Development, Validation, and Testing of a Self-Assessment Tool to Measure Food Safety Beliefs, Attitudes, and Behaviors in Healthcare Foodservice Operations

Abstract

The neutropenic diet has long been a dietary prescription for immunocompromised patients. Its effectiveness and consistency, unfortunately, have been constantly challenged. Researchers and healthcare policymakers call for liberalization of neutropenic diet, which shifts risk management strategies from excluding claimed “high-risk” food items to focus on safe food handling. The responsibility of food safety falls on foodservice workers in a healthcare setting. The objective of this study was to develop and conduct psychometric testing to determine the validity and reliability of a self-assessment survey instrument tool targeting beliefs, attitudes, and behaviors of safe food handling practices for healthcare foodservice workers. This survey validation study was conducted in four distinct phases. First, the tool was developed based on the Theory of Planned Behavior framework. After initial draft, the survey underwent content validity testing to establish face validity and test-retest reliability to measure temporal stability. Lastly, the 40-item survey was then pilot tested to assess internal consistency and construct validity. Pilot testing was conducted over a 16-month period on 211 healthcare foodservice workers across six acute care hospitals who serve immunocompromised populations. The original survey was comprised of 46 items. Six items were removed due to low content validity scores and temporal instability. Pilot testing revealed acceptable internal consistency (Chronbach’s alpha = 0.79). The linear regression model proved to be a good fit (p ≤ .0001) after assumptions were tested and met to predict behavior from attitude. A reliable and valid self-assessment survey instrument tool was developed for use in a healthcare foodservice operation. Results of this tool can help organizations pinpoint areas to improve food safety practices of foodservice workers who serve immunocompromised population.