Dr. Patricia Borrusso, ORISE Fellow, US FDA

resized PBorrusso_pic_0e82b935e1db160f456e081fdf28e4d3Dr. 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.