Informing Food Safety Trainings in Low- and Middle-Income Countries: A Novel Evaluation of Training Materials and Design

<B>Background</B>
Over the past two decades, food safety training interventions in LMICs have increased significantly, yet improvements in food hygiene and safety outcomes remain inconsistent. This limited effectiveness may reflect a lack of contextual adaptation and a failure to align training materials with the socio-economic constraints of participants.

<B>Objective</B>
To evaluate LMIC food safety training interventions and their educational materials on a novel framework, and to propose a checklist for the efficacy of future programs.

Methods
Relevant literature on training interventions was systematically identified, and only studies with accessible training materials were included. Interventions were evaluated using a novel qualitative framework, encompassing image–text ratios, readability grade, training design, incentives, and outcome parameters. Novel concepts, ‘Engagement features’ and ‘Contextual-fit factors’ were also developed, and the correlations between them were tested.

<B>Results</B>
A total of 28 studies met the inclusion criteria with available training materials. Infographics from 13 studies demonstrated a satisfactory balance of images and text. The readability assessment revealed an average result comparable to the US grade 6 level (5.90 ± 1.74), potentially hindering comprehension for low-literacy populations. Incentives were commonly used (n = 18), most frequently as non-cash economic incentives. Change in knowledge was the most measured outcome, and studies reporting null or negative results lacked several engagement and contextual-fit elements.

<B>Conclusions</B>
This study uses innovative methods to identify and shed light on the existing gaps in food safety trainings. Based on these findings, it proposes a 35-point checklist to support the development of more engaging, comprehensible, and contextually appropriate programs.

<B>PAPER CONTEXT</B>

Main findings: Our systematic evaluation of Low- and Middle-Income Countries’ food safety trainings has revealed critical deficiencies in design, implementation, and methodological reporting of interventions.

Added knowledge: This paper contributes a unique context-specific training evaluation framework supported by a checklist providing actionable recommendations for intervention design in Low- and Middle-Income Countries.

Global health impact for policy and action: Our work provides evidence-based recommendations for both optimization and specific policy adjustments, empowering governments and organizations to design more robust and impactful food safety public health interventions in Low- and Middle-Income Countries.