Food allergen communication in businesses feasibility trial

Abstract

Background: Clear allergen communication in food business operators (FBOs) has been shown to have a positive impact on customers’ perceptions of businesses (Barnett et al., 2013). However, the precise size and nature of this effect is not known: there is a paucity of quantitative evidence in this area, particularly in the form of randomised controlled trials (RCTs). The Food Standards Agency (FSA), in collaboration with Kantar’s Behavioural Practice, conducted a feasibility trial to investigate whether a randomised cluster trial – involving the proactive communication of allergen information at the point of sale in FBOs – is feasible in the United Kingdom (UK). Objectives: The trial sought to establish: ease of recruitments of businesses into trials; customer response rates for in-store outcome surveys; fidelity of intervention delivery by FBO staff; sensitivity of outcome survey measures to change; and appropriateness of the chosen analytical approach. Method: Following a recruitment phase – in which one of fourteen multinational FBOs was successfully recruited – the execution of the feasibility trial involved a quasi-randomised matched-pairs clustered experiment. Each of the FBO’s ten participating branches underwent pair-wise matching, with similarity of branches judged according to four criteria: Food Hygiene Rating Scheme (FHRS) score, average weekly footfall, number of staff and customer satisfaction rating. The allocation ratio for this trial was 1:1: one branch in each pair was assigned to the treatment group by a representative from the FBO, while the other continued to operate in accordance with their standard operating procedure. As a business-based feasibility trial, customers at participating branches throughout the fieldwork period were automatically enrolled in the trial. The trial was single-blind: customers at treatment branches were not aware that they were receiving an intervention. All customers who visited participating branches throughout the fieldwork period were asked to complete a short in-store survey on a tablet affixed in branches. This survey contained four outcome measures which operationalised customers’: perceptions of food safety in the FBO; trust in the FBO; self-reported confidence to ask for allergen information in future visits; and overall satisfaction with their visit. Results: Fieldwork was conducted from the 3 – 20 March 2020, with cessation occurring prematurely due to the closure of outlets following the proliferation of COVID-19. n=177 participants took part in the trial across the ten branches; however, response rates (which ranged between 0.1 - 0.8%) were likely also adversely affected by COVID-19. Intervention fidelity was an issue in this study: while compliance with delivery of the intervention was relatively high in treatment branches (78.9%), erroneous delivery in control branches was also common (46.2%). Survey data were analysed using random-intercept multilevel linear regression models (due to the nesting of customers within branches). Despite the trial’s modest sample size, there was some evidence to suggest that the intervention had a positive effect for those suffering from allergies/intolerances for the ‘trust’ (β = 1.288, p<0.01) and ‘satisfaction’ (β = 0.945, p<0.01) outcome variables. Due to singularity within the fitted linear models, hierarchical Bayes models were used to corroborate the size of these interactions. Conclusions: The results of this trial suggest that a fully powered clustered RCT would likely be feasible in the UK. In this case, the primary challenge in the execution of the trial was the recruitment of FBOs: despite high levels of initial interest from four chains, only one took part. However, it is likely that the proliferation of COVID-19 adversely impacted chain participation – two other FBOs withdrew during branch eligibility assessment and selection, citing COVID-19 as a barrier. COVID-19 also likely lowered the on-site survey response rate: a significant negative Pearson correlation was observed between daily survey completions and COVID-19 cases in the UK, highlighting a likely relationship between the two. Limitations: The trial was quasi-random: selection of branches, pair matching and allocation to treatment/control groups were not systematically conducted. These processes were undertaken by a representative from the FBO’s Safety and Quality Assurance team (with oversight from Kantar representatives on pair matching), as a result of the chain’s internal operational restrictions.