . It is important to note that there is a risk of microbiological contamination during every stage of food preparation and handling, which can lead to infection. Therefore, all consumers, especially youth, play a crucial role in preventing foodborne illnesses by retaining good knowledge of correct preparation, cooking, and storing of food. Studies have shown that university students often lack knowledge of food safety and proper handling practices [6] [7] . In fact, they may have some risky eating behaviors. Several lines of evidence suggest that risky eating habits due to a lack of awareness or busy schedules are common among young university students, such as consuming undercooked animal-sourced foods or engaging in other behaviors that can lead to food contamination [8] [9] [10] . To address this issue, efforts have been made to increase awareness of safe food practices among students, including hand washing, preventing cross-contamination, cooking food thoroughly, and storing it properly [11] . Therefore, it is essential to improve awareness regarding safe food practices among university students to prevent potential outbreaks of foodborne illnesses which might happen at any time [12] .
The aim of this research was to evaluate the overall knowledge of food safety preparation among university students from three different universities in Saudi Arabia. This study will cover the overall level of hygiene involved in the locations they visit, cooking, preparing, storing, preserving, and serving food that they consume outside their homes and on university compasses specifically in cafeterias located outside university premises. Additionally, the study aims to investigate whether students’ educational background influenced the way they perceived food safety.
2. Objects and Methods
2.1. Subjects
Out of 500 electronic questionnaires distributed, 408 students responded and joined the study. The students who joined during the spring 2018 were from three different universities: University A represented medical major, University B represented a mix of types of majors including medical and University C represented non-medical majors only. The study sample size was selected using Slovin’s Formula: n = N/(1 + Ne2) where n = sample size, N = population size, e = acceptable margin of error with a precision level of ±5% and a confidence level of 95%. The sum of the enrolled students in the three universities was 155,000 during the study period. Using Slovin’s Formula, 399 was the accepted minimum number of students that represented the three universities. The selection criteria of the study population were any undergraduate students between the 2nd to the 4th year from the three universities can voluntarily join. Postgraduate and students from other universities were not invited to join. The approval of the project was obtained through the official routes of university standards. It must be stated that none of the participated students provided any personal information or student ID numbers and they all participated anonymously using the electronic questionnaire that was circulated through a link on their mobile devices.
2.2. Questionnaire Design and Grading Standards
A questionnaire was developed for the study purpose to assess the food safety knowledge of students who frequently visit different off-campus cafeterias. The questionnaire covered basic information such as university name, major, date of birth and gender, but did not request students’ identification number or name. This self-administered questionnaire was inspired by the information in the book titled Modern Nutrition and Food Hygiene (2016) by Veronica Tuffrey, Published by Scientific Research Publishing. The validity of the study questionnaire was initially tested through a pilot study on a small group of students from University A. The students selected were both medical and non-medical majors. Two versions of the questionnaire were distributed among them, electronic and paper-based. The students who participated in this pilot were then interviewed to ensure that they understood the statements as intended and to provide feedback on them. A comparison was made between the results obtained from the electronic questionnaire and those obtained from the paper-based one to assess concurrent validity. Finally, an epidemiology expert was consulted to assess the concurrent validity of the questionnaire based on the pilot study results. The reliability testing of the questionnaire was also conducted by circulating both versions of the questionnaire at different time intervals (two weeks apart) to assess test-retest reliability. High correlation between responses was detected. Overall, this process ensured that the study questionnaire was valid and reliable for use in the subsequent research.
The questionnaire consisted of three parts. The first part had eighteen statements aimed at measuring students’ knowledge about cafeteria hygiene regulations, cleanliness, availability and functionality of ventilation fans, use of utensils, proper rubbish collection bags, and cleanliness of preparation benches. The second part had eight statements that assessed cafeteria employees’ basic hygiene and food safety skills as food workers. The third part included nine statements designed to evaluate food as preparation, storage, and preservation practices in cafeterias. In all three parts, students were asked to respond to the statement using a five-point Likert scale that consists of the following points: yes, maybe, no, it does not matter, I do not know. The level of knowledge among students was determined based on their responses to the questions. If a higher number of “yes” responses were selected, it was considered an indication of good knowledge regarding a particular statement. Conversely, if “no”, “I do not know”, or “it does not matter” were selected, it was assumed that the student had poor knowledge in that statements. A medium level of knowledge was inferred when the response “maybe” was selected (See Appendix 1: The Study Questionnaire).
The students were able to join the study by clicking on a link that they received on their mobile devices. Students needed to read the study objectives carefully and go through the statements if they agree to join. Prior to the survey, students were not provided with any orientation or instructions regarding the study and questionnaire was distributed among them during their daily university activities.
2.3. Statistical Analysis
All the data were entered into an Excel data sheet and the quality of the data were controlled by the double entry verification. After that, the data were analyzed using (SPSS version 13.0, Inc., Chicago, USA statistical software). Statistical analysis was conducted using the mean and standard deviation (SD) to summarize each student’s age and score on nutrition knowledge. Frequency and proportion were calculated to describe gender, majors, degree levels and attitudes towards food safety. An analysis of a variance test (ANOVA) was used as well to compare the overall knowledge of the students between the three universities.
3. Results
3.1. General Information
The questionnaire took an average of 4 minutes for a student to complete, and out of the 500 distributed questionnaires, 408 (82%) were completed. Of the participating students, 297 (72.8%) were females and 108 (26.5%) were males (see Table 1). The study population had an average age of 20 years old, with 68.6 % falling between the ages of 20 to 22 years old (see Table 2). The students represented various majors including arts, sciences, and medicine at different undergraduate levels, between the 2nd and 4th year.
3.2. Students’ Overall Knowledge
The overall results did not reveal a significant difference in the knowledge of students of basic food safety across the three universities. However, further analysis indicated that the students in one of the universities had better overall knowledge than the other two. This was established by examining the amount of variation within each sample, relative to the number of variations between the samples using the ANOVA test (see Table 3). This was clearly illustrated after multiple comparison methods using Fisher’s Least Significant Difference (LSD) to determine the source of the difference between the three universities. University A’s students were more knowledgeable in basic food safety than university B’s and C’s students combined and University C’s in particular (Mean difference 3.55,
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Table 1. The distribution of gender in the study.
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Table 2. Age groups of the study population.
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Table 3. The overall difference of knowledge in the students' between the three universities.
P < 0.05) (see Table 4). However, no significant differences were observed in the overall knowledge between University A’s and University B’s students. These findings suggest that University A’s students have greater baseline knowledge regarding food safety compared to University C’s students. Due to the high proportion of female students in the study, no attempt was made to compare knowledge levels between male and female students.
3.3. Cafeteria Location
In the first part of the questionnaire, which centered on the cafeteria’s location and general hygiene standards, 77% (14/18) of the answers were answered “yes”. The rest of the answers were directed to the other options. This indicates that students possess a solid foundational understanding of the cafeteria’s overall requirements. Only four statements out of the 18 failed to exceed a 48% response rate. The initial query pertained to rubbish bags and their function, characteristics, location, and whether or not they were covered when students were in the cafeteria. In response to this statement, around 47% (193/408) said “yes,” indicating that less than half of the students only have some knowledge about rubbish bags and their importance in maintaining overall hygiene in a cafeteria. The second statement focused on student behavior regarding observing the cleanliness of a cafeteria’s wall structure and if they are free from cracks and holes. Only 29% (121/408) responded positively to this statement by saying “yes,” indicating that only a few of them notice this when they enter a cafeteria. The third statement focused on whether windows were frequently opened to prevent dust and dirt accumulation. Only 26% (106/408) were positively knowledgeable about this. Lastly, ventilation fans and their efficacy in eliminating cooking odors from the cafeteria were addressed as well. The focus was to check if students noticed if fans were clean, functioning properly, and free from dirt or grease. Only 45% (187/408) responded “yes” to this statement (see Table 5).
3.4. Empylee Practice
As is seen in Table 6, university students were aware of the possible influence of employees’ performance with food safety. It was noticed that they reported more “yes” than other answers in most of the statements listed in this part of the questionnaire. In specific, more than three statements had response rates that exceeded 90%, one statement had more than 80%, and the four remaining ones had a positive response rate of more than 60%. Those were head cover use,
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Table 4. The significant differences between university A and other universities individually.
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Table 5. Statements and answers of university students on the cafeteria location.
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Table 6. Statements and answers of university students on employees’ performance.
availability of health and safety certificates, proper skills in preparing sandwiches, and wearing clean plastic gloves while preparing food. The least proportion detected in this part of the questionnaire was observing the employees’ hand hygiene performance and that was only 61% (249/408).
3.5. Food Practice
In third section of the questionnaire, students had nine statements to select which were about food preparation. Interestingly, seven out of these nine statements received a “yes” with a response rate exceeding 80%. However, two statements had a low response rate. The first one was related to the importance of not leaving fresh food and meat outside the fridge to avoid contamination. Only 54% (222/408) of the students chose “yes,” indicating that more than half of the student population were not aware of this crucial aspect of food safety. The other statement with a low response rate was about the availability and the condition of the fridge, and whether its temperature was monitored and recorded on a special sheet on the outside door. The response rate to this statement was 55.9% (228/408) (see Table 7).
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Table 7. Statements and answers of university students on food preparation.
4. Discussion
The study’s aim is to evaluate students’ knowledge of basic food safety from three different universities in Saudi Arabia when they visit off-campus cafeterias. Another aim is to investigate whether this knowledge will positively be influenced by their educational background or not using a simple questionnaire. Three universities from different cities were included University A, B and C.
The overall analysis of the data indicated that the results did not show a big difference between the overall knowledge of the students in the three different universities. Though further analysis was done on the same data, it was clear that University A out of the three universities was better than the other two in terms of food safety knowledge. The results, which are similar to other studies, indicate that medical students have better knowledge of food safety than other university students because of the nature of their type of education [13] [14] [15] . However, it was not possible to know if this knowledge will improve their behavior in changing the place they eat in if the hygiene standards are low. Roberts et al. state in their study that increased knowledge does not necessarily imply that a change in behavior will take place [16] .
When data were analyzed by cafeteria location, 77% of the students responded positively to most of the statements on the list. Nevertheless, the knowledge rate did not exceed 45% in four questions: the cafeteria walls, the cleanness of the ventilation fans, cafeteria windows opening to prevent dust accumulation and the availability of covered rubbish bags. Several factors could explain this finding. Firstly, students usually come in a rush to cafeterias to grab their meals and then go back to their educational activities. Observation of general hygiene is not important to them since cafeteria walls, cleanness of the ventilation fans, the covered rubbish bags and frequent opening of the cafeteria windows have no direct contact with their food [17] . Secondly, not all students, including medically oriented ones, go that far and study this issue in detail. This may be more relevant to food hygiene inspectors who interact with food establishments as health inspectors and monitor these aspects, rather than regular university students who simply grab a bite to eat at cafeterias without paying much attention to their environment. [18] [19] .
When the data were analyzed based on employees, which mainly observed their practice skills in the cafeteria during food preparation, the overall response to this section indicated high probable knowledge of the students. However, the response rate of the students to the statement relating to frequent employee hand hygiene application had only 60% response rate, which is considered low compared to other answered questions in this section. This was not surprising, as most employee(s) wear plastic gloves and this, might mislead consumers about the application of frequent hand hygiene in the cafeteria during food preparation. It is important to note that these gloves can be contaminated with different bacteria which may lead to food poisoning if they are not changed frequently [20] . Moreover, one can assume that the importance of hand hygiene with medical students is associated more with clinical practice than food preparation and that is why they are not concerned. However, this is not always the case. Bakarman et al. [21] found that only 46% of 453 medical students who studied the importance of hand hygiene during their studies had proper knowledge about it. It can be suggested then that the importance of hand hygiene with non-medical students can be even poorer. Based on the nature of the population studied, it was not possible to analyze the data by medical students against non-medical students. However, the rate of these answers demonstrates that the knowledge with regards to hand hygiene of the study population is attenuated.
Regarding the third set of questionnaire statements on food, seven out of the nine statements had a response rate that exceeded 80%. One unanticipated result clearly showed that only 54.4% of the study population were positive about fresh food and meat that should not be left outside the fridge to avoid contamination. The remaining results had negative answers which indicated uncertainty about the response to the statements. These results reflected those of [22] [23] respectively, who found that the overall knowledge, practices, and attitudes towards food safety among students (medical and non-medical) were low. It seems possible that this study’s results, identified in this section, are due to students’ poor knowledge or carelessness of basic food knowledge.
The other statement which has a very close response rate of 59.9% was related to the fridge’s appearance in good condition, and if its temperature is monitored and recorded on a special sheet on the outside door of the fridge. The rate of answers obtained to this question is not surprising. This kind of information is usually monitored through a special systematic survey known as Hazard Analysis and Critical Control Points (HACCP), which is run by some specialized agencies in food safety. It must be stated however that nothing was found in the literature that indicates a link between HACCP importance and medical/non-medical students. Only students who study food science as an undergraduate course are introduced to the HACCP program during their academic years [24] . Hence, they are aware that it could prevent food-related risks; however, these students were not included in this study.
The findings of this study demonstrate that there are differences in attitudes toward food safety in university students’ responses. Furthermore, the food safety knowledge score of the students in majors other than medicine needs to be improved. This is because this study’s results clearly showed that University A’s students were better at their food knowledge than the other two universities. This may confirm that one’s educational background can interfere with the overall knowledge of the subject. Medical students gave more attention to nutrition and health knowledge because of their major. Besides, they have more opportunities to access that knowledge than other students through their readings, so it could explain their relatively higher scores. This finding comes in agreement with other domestic reports which had similar outcomes that confirmed that non-medical students had poor knowledge of food safety [25] . Therefore, it is important to strengthen the knowledge of all types of university students, in food safety education, to improve their overall knowledge of the subject and even make them more vigilant to issues linked to food health that could lead to health-related diseases [26] [27] .
In conclusion, the main aim of this study was to assess the basic knowledge of food safety among three different university student types in Saudi Arabia beyond the confines of their university cafeterias. Additionally, another aim was to investigate whether students’ educational background had a positive impact on this knowledge or not. The findings indicated that medical students who represented one of the universities, exhibited better knowledge compared to students from other majors in the remaining two universities. This suggests that students’ academic background may influence their overall response. Furthermore, the study revealed that there is an overall good level of basic knowledge regarding food safety, as evidenced by the high response rates for most of the statements, with only a few statements receiving low response rates. For that reason, students from other majors may still need knowledge about food safety to apply when they use off-campus cafeterias, which may help in controlling food-related illnesses.
Like all research studies, this study has certain limitations. Firstly, it only included three universities, and therefore, the findings may not be representative of the knowledge of all students across the country. Secondly, the study did not differentiate between senior and junior students, which could have impacted the results as senior students may possess more relevant knowledge than juniors. Thirdly, the students’ economic status or monthly income was not determined which may interfere with the students’ selections of the type of cafeteria they go to. Lastly, due to a significantly higher number of female participants, it was not feasible to analyze data based on gender. This presents an opportunity for future research to explore this topic further. Therefore, it is recommended that future studies consider these limitations and address them accordingly.
Appendix 1: The Study Questionnaire
Y = Yes, M = Maybe, N = No, D = does not matter, I = I do not know, F = missing value.