The goals/objectives for this project are as follows: <OL> <LI> To determine gaps in food safety knowledge among restaurant food handlers and compare if food safety knowledge differs based on if they are fluent in English versus fluent in Spanish but not English and socioeconomic status of the U.S. census tract where they are employed<LI> To create an educational intervention that can be easily distributed to restaurant food handlers that targets the knowledge gaps identified among the food handlers, is language appropriate, and includes a cartoon and simple brochure format (the outputs of the project)<LI> To assess the impact on knowledge of the educational intervention <LI> To assess if the increased knowledge among food handlers results in improved restaurant inspection report scores, and thus, can be translated into recognizable practice improvement.
NON-TECHNICAL SUMMARY: The goals of this project are to gain a better understanding of and improve restaurant food handler knowledge among English and Spanish speaking food handlers in Chicago to help reduce the risk of food poisoning. The project will involve stakeholder input (such as local and state health department personnel), knowledge surveys of Chicago restaurant food handlers, the creation of two educational interventions to be published in English and Spanish (a brochure and a comic book) based on the most significant and substantial knowledge gaps identified in the survey. The project will compare the knowledge of the restaurant food handlers by performing the knowledge survey before and after the brochure and educational comic book are distributed. It will also examine restaurant inspection scores before and after the brochure and educational comic book are distributed. This project will provide needed insight into food handler knowledge that may be helpful to local and state health departments and restaurant industry personnel responsible for food handling inspection and training of food safety managers in the United States. It will also create evidence-based language-appropriate food handler educational material that may be capable of translation nationwide with the intended purpose of reducing the risk of food poisoning from consumption of restaurant food.<P>APPROACH: The following methods will be used: Initially, a stakeholders meeting will be convened, the food handler survey will be agreed upon, and then the survey will be performed in a wide variety of Chicago census tracts. A $10 local grocery shopping card will be offered to participants. Data analysis will determine gaps in food safety knowledge among restaurant food handlers and compare if food safety knowledge differs between food handlers who are fluent in English and those fluent in Spanish but not English. We will also examine potential restaurant and food handler factors that may influence their knowledge. Afterwards, a second stakeholders meeting will be convened and the analysis results from the pre-intervention knowledge survey will be presented for discussion and review, the evidence-based educational intervention will be created (a brochure and a storytelling based comic book each in English and Spanish). These educational interventions will emphasize the greatest gaps in food handler knowledge observed. Focus groups of English and Spanish fluent restaurant food handlers will be held to obtain comments that will be used to revise the interventions. In the intervention restaurants only, food handlers will receive both of the educational materials. Surveys will be repeated in all participating restaurants. Data analysis will determine whether the intervention significantly improved food handler knowledge by comparing food handler pre-intervention knowledge with their post intervention knowledge and by comparing the change in knowledge of the food handler in the intervention restaurants with that of the food handlers in the nonintervention restaurants. We will also examine if there was any change in knowledge among the nonintervention group from the first to the second survey to help understand any potential effect of taking the survey. Restaurant inspection scores for participating restaurants will be reviewed to compare pre-intervention scores with post intervention scores. Descriptive information regarding food handler background, demographic characteristics, and restaurant characteristics will be provided after each of the two survey data collection activities. Frequencies for the answers to each knowledge question (before and after interventions) will be looked at to determine the deficiencies in knowledge. Before and after interventions, the scores from the knowledge survey will be compared between food handlers with English fluency to those who speak Spanish but lack English fluency using t-tests. Analysis of Variance (ANOVA) models can be used to compare the mean change in knowledge between intervention groups, language groups, and their interactions. Regression models will be employed to the pre-intervention knowledge outcome to examine the associations between the language groups and other eligible factors. Mediation analysis for the effects of interventions on restaurant inspection outcome will also be performed.