native answers or provide elaboration via an open-ended text field. Data gathered via the area of focus ques- tions were then tabulated and ordered accord- ing to their frequency. Data gathered via the methods of assessment questions were also tabulated and ordered according to frequency. Answers provided via the open-ended text field were thematically categorized, counted, and tabulated. Additional analysis was performed on the areas of focus data by cross-tabulation against the variables of country, training, and expe- rience. We performed Pearson’s chi-squared analysis using the Monte Carlo method. The e ect size was calculated using Cramér’s V, accompanied by bootstrapping to 5,000 samples as a means of informing confidence intervals. An adjusted residual was also cal- culated as a guide to identifying sources of significant variation. All calculations were performed using IBM SPSS Statistics and Microsoft Excel. Our research was approved by the Flinders University Human Research Ethics Committee (reference HREC #5058). Results The online survey was accessed by 347 prospective respondents, of which 89 were excluded for not providing consent to par- ticipate or for not meeting the eligibility criteria of undertaking food safety inspec- tions as part of their employment. Another 47 respondents withdrew their participation before completing the entire survey, resulting in a total of 211 respondents who completed the survey. Engagement, eligibility, and with- drawal from the online survey are shown in Supplemental Figure 2. A self-selection recruitment approach and a disproportionate sample distribution meant the results did not render complete representa- tiveness of food safety inspectors by respective countries. Supplemental Table 1 shows the dis- tribution of survey respondents among coun- tries, which shows that the number of survey responses for countries was not proportion- ate. Despite having a relatively small popula- tion and an ostensibly smaller number of food safety inspectors, the proportion of Australian survey respondents is high and thus is likely to prejudice the survey results to reflect an Aus- tralian perspective more prominently. The majority of survey respondents were employed by local governments that are
FIGURE 1
Regularity of Assessing Food Safety Culture at a Food Business ( n = 225)
0
10
20
30
40
50
60
70
80
90 100
% of Respondents
Never Sometimes
Approximately One Half of the Time
Most of the Time Always
is often performed by environmental health practitioners (EHPs) who apply a regula- tory framework to prevent the sale and con- sumption of unsafe food (Grith, 2005). These inspections, however, are the subject of sustained criticism, particularly for their e ectiveness in preventing foodborne illness (Green & Kane, 2014; Grith, 2005; Powell et al., 2013). Our research, conducted via an online sur- vey, examined a) how inspectors from across the globe assessed food contamination con- trol during inspections of food premises and b) the sources of contamination they rou- tinely assessed. These data allow the analysis of food safety inspections to determine their e ectiveness as a health protection measure. Subsequently, our findings can inform the development of improved food safety inspec- tion methodology to reduce the incidence of foodborne illness. Methods An online survey was developed and distrib- uted to EHPs via organizations that repre- sent environmental health professionals in Australia, Ireland, New Zealand, the UK, and the U.S. Survey participation was voluntary, with respondents electing to participate by following web links embedded within pro- motional material circulated by the organi-
zations to members. Eligibility criteria were formulated and reflected in the survey logic and limited survey access only to respon- dents who conduct food safety inspections as part of their employment. The online survey was limited to the five countries because food safety inspection is a long-standing practice that is embedded within the legislation and policy of these English-speaking countries, thus avoiding the need for costly translations and extensive testing of contextual and interpretive com- patibility of translated materials. Further, the environmental health organizations within these countries were accessible and capa- ble of distributing the survey to a large and diverse population of food safety inspectors. The online survey (Supplemental Figure 1, www.neha.org/jeh-supplementals) presented respondents with 17 questions about how reg- ularly they assessed food production points, processes, and food contamination sources during food safety inspections. Respondents selected a description of regularity from five categories spanning from never to always. Where respondents provided an answer other than never, they were asked a subse- quent question about how they make their assessment of adequacy or control. Respon- dents selected all relevant answers provided by the survey and could elect to provide alter-
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May 2024 • Journal of Environmental Health
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