Teaching young consume s in Eu ope: a mul icen e quali a i e needs assessmen wi h educa o s on ood hygiene and ood sa e y
Copy igh © Royal Socie y o Public Heal h 2021 Mon h 2020 Vol XX No X l Pe spec i es in Public Heal h 1
SAGE Publica ions
ISSN 1757-9139 DOI: 10.1177/1757913920972739
PEER REVIEW
In oduc Ion
Foodbo ne illnesses a e a global bu den
and WHO Di ec o Gene al ad ised ha
‘ ood sa e y is a hidden, and o en
o e looked, p oblem’. WHO1 de ines
ood hygiene as ‘ he condi ions and
measu es necessa y o ensu e he
sa e y o ood om p oduc ion o
consump ion’ and ood sa e y o include
‘sa e ood handling’. E e y yea almos
one in 10 people globally de elop
oodbo ne illnesses and 420,000 people
die.2 WHO2 es ima es ha he e a e
23 million oodbo ne illnesses and 5000
Abs ac
Aim: Foodbo ne illnesses ha e a signi ican global bu den and can be li e-
h ea ening, wi h highe isk in ulne able g oups such as child en.
Sa eConsume is an EU- unded, ansdisciplina y p ojec aiming o imp o e
consume s’ ood sa e y beha iou . De eloping educa ional esou ces on ood
sa e y o use in schools has po en ial o imp o e eaching o ou young
consume s. The aim o his s udy was o explo e school educa o s’ a i udes,
beha iou s and knowledge owa ds ood hygiene, sa e y and educa ion.
Me hods: Focus g oups and in e iews in England, F ance, Po ugal and
Hunga y explo ed educa o knowledge, skills, in en ions and belie s a ound
educa ing young people (11–18 yea s) abou ood sa e y. Da a we e analysed
using NVi o and eme ging hemes we e applied o he Theo e ical Domains
F amewo k.
esul s: A o al o 48 educa o s pa icipa ed. Knowledge, con idence and
skills o each ood sa e y o young people a ied depending on backg ound
and aining. Educa o s epo ed hey had a ole o each ood sa e y o young
people, we e posi i e abou deli e ing educa ion and op imis ic hey could
imp o e s uden s’ ood sa e y beha iou . Ba ie s o eaching included lack o
na ional cu iculum co e age, limi ed ime and money, and lack o acili ies.
Educa o s epo ed ha social in luences ( amily, celeb i y che s, public heal h
campaigns and social media) we e impo an oppo uni ies o imp o e young
peoples’ awa eness o ood sa e y and consequences o oodbo ne illness.
conclusion: Educa o ood sa e y expe ise a ied; aining could help o
op imise educa o knowledge, con idence and skills. Minis ies o Heal h and
Educa ion need encou agemen o ge ood sa e y inco po a ed u he in o
school cu icula ac oss Eu ope, so schools will be mo i a ed o p io i ise hese
opics.
Teaching young consume s in
Eu ope: a mul icen e quali a i e
needs assessmen wi h educa o s
on ood hygiene and ood sa e y
Co esponding au ho :
Cha lo e Eley, as abo e
972739RSH Teaching young consume s in Eu ope: a mul icen e quali a i e needs assessmen wi h educa o s on ood hygiene and ood sa e yTeaching young consume s in Eu ope: a mul icen e quali a i e needs assessmen wi h educa o s on ood hygiene and ood sa e y
Au ho s
C Eley
P ima y Ca e and
In e en ions Uni ,
Public Heal h England,
4 h Floo , Twy e
House, Glouces e GL1
1DQ, UK
Email: Cha lo e.Eley@
nhs.ne
PT Lundg en
Nice Uni e si y Hospi al,
Nice, F ance
G Kasza
Na ional Food Chain
Sa e y O ice, Budapes ,
Hunga y
M T uninge
Uni e si y o Lisbon,
Lisboa, Po ugal
C B own
P ima y Ca e and
In e en ions Uni ,
Public Heal h England,
Glouces e , UK
VL Hugues
Nice Uni e si y Hospi al,
Nice, F ance
T Izso
Na ional Food Chain
Sa e y O ice, Budapes ,
Hunga y
P Teixei a
Uni e sidade Ca ólica
Po uguesa, Lisboa,
Po ugal
R Syeda
P ima y Ca e and
In e en ions Uni ,
Public Heal h England,
Glouces e , UK
N Fe é
Nice Uni e si y Hospi al,
Nice, F ance
A Kunszabo
Na ional Food Chain
Sa e y O ice, Budapes ,
Hunga y
C Nunes
Uni e si y o Lisbon,
Lisboa, Po ugal
C Hayes
P ima y Ca e and
In e en ions Uni ,
Public Heal h England,
Glouces e , UK
K Me akou
Na ional School o
Public Heal h, Uni e si y
o Wes A ica, Egaleo,
A ica, G eece
CAM McNul y
P ima y Ca e and
In e en ions Uni ,
Public Heal h England,
Glouces e , UK
Keywo ds
ood hygiene; ood
sa e y; needs
assessmen ; quali a i e
esea ch; educa ion;
educa o ; eache ;
schools
2 Pe spec i es in Public Heal h l Mon h 2020 Vol XX No X
Teaching young consume s in Eu ope: a mul icen e quali a i e needs assessmen wi h educa o s on ood hygiene and ood sa e y
PEER REVIEW
PEER REVIEW
dea hs in Eu ope annually. Co ec ood
handling and hygiene p ac ice could
p e en mos oodbo ne illness.2
Al hough anyone can ge a oodbo ne
illness, child en a e a a highe isk o
de eloping in ec ion and ha ing se ious
consequences along wi h p egnan
women, olde adul s and
immunocomp omised indi iduals.
Sa eConsume is an EU- unded,
ansdisciplina y p ojec in ol ing 32
pa ne s om 14 coun ies which aims o
educe oodbo ne illnesses. e-Bug,
ope a ed by Public Heal h England
(PHE), lead on he Sa eConsume
educa ional wo k package. e-Bug wi h
hei Eu opean pa ne s de elop
educa ional esou ces o child en and
young people o imp o e hygiene
beha iou s.3 Educa ing child en and
young people on ood hygiene and
mic obiological ood sa e y is an
oppo uni y o c ea e ood sa e y-
conscious consume s o he u u e,
he e o e educing he u u e bu den o
oodbo ne illness. This s udy is an
ou come o he Sa eConsume EU
p ojec .
Se e al s udies ha e explo ed child en
and young peoples’ knowledge and
beha iou s owa ds ood hygiene and
sa e y in he UK, Eu ope and USA,4–9 bu
s udies explo ing educa o iews a e
limi ed. In a small s udy, UK eache s
epo ed ha he mos e ec i e me hod
o each ood hygiene and o ein o ce
ood sa e y messages was wi h
demons a ions o good p ac ice and
p ac ical ac i i ies in ol ing young people
p epa ing ood.10 Swedish educa o s
belie ed ood sa e y was an impo an
pa o he school, home and consume
s udies (HCS).11 Almos all coun ies
ha e in hei school cu icula opics
co e ing ood hygiene and sa e y o
s uden s 11–18 yea s old.12
The aim o his s udy was o explo e
educa o s’ needs in ela ion o eaching
abou ood hygiene and ood sa e y
ac oss ou Eu opean coun ies o in o m
he de elopmen o educa ional
esou ces o add ess any gaps in
knowledge, skills, a i udes and belie s.
Findings om complemen a y esea ch
comple ed wi h young people and
cu iculum o e iew we e epo ed by
Syeda e al.12
Me hods
Resea ch design
Quali a i e in e iews and ocus g oups
wi h educa o s we e conduc ed du ing
No embe 2017 – June 2018 in ou
Eu opean coun ies: England, F ance,
Hunga y and Po ugal. These ou
Eu opean coun ies we e pa o he
Sa eConsume EU p ojec educa ional
wo k package no ed in he in oduc ion.
S anda dised p o ocols o he esea ch
we e de eloped, e iewed and ag eed by
he p ojec eam.
S udy se ing
Seconda y o high schools ha each
s uden s aged 11–18 yea s we e
ec ui ed; be ween ou and nine schools
we e ec ui ed pe coun y (see Table 1).
Rec ui men aimed o ep esen schools
wi h a mix u e o high and low
socioeconomic s a us; o example, a
mix u e o schools loca ed in a luen and
dep i ed a eas (as de ined by he speci ic
coun y). Fu he mo e, ec ui men also
aimed o ep esen a mix u e o
geog aphical loca ions ( u al and ci y) in
each coun y. Ru al loca ed schools a e
gene ally smalle wi h a lowe popula ion
densi y and loca ed in owns, illages
and inge a eas, whe eas ci y schools
a e gene ally la ge wi h a highe
popula ion densi y and loca ed in la ge
ci ies. The esea ch a eas did no ha e
any known oodbo ne illness ou b eaks
o p oduc ecalls du ing he s udy ha
could ha e a ec ed he indings.
Pa icipan s
A minimum o eigh educa o s in each
coun y employed a a school ha augh
11- o 18-yea olds ood, echnology o
science- ela ed subjec s. Educa o s we e
conside ed app op ia e o he s udy i
hey we e quali ied and eaching ood,
echnology o science- ela ed subjec s.
Rec ui men
Each coun y s a i ied schools in wo
geog aphic loca ions in o high and low
socioeconomic g oups, andomised he
s a a, and in i ed each school o
pa icipa e by le e , email and elephone.
I schools declined o pa icipa e, he
nex school in he andomised lis was
app oached. In i a ion con inued un il
da a sa u a ion was eached. Educa o s
we e gi en an incen i e in each coun y
excep o Po ugal; £20 ouche s in
England; USB s icks in F ance; small gi
packs in Hunga y.
opIc GuIdes And
BehA Iou Al heo y
Comp ehensi e opic guides we e
de eloped by he p ojec eam using he
Theo e ical Domains F amewo k (TDF)13
o guide ques ions o explo e knowledge,
skills, belie s and a i udes a ound ood
hygiene and ood sa e y, mo i a ion and
oppo uni ies. Ques ions also discussed
wha esou ces educa o s cu en ly use
o would like o use o eaching abou
ood hygiene and ood sa e y.
The TDF desc ibes 14 ac o s om
heo ies o beha iou change ha all
unde he ca ego ies o capabili y,
oppo uni y and mo i a ion as ou lined in
he Beha iou Change Wheel desc ibed
by Michie e al.13 The TDF was used as i
can help explain he beha iou s equi ed
o success ul educa ion o ood hygiene
and ood sa e y. The TDF can also help
d aw conclusions on he need o u u e
app op ia e in e en ions, o example,
de eloping educa ional esou ces,
es ablishing p ac ical expe ience o
deli e ing aining. The conclusions
d awn om ou quali a i e s udy will help
in o m u u e in e en ions (no included
in his s udy).
Resea che s in England and F ance
pilo ed he opic guide wi h a ood
echnology and science educa o ,
espec i ely, and mino modi ica ions
we e made ollowing educa o
commen s. All esea che s wi hin hei
espec i e coun y commen ed on he
opic guide o ensu e ele ance in hei
coun y; he e o e, he opic guides we e
s anda dised ac oss he ou coun ies
and ansla ed in o hei espec i e
language.
dA A collec Ion
Semi-s uc u ed in e iews and ocus
g oups wi h educa o s we e conduc ed
and acili a ed in a p i a e class oom a
he schools by esea che s in each
coun y; all esea che s we e ained in
quali a i e esea ch me hods (C.B., R.S.
and C.H. in England; P.T.L. and V.L.H. in
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F ance; T.I. and A.K. in Hunga y and M.T.
and J.F. in Po ugal). The in e iewe (s)
did no know any o he educa o s p io
o he da a collec ion and all acili a o s
excep one we e emale. Educa o s we e
p o ided wi h a de ailed in o ma ion
shee , we e awa e o he aims o he
s udy and he in e iewing esea che ’s
o ganisa ion. Second esea che s we e
o en p esen o obse e. In e iews and
ocus g oups las ed be ween 37 and
76 min and many had o be 40–50 min o
adhe e o he du a ion o a lesson. All
esea che s made e lec i e no es
ollowing each da a collec ion o
i e a i ely eedback on opic guide
de elopmen . All da a we e eco ded,
enc yp ed, anonymised and ansc ibed
e ba im and checked o accu acy;
ansc ip s we e no e u ned o he
educa o s. In e iews and ocus g oups
we e conduc ed un il da a sa u a ion was
eached.
dA A AnAlysIs
Quali a i e da a was ini ially analysed
indi idually by each coun y, using an
ag eed common six-s age hema ic
analysis14 (Figu e 1).
NVi o so wa e e sion 11 (QSR
In e na ional P y L d. Ve sion 11, 2015)
was used as a ool o o ganise and code
he da a o hema ic analysis. Ini ial
hema ic analysis was an induc i e,
i e a i e p ocess unning in pa allel o
da a collec ion. One esea che om
each coun y analysed all he coun y-
speci ic da a and a second esea che
double coded 20% o hei coun y da a,
ag eeing he main eme ging hemes
oge he . Main hemes we e hen
discussed be ween all coun ies and an
ag eed consensus o a coding
amewo k was eached h ough
discussions a wo ace- o- ace mee ings
and mon hly elecon e ences. Once he
main codes we e ag eed, an addi ional
da a analysis s age was conduc ed, and
he indings we e applied o he TDF.
Da a o each coun y was summa ised
in a ma ix Excel documen wi h each
heo e ical domain and ele an
co esponding quo es om each coun y
ansla ed in o English. Resul s we e
Table 1.
numbe o pa icipan s (educa o s) pe coun y
coun y u al schools ci y schools educa o in e iew educa o ocus g oup
(pa icipan s)
o al educa o s
England 3 3 5 1 (3) 8
F ance 4 5 10 0 10
Po ugal 1 3 9 0 9
Hunga y 2 2 0 4 (21) 21
To al 10 13 24 5 (24) 48
Figu e 1.
six-s aged hema ic analysis
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Teaching young consume s in Eu ope: a mul icen e quali a i e needs assessmen wi h educa o s on ood hygiene and ood sa e y
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again discussed leading o implica ions,
including he needs and design o
educa o in e en ions. Each coun y
p o ided a w i en epo o educa o
indings based on he TDF wi h
suppo ing quo es and educa o needs
o acili a e s uden educa ion.
esul s
A o al o 48 educa o s pa icipa ed in 24
in e iews and 5 ocus g oups om 10
u al and 13 ci y schools om he 4
coun ies (Table 1). Key hemes a e
desc ibed wi hin each domain o he TDF
and in Table 2 wi h e lec i e quo es,
o he less p e alen hemes a e
summa ised bu no included in Table 2.
Key doMAIns
Knowledge
Educa o knowledge a ied conside ably
ac oss he ou coun ies. O e all, mos
educa o s (excep hose in Po ugal) had
good knowledge on he isks and
consequences o c oss con amina ion,
ehea ing oods and oodbo ne illness.
Educa o s’ unde s anding o ‘ ood
sa e y’ a ied, some educa o s
discussed knowledge o ‘ a m o o k’
and p e en ing oodbo ne in ec ions and
some educa o s discussed chemical
haza ds in ood a he han
mic obiological haza ds.
Few educa o s knew he ypes o
oodbo ne mic obes including Salmonella
en e ica, Lis e ia monocy ogenes and
Esche ichia coli. Knowledge and
pe cep ion o ood hygiene a ied: in
England educa o s unde s ood ood
hygiene o be abou pe sonal hygiene,
ha is, washing hands, ye in F ance and
Po ugal educa o s discussed ood
hygiene in e ms o cooking p ecau ions
and cleaning he cooking en i onmen .
Some educa o s unde s ood he link
be ween ood hygiene and ood sa e y
and he wo we e in e ela ed, bu his
was no consis en . Educa o knowledge
was dependen on hei educa ional and
eaching backg ound: in gene al, mos
educa o s did no ha e any specialisa ion
o quali ica ions in ood subjec s. In
Po ugal, mos educa o s had a biology
deg ee and in F ance a science deg ee.
Educa o s in o he coun ies had o he
backg ounds, including wo king in
indus y.
Skills
Educa o s epo ed hey ha e skills o be
c ea i e, o adap and de elop
us wo hy and in e ac i e esou ces
including playing ca ds, pos e s, ac i i ies
and Powe Poin s. Some educa o s had
augh scien i ic expe imen s in class
including cul u e o yeas , cul u e om a
doo handle, mic oscope obse a ions o
yoghu and expe imen s. Many
educa o s epo ed skills o use online
esou ces in class including ideos,
games, YouTube and so on. Educa o s in
Hunga y epo ed a lack o con idence o
use sma echnology, including
p ojec o s. A ew educa o s in F ance
epo ed eeling skilled o deli e lessons
on mic obes in gene al bu no
oodbo ne mic obes. In Po ugal, o his
subjec a ea, educa o skills a e
ou sou ced when expe s come in and
alk abou mic obes.
Educa o s in all coun ies epo ed
hey ha e he skills in hei pe sonal li e
o check ood has been cooked
co ec ly and is sa e o ea and sha e
hese skills wi h hei s uden s. They
epo ed checking o doneness o
mea h ough no pink bi s and juices
unning clea . Skills in using cooking
implemen s such as empe a u e
p obes o educa e young people abou
ood hygiene a ied ac oss coun ies.
In England, educa o s would explain o
olde s uden s how empe a u e p obes
we e used, bu in Po ugal, educa o s
did no use empe a u e p obes; in
F ance, educa o s do no deli e
p ac ical lessons, so p obes a e no
used.
Social in luences
Educa o s epo ed ha he amily has
he bigges in luence on s uden s’ ini ial
beha iou as hey g ow up and ake on
pa en s’ habi s, a i udes and beha iou s
owa ds ood hygiene lea ning. In all
coun ies, educa o s epo ed ha
iends can also in luence ood hygiene
beha iou and in F ance school nu ses
also play a ole du ing heal h educa ion
classes.
Mos educa o s epo ed ha celeb i y
che s on TV could ha e an impac on
changing s uden s’ exis ing ood hygiene
beha iou . Real-li e media s o ies abou
oodbo ne illness o iends/ amily ha ing
oodbo ne illness, public heal h campaigns
and ad e isemen s we e conside ed by
educa o s, o ha e he bigges capaci y o
change s uden s’ u u e beha iou . Social
media such as Facebook and YouTube a e
popula me hods o communica ion o
s uden s when sea ching o in o ma ion on
hese opics. Educa o s pe cei e online
ecipes as he p e e ed media o s uden s
o lea n abou cooking, o e physical
ecipe books.
Educa o s epo ed ha hey could
ha e a ce ain in luence on s uden
beha iou h ough p o iding ad ice.
Cul u al di e ences in cooking and ood
hygiene we e highligh ed by educa o s,
and hey epo ed ha making s uden s
awa e o hese di e ences would
con ibu e o unde s anding a ound
hygiene and ood sa e y. Educa o s
ac oss coun ies epo ed ha s uden
knowledge abou ood hygiene and ood
sa e y was basic.
Belie s abou capabili ies
Educa o s epo ed being capable o
eaching he basics o ood hygiene such
as hand washing and pe sonal hygiene;
and ood sa e y such as sa e use o
equipmen and e-hea ing. Howe e ,
c oss con amina ion, ood mic obiology
and oodbo ne illnesses we e desc ibed
as mo e di icul o explain o s uden s.
Educa o s epo ed ha poo ood
hygiene may be di icul o imp o e in
school as s uden beha iou is mos ly
in luenced om habi s hey lea n a home
and om he media.
Le el o educa o con idence was
in luenced by lesson du a ion and p io
expe ience o wo king wi h ood. Many
educa o s in F ance desc ibed
hemsel es as ‘a ease’ o each abou
mic oo ganisms bu less con iden o
each abou p ac ical ood hygiene; in
F ance hey do no ha e p ac ical
cooking lessons o school ki chens. In
con as , educa o s in England, whe e
p ac ical lessons a e mo e common, did
no eel capable o eaching abou
oodbo ne mic obes especially i hei
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PEER REVIEW
Table 2.
summa y o main indings aligned o he dF
dF domain Main hemes Key indings Quo es
Knowledge Food mic obiology
Food sa e y
Food hygiene
C oss con amina ion
Foodbo ne illness
Rehea ing oods
Quali ica ions & aining
Educa o knowledge a ied conside ably ac oss he
ou coun ies and a ied on hei quali ica ions and
backg ounds.
Some educa o s unde s ood he link be ween ood
hygiene and sa e y, bu i was no consis en .
‘[Food sa e y means] I can ead wha ood con ains . . .. And I pay a en ion o s o age a home and
he p ope handling o oods’. (Hunga y)
‘Food hygiene is abou c oss con amina ion whe e you' e lea ing, maybe i you' e go aw mea and
salad, o aw mea and cooked mea , and i you' e c ossing o e wi h a kni e, so i you' e chopping he
aw mea and hen you' e chopping he salad’. (England)
‘Pe sonally, heal hy li es yle i 's wha I mean by “ ood hygiene”’ (F ance)
‘C oss-con amina ion ansmission, is whe e a ood ha could be good, can be con amina ed wi h his
kind o mic o-o ganisms’. (Po ugal)
Skills Abili y o adap /de elop
esou ces
Abili y o cook
Cooking empe a u e
skills
Making ood sa e o ea
Educa o s ha e skills o be c ea i e, o adap and
de elop us wo hy and in e ac i e esou ces.
Educa o s gene ally ha e basic cooking skills and he
skills o check ood is hea ed co ec ly and sa e o ea .
‘I' e been eaching o a while now, so I ha e my “ icks”. Mos o he ime I ell s o ies o mo i a e
hem’. (F ance)
‘Fo example, du ing a biology lesson, somebody has a bag o chips, and we ead up he ing edien s. And
hey didn’ know i . They didn’ look a i a home. So, he e a e many hings ha we alk abou ’. (Hunga y)
‘We b ough wo expe s om Rica do Jo ge Ins i u e o do some expe iences wi h kids abou he
mic obes we ha e in ou hands and he impo ance o washing hands’. (Po ugal)
‘The juices mus un clea . I always say, pu a kni e in he hickes bi and hen ake he kni e ou . . . I ’s
go o be ho ho . . . Tha ’s wha I always say o piping ho igh h ough’. (England)
Social in luences Family/Cul u e
Media in luence
Cu iculum
Educa o ole o each
abou ood hygiene/
sa e y
Family and cul u al in luences can impac s uden ’s
beha iou as his is whe e educa o s belie e s uden s
lea n mos o hei ood hygiene a i udes and beha iou s.
Educa o s pe cei e s uden s o lea n using he
In e ne and ha is whe e s uden s ge a lo o hei
in o ma ion om.
The ole o he eache and cu iculum in luences we e
also epo ed by educa o s as a social e ec .
‘I could be use ul lea n mo e a school because some s uden s, especially he younge ones, a e e y
s ic and hey pass o hei pa en s and wan o do wha hey ha e lea ned a school, so I hink i ’s
impo an ’. (Po ugal)
‘I ’s easie o app oach he child en om he angle o he in e ne . Today’s s uden s, including my child en,
a e li ing in he wo ld o he in e ne and cell phones. And pe haps, i we show hem wi h i , hey migh
look o i . Because I’m no su e, ha i I ell hem (wi hou in e ne ), hey will do i a home’. (Hunga y)
‘I y o he ex en o cu iculum, I y no o de ia e’. (F ance)
‘I ’s de ini ely ou esponsibili y o each s uden s abou ood hygiene and ood sa e y’. (England)
Belie s abou
capabili ies
Abili y o each
Abili y o change
beha iou
Le el o con idence
Educa o s eel capable o eaching ce ain elemen s o
ood hygiene, ha is, hand washing and pe sonal
hygiene, bu c oss con amina ion and ood
mic obiology was desc ibed as mo e di icul o deli e .
Educa o con idence depended on ac o s like lesson
du a ion and p io ood expe ience.
‘I eel like I’m one s ep ahead o he s uden s when I’m eaching i . . . I’m lea ning i mysel o be able o
each i he ollowing couple o days so, and hen a e ha i ’s gone om my head as well’. (England)
‘We each hem, bu hen we can’ con ol whe he hey eally wash hei hands o wash he egg. I ’s
e y ha d o e i y i hey apply he knowledge a home ha we’ e augh hem’ (Hunga y)
‘I eel a ease o alk abou immunology and mic oo ganisms. Maybe I’m no ex emely compe en . . .
o ood hygiene and ood bo n in ec ions’. (F ance)
‘These a e no subjec s ha I usually each wi h a lo o de elopmen ’. (Po ugal)
Belie s abou
consequences
Pe sonal expe iences
S uden isky beha iou s
High- isk oods e sus
low- isk oods
Educa o pe cep ion o
hei eaching in luence
Educa o s belie e ha school eaching can in luence
s uden ’s daily li e and can be ans e ed o he home
li e.
Educa o s el ha s uden s ha e isky beha iou s
including missing c i ical hygiene poin s and lack
conce n abou he consequences.
‘I' e been ood poisoned h ee imes . . . he i s ime was when I go my own house and I didn' cook
salmon p ope ly ... hen wice I' e been poisoned om [name o as ood es au an ], wi h he salad
ba ’. (England)
‘Some imes I go o he gi ls' ba h oom and I ha e al eady no iced ha hey do no wash hei hands
. . . They p obably lea e he ba h oom and go o he ba o ha e hei b eak as . They do no wash
because hey ha e no wash habi s, o hey o ge , o because hey wan o go o class oom . . .. I
hey a e my s uden s, I ell: “don’ you wash you hands?”’. (Po ugal)
‘I depends on home educa ion. Because i hey g ow up in such an en i onmen , ha i is an
impo an issue, hen ob iously i will be impo an o hem. Bu i hey don’ g ow up in such an
en i onmen , hey will no ca e abou i ’. (Hunga y)
‘I 's a domain whe e we manage o ca ch s uden s a en ion’. (F ance)
(Con inued)

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summa y o main indings aligned o he dF
dF domain Main hemes Key indings Quo es
En i onmen ,
con ex and
esou ces
Ba ie s o educa ion
School acili ies
Fu u e esou ces
Ba ie s o eaching ood hygiene and ood sa e y
include ime, cos , lack o cooking/ki chen acili ies,
poo equipmen , lack o con en in he cu iculum,
di e en exam speci ica ions, eache aining
challenges, poo school hand hygiene acili ies,
socioeconomic di e ences be ween schools.
Facili a o s include new esou ces ha a e in e ac i e
and engaging.
‘Cu iculum ime is cu all he ime o gi e mo e ime o English and Ma hs. So, you don’ ha e e y
long [ o each ood hygiene]. I ha e hem o one e m, a lesson a week o a e m’. (England)
‘Time. We don’ ha e enough ime. This is he p oblem, ime. I ’s a lo o subjec s, a lo o s uden s and
only a ew hou s. We ha e o do a lo o p ojec s and epo s, a lo o eques s and esou ce
managemen bu we ne e ha e money o buy any hing, i is e y di icul ’. (Po ugal)
‘We don’ ha e an educa ional ki chen’. (Hunga y)
‘Human expe ience is li elie han books’. (F ance)
Memo y, a en ion
and decision
p ocesses
Wha eache s
emembe /s uggle o
emembe
Decision making
Online aining
Educa o s lack knowledge and memo y a ound
oodbo ne mic obe names and causes o oodbo ne
illness.
Online aining o educa o s was discussed posi i ely
and in e ac i e ideos and examples o e e yday li e
a e equi ed o any aining.
‘I chea in he lessons . . . We can alk abou he whole diges i e sys em, and lea n abou ana omy, bu
I’d be e sa e 15 minu es om ha lesson and o alk abou i [ ood sa e y]’. (Hunga y)
‘I hink online aining mus s a wi h e e yday li e examples and hen explain hem’. (F ance)
‘I we ha e some in e es ing ideos [in he online aining], i would be g ea . In Po ugal, we don’ sha e
a lo in o ma ion . . . In B azil, hey ha e a lo o mo ies abou es au an s. The e a e many hings ha
would be in e es ing o kids, we do no ha e any hing he e. He e we don’ do any hing. We do no
ha e ha kind o esou ces’. (Po ugal)
In en ions In en ions o each
In en ions o p e en
oodbo ne illness
Educa o s ha e good in en ions o each ood hygiene
and ood sa e y and ha e he in en ions o make
lea ning abou hese opics in e es ing, in e ac i e and
ela able o e e yday li e.
Howe e , in en ions a e dic a ed by he cu iculum.
‘I ’s inc edibly impo an [ eaching on ood poisoning] . . . because ob iously i has such a big impac
on ou heal hca e sys em’. (England) I is impo an o each ood hygiene and ood sa e y ‘The soone
he be e ’. (Hunga y)
‘The public need o be mo e awa e. I ’s no jus people in he p o ession, i ’s no jus hose ca e e s, i ’s
no jus he people ha un he local ca é o he li le sandwich shop o wha e e . I hink e e ybody
needs o be ully awa e o ood hygiene . . . because he whole idea o his is o educe he amoun o
ood poisoning. Bu I hink i e e ybody was made awa e as a na ion and, I hink i would help and,
yeah I eally do’. (England)
TDF: Theo e ical Domains F amewo k.
Table 2.
educa ional backg ound was no science
ela ed. Educa o con idence was
epo ed o inc ease i hey used a ood
sa e y esou ce om a us ed sou ce.
Educa o s mos ly lacked speci ic aining
in ood hygiene and sa e y.
Belie s abou consequences
Educa o s belie ed ha school eaching
could in luence s uden s’ daily li e by
ans e ing beha iou s o he home
se ing, by sha ing hygiene ules;
howe e , key messages need o be
consis en in bo h se ings o embed
app op ia e beha iou .
Consequences o oodbo ne illness,
high- isk oods and insu icien ood
hygiene we e a se ious conce n o
educa o s and mos epo ed memo able
pe sonal expe iences ha hey sha ed
wi h s uden s.
En i onmen , con ex and esou ces
En i onmen al ba ie s o eaching ood
hygiene and sa e y common ac oss all
coun ies included ime o co e he opics
wi hin he cu iculum, cos , lack o acili ies,
equipmen , lack o con en in he
cu iculum, di e en examina ion
speci ica ions, poo school hygiene acili ies
and socioeconomic di e ences be ween
schools. Facili a o s, common ac oss all
coun ies, included he de elopmen o
new in e ac i e and engaging esou ces
such as online games, boa d games, ca d
games, podcas s, ideos, ole play; hand
hygiene and ood labelling pos e s; sho
p ac ical expe imen s wi h yeas o
mic oscope obse a ion; ho news opics;
and Powe Poin s.
Memo y, a en ion and decision
p ocesses
Educa o s, pa icula ly hose lacking a
science backg ound, ac oss coun ies
epo ed some di icul y emembe ing
oodbo ne mic obe names, he causes o
oodbo ne illness and di icul y keeping
up o da e wi h changes in ood
legisla ion, including Food Sa e y Ac s.
Educa o s eques ed ace- o- ace o
online aining ha needed o be
in e ac i e, wi h ideos, engaging,
lexible, and easy o access, and should
be pedagogic bu also inco po a e
scien i ic aspec s. Educa o s epo ed
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choosing esou ces wi hin he cu iculum
amewo k, om us ed sou ces and
wi h accompanying aining, and
p e e ed p ac ical lessons which we e
memo able o s uden s.
In en ions
Educa o s epo ed in en ions o each
s uden s abou ood hygiene o p e en
oodbo ne illness om a young age using
in e es ing, in e ac i e esou ces ela able
o e e yday li e. Educa o in en ions o
each ood- ela ed opics we e dic a ed
by he cu iculum con en , hough
educa o s epo ed hey could
inco po a e hygiene and sa e y in o many
subjec a eas, ha is, biology, Pe sonal
Social Heal h Economic (PSHE),
echnology, ci izenship and chemis y.
O he hemes
Educa o s ac oss all coun ies epo ed
ha hey had a ole in eaching ood
hygiene and ood sa e y especially o
young s uden s, ins illing key hygiene
messages and building on he knowledge
each academic yea . Educa o s we e
gene ally op imis ic ha hei eaching
could change he beha iou o s uden s
ou side he school en i onmen and
make a posi i e con ibu ion o educe
u u e oodbo ne illness a es and
imp o e hygiene in ood es ablishmen s
by educa ing ou u u e che s.
Educa o s epo ed posi i ely ein o cing
s uden ood hygiene by encou aging
good p ac ice and good beha iou , gi ing
eminde s and ha ing se ou ines o
good hygiene du ing cooking lessons.
Educa o s desc ibed p o iding nega i e
ein o cemen using examples h ough he
media o case s udies on how
mic oo ganisms can g ow when washing
and d ying u ensils o c ocke y has no
been comple ed o a sa is ac o y
s anda d. Educa o s epo ed egula ing
ood hygiene beha iou in s uden s
h ough employing ules in school such as
asking s uden s o wash hei hands
be o e s a ing a p ac ical lesson, and
class oom hand hygiene eminde s and
wa nings abou he impo ance o
pe sonal, hand and ood hygiene.
Regula ions om he na ional and school
cu iculum ul ima ely decide wha is augh
on ood hygiene and ood sa e y.
Repo ed nega i e emo ions o ood
hygiene and sa e y educa ion included
us a ion and nega i i y owa ds ba ie s
o eaching; being wo ied abou doing
scien i ic expe imen s; conce ns abou
oodbo ne illness and ood sa e y o
hei iends and amily; and complain s
abou la ge classes. Posi i e emo ions
included s uden s’ in e es in heal h
opics, ha is, heal hy ea ing and ood
sa e y and us in hei go e nmen ’s
ood sa e y o ganisa ion.
dIscussIon
P incipal indings
The a i udes o educa o s a e posi i e
owa ds educa ing young people on ood
hygiene and ood sa e y, ye he e a e
se e al ba ie s ha p e en his
educa ion om being ou ine in Eu opean
schools including a ied educa o subjec
knowledge, lack o ime o each ou side
o he cu iculum, lack o esou ces and
lack o ki chen and hand hygiene
acili ies.
Teache s epo ed ha social
in luences (cul u e, amily, celeb i ies,
public heal h campaigns, social media)
can con ibu e o s uden decision
making abou ood hygiene and ood
sa e y.
S eng hs and limi a ions
This mul icen e s udy ac oss ou
Eu opean coun ies p o ides a wide
ange o educa o iews ha a e
ans e able ac oss o he Eu opean
coun ies. Bo h in e iews and ocus
g oups we e used o explo e indi idual
and g oup iews on his subjec and he
open in e iew schedule allowed
esea che s o p obe and explo e
a i udes and belie s in de ail.
Al hough se e al esea che s
pa icipa ed in da a collec ion and
analysis, common me hodology including
20% double coding and a coding
amewo k we e ag eed by he p ojec
eam. The induc i e analysis was ollowed
by mapping hemes in o he TDF o help
in o m u u e beha iou al in e en ions.
Compa ison wi h exis ing li e a u e
P e ious wo k wi h educa o s in
Aus alian seconda y schools epo ed
simila en i onmen al ba ie s o ood
educa ion including a lack o educa ional
esou ces, acili ies, human esou ces
and con en in he school cu iculum.15
Ou s udy epo s ha educa o s eel
hey ha e a ole o play in educa ing
young people on ood hygiene and ood
sa e y opics, and his is echoed in
indings in Sweden.11,15,16 Educa o s in
Sweden belie ed ha ood sa e y is an
impo an pa o HCS.11 Home
economic eache s in Aus alia epo ed
ha high schools a e well posi ioned o
imp o e adolescen s’ ood sa e y
knowledge15 and his is e lec ed in
ecen esea ch ha ood, heal h and
educa ion p o essionals in Aus alia a e
highly suppo i e o senio seconda y
school ood li e acy educa ion.16 Fu he
esea ch wi h pa en s in he USA
ein o ced iews ha ood sa e y
educa ion needed o be augh and
ein o ced in school and a home.17
The p esen esea ch indica es ha
educa o s would bene i om he
de elopmen o new educa ional
esou ces o use in schools ( o s uden s
and eache s), ood hygiene and online
aining o imp o e educa o knowledge,
con idence and skills. New educa ional
esou ces could include in e ac i e
demons a ions; Egan e al.10 epo ed ha
UK seconda y school educa o s a ed
in e ac i e demons a ions o good
p ac ice and p ac ical ac i i ies in ol ing
young people p epa ing ood as he mos
e ec i e eaching me hod in a na ionwide
su ey. Mos eache s in an Aus alian
s udy epo ed ha hey needed mo e
aining and esou ces o inc ease hei
con idence in eaching he ood li e acy
cu iculum,18 which is also e lec ed in a
USA s udy ha ound by s eng hening he
knowledge le el o seconda y educa o s,
hey we e be e p epa ed o each ood
sa e y,19 and ea ly esea ch in England and
Wales ound ha eache s need mo e
ma e ials conce ning ood p oduc ion.20
One o he impo an ac o s needed o
each ood sa e y in eache s in Slo enia,
besides he cu iculum, was su icien
knowledge and a posi i e a i ude owa ds
ood sa e y.8 P ima y and seconda y
school educa o s in Romania epo ed ha
ood hygiene and ela ed isks was one o
he mos impo an opics ha hey, as
educa o s, wished o lea n in he con ex
o nu i ion and heal h and ood sa e y.21
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Ou s udy is unde pinned by
heo e ical beha iou , which we ha e no
ound in simila s udies, and indica es
key heo e ical domains o educa o s o
help in o m app op ia e in e en ions o
change educa o and s uden beha iou .
Food sa e y esou ces o high school
and communi y colleges in he USA
including a case s udy on oodbo ne
illness ou b eaks, a ideo on labo a o y
in es iga ion o oodbo ne illness,
in e ac i e web ac i i ies and suppo ing
ma e ials o eache s and class oom
display posi i ely impac ed educa o
amilia i y wi h gene al mic obiology, ood
sa e y s a egies, egula o y equi emen s
and e minology;22 he e o e, u u e EU
esou ces should conside hese ypes o
ma e ials.
Implica ions o esou ce
de elopmen
When de eloping educa ional esou ces,
ba ie s such as ime, cos , lack o
acili ies and poo school hygiene
acili ies need o be conside ed; a
combina ion o sho ac i i ies and
lesson plans including p ac ical cooking
lessons, wa ching ideos, ole play,
games and apps will acili a e
implemen a ion. Food hygiene and ood
sa e y messages a home and a school
need o be consis en , he e o e
esou ce de elope s should seek
endo semen om in luence s in ood
and social media like celeb i y che s o
ensu e he whole amily a e lea ning he
same key messages.
Implica ions o schools, eache s
and Minis ies o Educa ion and
Heal h
Dissemina ion o ou indings should be
ci cula ed o Minis ies o Heal h and
Educa ion ac oss Eu ope o p o ide
e idence o he need o include ood
hygiene and ood sa e y opics in o he
cu iculum. Embedding hese opics in
he cu iculum will allow eache s o
p io i ise deli e ing hese impo an
opics and help educe he bu den o
oodbo ne illness on public heal h.
Schools should deli e key ood
hygiene and ood sa e y messages
h ough he cu iculum, daily ou ines and
whole school ini ia i es o ackle
oodbo ne illness. App op ia e hand
hygiene acili ies a e equi ed in schools
so ha s uden s and educa o s can
ollow app op ia e hygiene ules p io o
ea ing o p epa ing ood. Pos e s and
eminde s h oughou he school and
ac i i ies o do a home will no only
ein o ce app op ia e hand and ood
hygiene messages o s uden s bu also
sp ead hese messages o educa o s
and isi o s a he school and home
en i onmen .
A eache aining in e en ion ha is
accessible ac oss Eu ope o ood,
science and echnology eache s would
be a use ul addi ion o hei con inuous
p o essional de elopmen o inc ease
hei knowledge, con idence and skills
o deli e hese impo an heal h opics.
AcKnowledGeMen s
We would like o hank pa ne s in ol ed in
he Sa eConsume p ojec o hei suppo
and commen s on he p ojec ; Danish
Council o Be e Hygiene, Uni e si y o
Copenhagen, Uni e si y Hospi al Nice,
Na ional School o Public Heal h G eece,
Na ional Food Chain Sa e y O ice Hunga y,
Uni e si y o Lisbon, Minis y o Educa ion
Po ugal, The Ca holic Uni e si y o
Po ugal, Uni e si y o Ba celona,
Uni e si y o Ve e ina y Medicine o
Budapes , F ench Na ional Ins i u e o
Ag icul u al Resea ch, and Ins i u e o
Science, echnologies and en i onmen o
he Uni e si y o Po o. Fu he hanks o
Julie B ooke (PHE) o he adminis a ion
suppo . Many hanks o he educa o s
who ook pa in his esea ch.
Au ho con IBu Ions
England Lead: C.E. managed he p ojec
ollowing da a collec ion; suppo ed
England da a analysis epo ing; led
in e p e a ion o he o e all quali a i e da a
om all ou coun ies; w o e and led he
needs assessmen epo ; d a ed all
e sions o he manusc ip and c i ically
e ised i ; ga e inal app o al o he e sion
o be published; and has ag eed o be
accoun able o all aspec s o he wo k.
F ance Lead: P.T.L. was he lead esea che
o F ance; ec ui ed schools, conduc ed
da a collec ion and supe ised da a
analysis o F ance; commen ed on he
needs assessmen epo and c i ically
e ised he manusc ip ; ga e inal app o al
o he e sion o be published; and has
ag eed o be accoun able o all aspec s o
he wo k. Hunga y Lead: G.K. was he lead
o Hunga y and he esea ch ha was
conduc ed including ec ui men , da a
collec ion and analysis; c i ically e ised he
manusc ip ; ga e inal app o al o he
e sion o be published; and has ag eed o
be accoun able o all aspec s o he wo k.
Po ugal Lead: M.T. was he lead
esea che o Po ugal, ec ui ed schools,
conduc ed da a collec ion and da a
analysis o Po ugal; commen ed on he
needs assessmen epo and c i ically
e ised he manusc ip ; ga e inal app o al
o he e sion o be published; and has
ag eed o be accoun able o all aspec s o
he wo k. England second au ho : C.B.
managed he p ojec du ing da a collec ion,
ec ui ed schools, conduc ed da a
collec ion in England, ga e inal app o al o
he e sion o be published; and has
ag eed o be accoun able o all aspec s o
he wo k. F ance second au ho : V.L.H.
was he esea ch assis an o F ance;
ec ui ed schools, conduc ed da a
collec ion and double coding o F ance;
c i ically e ised he manusc ip ; ga e inal
app o al o he e sion o be published;
and has ag eed o be accoun able o all
aspec s o he wo k. Hunga y second
au ho : T.I. was a esea che o Hunga y;
ec ui ed schools, conduc ed da a
collec ion and analysis o Hunga y;
commen ed on he needs assessmen
epo ; c i ically e ised he manusc ip ;
ga e inal app o al o he e sion o be
published; and has ag eed o be
accoun able o all aspec s o he wo k.
Po ugal second au ho : P.T. helped ec ui
schools in Po ugal, a ended needs
assessmen elecon e ences and ace- o-
ace mee ings; c i ically commen ed on he
needs assessmen epo ; c i ically e ised
he manusc ip ; ga e inal app o al o he
e sion o be published; and has ag eed o
be accoun able o all aspec s o he wo k.
England hi d au ho : R.S. was he esea ch
assis an o England; ec ui ed schools,
conduc ed da a collec ion and da a
analysis o England; commen ed on he
needs assessmen epo and c i ically
e ised he manusc ip ; ga e inal app o al
o he e sion o be published; and has
ag eed o be accoun able o all aspec s o
he wo k. F ance hi d au ho : N.F. was a
esea che o F ance; conduc ed coding
o F ance; c i ically e ised he manusc ip ;
ga e inal app o al o he e sion o be
published; and has ag eed o be
accoun able o all aspec s o he wo k.
Hunga y hi d au ho : A.K. was a
esea che o Hunga y; ec ui ed schools,
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conduc ed da a collec ion and analysis o
Hunga y; c i ically e ised he manusc ip ;
ga e inal app o al o he e sion o be
published; and has ag eed o be
accoun able o all aspec s o he wo k.
Po ugal hi d au ho : C.N. was a
esea che o Po ugal; conduc ed da a
analysis; con ibu ed subs an ially o
o ganise he da a collec ed, anonymised all
he da a; and con ibu ed o he needs
assessmen epo wi h da a analysis;
c i ically e ised he manusc ip ; ga e inal
app o al o he e sion o be published;
and has ag eed o be accoun able o all
aspec s o he wo k. England ou h au ho :
C.H. was he suppo ing esea ch assis an
o England; ec ui ed schools, conduc ed
da a collec ion and double coding o
England; commen ed on he needs
assessmen epo and c i ically e ised he
manusc ip ; ga e inal app o al o he
e sion o be published; and has ag eed o
be accoun able o all aspec s o he wo k.
G eece i s au ho : K.M. has p o ided
inpu om a G eece pe spec i e;
con ibu ed o he cu iculum e iew o ood
hygiene and sa e y in G eece; commen ed
on he needs assessmen epo and
c i ically e ised he manusc ip ; ga e inal
app o al o he e sion o be published;
and has ag eed o be accoun able o all
aspec s o he wo k. Ancho au ho :
C.A.M.M. had he ini ial idea o unde ake
he s udy; had subs an ial con ibu ions o
he design o he wo k (helped de elop he
p o ocol, commen ed on he in e iew
schedule), e iewed he analysis and
in e p e a ion o he quali a i e da a; helped
w i e he manusc ip and c i ically e ised i ;
ga e inal app o al o he e sion o be
published; and has ag eed o be
accoun able o all aspec s o he wo k.
conFlIc oF In e es
The au ho (s) decla ed no po en ial con lic s
o in e es wi h espec o he esea ch,
au ho ship and/o publica ion o his a icle.
e hIcAl App o Al
In England, Public Heal h England
app o al was g an ed by he Resea ch
E hics and Go e nance G oup. In F ance,
e hical app o al was no equi ed
(acco ding o A icle R1121-1-1 o F ench
Public Heal h Code) and da a p o ec ion
au ho i y’s app o al was ob ained om
he Cen e Hospi alie Uni e si ai e de
Nice. In Hunga y, law-compliance o he
esea ch and e hical issues was ensu ed
by he Legal Depa men wi h he o icial
app o al o he Na ional Food Chain
Sa e y O ice P esiden . In Po ugal,
app o al was g an ed by he Comissão
Nacional de P o ecção de Dados.
Educa o s p o ided w i en in o med
consen o pa icipa ion in he esea ch,
audio eco ding and he publishing o
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in line wi h he Da a P o ec ion Ac 1998
and Caldico 1999 egula ions on
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FundInG
The au ho (s) disclosed eceip o he
ollowing inancial suppo o he esea ch,
au ho ship and/o publica ion o his a icle:
The p ojec has ecei ed unding om he
Eu opean Union’s Ho izon 2020 esea ch
and inno a ion p og amme unde G an
Ag eemen No. 727580.
o cId Ids
Rowshona a Syeda h ps://o cid.
o g/0000-0002-6974-8573
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suppleMen Al MA e IAl
Supplemen al ma e ial o his a icle is
a ailable online.
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