title: A systematic review and meta-analysis of the effectiveness of food safety education interventions for consumers in developed countries.
abstract: BACKGROUND
  Foodborne illness has a large public health and economic burden worldwide, and many cases are associated with food handled and prepared at home. Educational interventions are necessary to improve consumer food safety practices and reduce the associated burden of foodborne illness.
  
  
  METHODS
  We conducted a systematic review and targeted meta-analyses to investigate the effectiveness of food safety education interventions for consumers. Relevant articles were identified through a preliminary scoping review that included: a comprehensive search in 10 bibliographic databases with verification; relevance screening of abstracts; and extraction of article characteristics. Experimental studies conducted in developed countries were prioritized for risk-of-bias assessment and data extraction. Meta-analysis was conducted on data subgroups stratified by key study design-intervention-population-outcome categories and subgroups were assessed for their quality of evidence. Meta-regression was conducted where appropriate to identify possible sources of between-trial heterogeneity.
  
  
  RESULTS
  We identified 79 relevant studies: 17 randomized controlled trials (RCTs); 12 non-randomized controlled trials (NRTs); and 50 uncontrolled before-and-after studies. Several studies did not provide sufficient details on key design features (e.g. blinding), with some high risk-of-bias ratings due to incomplete outcome data and selective reporting. We identified a moderate to high confidence in results from two large RCTs investigating community- and school-based educational training interventions on behaviour outcomes in children and youth (median standardized mean difference [SMD] = 0.20, range: 0.05, 0.35); in two small RCTs evaluating video and written instructional messaging on behavioural intentions in adults (SMD = 0.36, 95% confidence interval [CI]: 0.02, 0.69); and in two NRT studies for university-based education on attitudes of students and staff (SMD = 0.26, 95% CI: 0.10, 0.43). Uncontrolled before-and-after study outcomes were very heterogeneous and we have little confidence that the meta-analysis results reflect the true effect. Some variation in outcomes was explained in meta-regression models, including a dose effect for behaviour outcomes in RCTs.
  
  
  CONCLUSIONS
  In controlled trials, food safety education interventions showed significant effects in some contexts; however, many outcomes were very heterogeneous and do not provide a strong quality of evidence to support decision-making. Future research in this area is needed using more robust experimental designs to build on interventions shown to be effective in uncontrolled before-and-after studies.
authors: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada. iyoung@uoguelph.ca.
authors: Ian
authors: I
authors: Young
authors: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada. lisa.waddell@phac-aspc.gc.ca.|Department of Population Medicine, University of Guelph, 50 Stone Road, Guelph, ON, N1G 2W1, Canada. lisa.waddell@phac-aspc.gc.ca.
authors: Lisa
authors: L
authors: Waddell
authors: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada. hannon.harding@phac-aspc.gc.ca.
authors: Shannon
authors: S
authors: Harding
authors: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada. judy.greig@phac-aspc.gc.ca.
authors: Judy
authors: J
authors: Greig
authors: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada. mariola.mascarenhas@phac-aspc.gc.ca.
authors: Mariola
authors: M
authors: Mascarenhas
authors: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada. bsivaram@uoguelph.ca.|Department of Population Medicine, University of Guelph, 50 Stone Road, Guelph, ON, N1G 2W1, Canada. bsivaram@uoguelph.ca.
authors: Bhairavi
authors: B
authors: Sivaramalingam
authors: Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, ON, N1G 5B2, Canada. phamm@uoguelph.ca.|Department of Population Medicine, University of Guelph, 50 Stone Road, Guelph, ON, N1G 2W1, Canada. phamm@uoguelph.ca.
authors: Mai T
authors: MT
authors: Pham
authors: Department of Population Medicine, University of Guelph, 50 Stone Road, Guelph, ON, N1G 2W1, Canada. apapadop@uoguelph.ca.
authors: Andrew
authors: A
authors: Papadopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries; D059022:Food Safety; D006266:Health Education / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D017063:Outcome Assessment, Health Care