Physicians' Attitudes Toward Food Safety Education

Introduction

This report summarizes the findings of qualitative research conducted by Axiom Research Company on behalf of the International Food Information Council (IFIC). The purpose of the study was to understand physicians' views of food safety issues and education materials concerning this topic. In particular, the research was designed to investigate physicians' understanding of foodborne illness, their priorities in educating patients on these matters, and their opinions of existing educational materials available to them.

Axiom conducted a total of eight groups in four markets: Baltimore, Maryland, Boston, Massachusetts, Chicago, Illinois, and San Francisco, California. All participants were required to meet specific screening criteria developed by Axiom and IFIC. These criteria provided each group with a mix of physicians from specialties that treat patients who are at particularly high risk for contracting a foodborne illness. The specialties represented included: Geriatrics, HIV/AIDS, Infectious Diseases, Obstetrics/Gynecology, Oncology, and Pediatrics. The groups were conducted on July 12, 1999 (Baltimore), July 13, 1999 (Boston), May 16, 2000 (Chicago) and May 17, 2000 (San Francisco). Each session lasted approximately one-and-a-half hours.

While the findings of focus groups provide useful insights into a particular subject and allow researchers to unearth unanticipated key issues, it is important to note that the results of focus groups are not statistically valid. In other words, one cannot project the findings of a single group, or for that matter, multiple focus groups to the entire population.

Executive Summary

Dominant Findings

This research indicates that, with very few exceptions, physicians who treat patients at high risk for foodborne illness are not talking about food safety or foodborne illness with these patients. While physicians agree that foodborne illness can pose a serious threat when patients present with symptoms, they feel that in general, providing patients with preventive information in this area is relatively unimportant. In fact, one of the most striking findings in this research was that physicians generally believe that the topic of food safety, and foodborne illness as its main component, is less important than other topics-namely heart health, smoking, and drug/alcohol use.

There are numerous reasons why physicians hold this viewpoint; however, most are centered around three main themes, described briefly below.

Limited time. For the following reasons, foodborne illness is not seen as one of the issues worthy of the limited time physicians have with patients. First, the typical outcomes associated with foodborne illness are viewed as significantly less serious than those associated with other issues such as heart disease, smoking, and alcoholism among others. Second, the likelihood of patients contracting a foodborne illness (at least to the point where they require medical attention) is extremely low. Finally, if a patient does contract a foodborne illness, there is often little to nothing physicians feel they can do in the way of medical treatment.

Inundation Prevention. Several physicians stated that even if they had more time to talk with patients, they would not use this time to discuss food safety. They explained that patients are inundated with health information and recommendations, and there are limits to how much they can absorb. Therefore, physicians feel that it is their role to prioritize the health needs of patients and focus on information that will be most effective and efficient.

"It's not my job." Physicians believe the issue of food safety is a topic more appropriate for "public health" measures or for nurses, dietitians or health educators, rather than for direct patient-physician interaction. They feel this way for several reasons. First, patients typically do not contact physicians when they have symptoms. Second, physicians feel that consumers have better sources of information regarding foodborne illness, such as the supermarket, product labels, morning talk shows, and the Internet. Third, physicians feel that patients do not expect or want them to discuss foodborne illness because patients would rather focus on issues for which they have no other sources of information or on health problems about which they are more concerned.

Hierarchy of Health Behaviors

Physicians' comments indicated that for the most part, they evaluate which health behaviors are most important within the context of each patient's demographic characteristics and personal health history. Thus, for example, immunizations are important for older people and newborns, while mammograms are important for older women. On a population-wide basis, however, physicians agreed that heart disease prevention and smoking cessation are the most important issues for patients' overall health and therefore the most important to discuss.

Hierarchy of Food Risks to Health

Most physicians agreed that of all the food safety risks, foodborne illness poses the greatest threat to their patients and to the general public. For the most part, participants dismissed the risk of pesticides and environmental toxins as exaggerated by the media. However, it was pointed out that the scientific community may be unaware of the true risk because it is difficult to prove the relationship between pesticides or environmental toxins and human disease. Therefore, some physicians were unwilling to discount the potential risk.

Knowledge About Foodborne Illness and Risks to Health

All in all, the physicians we spoke with illustrated a fairly accurate and sophisticated understanding of food risks to health, foodborne illness, clinical presentations, and transport mechanisms. They were able to name specific pathogens, such as E. coli, Listeria, and Salmonella. It should be noted, however, that they were not always precise in their knowledge. Physicians occasionally made mistakes or asked one another about the exact origins or classifications of the different pathogens, for example.

Educating Themselves

Physicians we spoke with indicated that they rely on a base of knowledge about foodborne illness that they developed during their medical training. Several physicians even went so far as to indicate that they would return to their medical textbooks if patients presented with symptoms unknown to them, or if patients had basic questions. The majority of physicians indicated that if they required more information than their medical training had provided them, they would contact a peer (most likely an infectious disease specialist), search journals, or use the Internet. For more regular updates about research concerning foodborne illness, the physicians explained that they relied on many of the same sources as their patients. They learned from the radio or television talk shows, as well as read newspapers and the popular press. Finally, some physicians mentioned that they also skim "throw-away" journals.

Discussing Food Safety with Patients

Although physicians in these groups stated that they would always welcome patient questions concerning foodborne illness, patients rarely ask them about food safety. The exception to this generalization, they added, is that expectant or new mothers may occasionally ask about food safety practices relative to their new infant's health.

There are a few instances where physicians do feel it is important to bring up the topic of food safety and foodborne illness. The patients with whom physicians do discuss these issues typically fall within the following categories:

  • Patients with a foodborne illness
  • Patients travelling abroad
  • Immuno-compromised patients
  • Mothers of infants

Physicians provide written materials to patients even more rarely than they discuss the information. A few physicians explained that they provide books or more comprehensive pamphlets containing paragraphs that cover foodborne illness. These physicians were primarily infectious-disease specialists, and they provide such information for patients who are travelling abroad and for HIV-infected patients. More rarely, a few physicians noted that they would download information from the Internet for patients who requested materials.

Sample Materials Discussion

When asked to review sample materials, physicians provided very direct responses. They appreciated the simplicity of the glossy, 1- or 2-page pamphlets and frowned upon more detailed information, as presented in a Listeria-focused pamphlet or on the IFIC Foundation web site. Physicians worried that such detailed information would overwhelm patients or confuse them. However, many physicians explained that they would appreciate having the more detailed references themselves. In fact, several physicians asked if they could keep copies of the example informational pamphlets for their own use.

Recommendations

The rich information derived from these focus groups led us to make several recommendations as to how the IFIC Foundation might promote the issues of food safety and foodborne illness strategically in the future. However, it should be kept in mind that these recommendations are based on only these initial qualitative studies. To ensure the effectiveness of these recommendations, and to explore some of the subtle dimensions of the information, additional research should be performed.

The participant responses indicate that there may be several ways to promote the issues of food safety and foodborne illness effectively. The following methods indicate that there are multiple audiences and multiple media that may be included in an overall strategy. Possible methods include:

  • Less formal medical information sources, such as magazines and supermarkets. These methods would reach patients and consumers directly and supplement physician knowledge. Stories on news shows may also reach this joint audience effectively.
  • Throwaway journals and journals designed for groups of allied health professionals. Including articles in these types of journals will reach physicians and other health care workers, like physician assistants, nurses, dietitians and health educators. Physicians may appreciate including allied health care professionals in the efforts.
  • Internet references. The materials concerning basic foodborne illness information may be made to meet the needs of physicians and of patients separately. Physicians particularly appreciated the more detailed information, including organism and incubation time. Patients, on the other hand, may prefer general information that highlights health behaviors they can adopt.
  • Easy-to-read materials for physician waiting rooms. Some physicians may wish to make them available all the time to patients. Other physicians may prefer to have access to them without using their office space for displaying them. Therefore, these materials could be coordinated with the Internet for ease of access. The research suggested that physicians in certain specialties, like infectious disease and pediatrics, may have a greater need for such information as they discuss it more routinely with patients.

The research also suggested there may be additional important modifications to be made to food safety campaigns. Specifically, it seemed in these groups that the obstetrician/ gynecologists were least aware of the risks to their patients, pregnant women and women of childbearing age. Therefore, future campaigns may have a large impact by focusing on this population. Additional focus groups that include obstetrician/gynecologists would be required to assess whether this gap in physician knowledge is reflective of the physician population at large, or whether it is a function of this particular set of physicians who came to these groups. Introduction

This report summarizes the findings of qualitative research conducted by Axiom Research Company on behalf of the International Food Information Council (IFIC). The purpose of the study was to understand physicians' views of food safety issues and education materials concerning this topic. In particular, the research was designed to investigate physicians' understanding of foodborne illness, their priorities in educating patients on these matters, and their opinions of existing educational materials available to them.

Axiom conducted a total of eight groups in four markets: Baltimore, Maryland, Boston, Massachusetts, Chicago, Illinois, and San Francisco, California. All participants were required to meet specific screening criteria developed by Axiom and IFIC. These criteria provided each group with a mix of physicians from specialties that treat patients who are at particularly high risk for contracting a foodborne illness. The specialties represented included: Geriatrics, HIV/AIDS, Infectious Diseases, Obstetrics/Gynecology, Oncology, and Pediatrics. The groups were conducted on July 12, 1999 (Baltimore), July 13, 1999 (Boston), May 16, 2000 (Chicago) and May 17, 2000 (San Francisco). Each session lasted approximately one-and-a-half hours.

While the findings of focus groups provide useful insights into a particular subject and allow researchers to unearth unanticipated key issues, it is important to note that the results of focus groups are not statistically valid. In other words, one cannot project the findings of a single group, or for that matter, multiple focus groups to the entire population.