Food Control 159 (2024) 110280

Contents lists available at ScienceDirect

Food Control
journal homepage: www.elsevier.com/locate/foodcont

The effect of online versus offline interventions on food safety and handling
knowledge of household food handlers: A continuous experimental design
Zaidi Guo a, Li Bai b, *
a
School of Management, Nanjing University of Posts and Telecommunications, 66 Xinmofan Road, Nanjing, 210003, PR China
b
College of Biological and Agricultural Engineering, Jilin University, 5988 Renmin Street, Changchun, 130022, PR China

A R T I C L E I N F O A B S T R A C T

Keywords: In China, 30–40% of foodborne diseases occur in households. Furthermore, compared with those in urban
Household food handler households, foodborne diseases are more prevalent in rural Chinese households, as evidenced by epidemiological
Food handling and safety data. The mastery of food safety and handling knowledge is considered crucial to ensure food safety, and this
Online intervention
study represents the first exploration of food safety educational interventions for food handlers in the Chinese
Offline intervention
Rural household
context. Knowledge-based interventions on food safety and handling were conducted among food handlers from
China 139 rural households. Over a two-month period, each participant received ten consecutive knowledge-based
interventions, resulting in a total of 1390 interventions. Among them, 74 participants underwent online in­
terventions, while 65 participants received offline interventions. Throughout the two-month intervention period,
a questionnaire was administered to assess participants’ food safety and handling knowledge four times: before
the intervention, after the fourth intervention, after the eighth intervention, and after the tenth intervention. A
total of 556 valid questionnaires were collected. The results indicated that both the online and offline in­
terventions significantly improved participants’ knowledge levels. Knowledge scores increased from 13.54 to
20.93 points (out of 36 points) after 10 consecutive online interventions and from 13.89 to 22.00 points after 10
consecutive offline interventions. Furthermore, no significant difference in knowledge growth was observed
between the online and offline intervention groups, although the growth rate decreased with increasing inter­
vention time. These findings suggest that in the Chinese context, stakeholders can use the WeChat platform to
design high-efficiency and comprehensive food safety knowledge-based interventions. Additionally, optimal
intervention frequency and intensity can be determined through small-scale field experiments before launching
large-scale campaigns.

1. Introduction
It is estimated that one in 10 people worldwide falls ill each year due
to the consumption of contaminated food, resulting in 420,000 deaths
and a loss of 33 million healthy life years (World Health Organization,
2015). Approximately 200 million cases of foodborne diseases occur
annually in China, leading to significant health hazards and economic
burdens (Li et al., 2021). Consumers play a vital role in ensuring the
safety of the food they consume, particularly in how they handle food
(Bass et al., 2022). While most consumers possess some knowledge
about the quality and safety of food, many have a limited understanding
of how to properly prepare and cook foods to reduce the risk of food­
borne illnesses at home (Kunadu et al., 2016). Foodborne diseases in
households are closely related to residents’ hygiene habits (Evans &
Redmond, 2019), food safety knowledge (Mol et al., 2018; Wilcock
et al., 2004), food safety awareness (Hudson & Hartwell, 2002), tem­
perature and storage conditions (Ovca et al., 2021), and food handling
practices (Guerrero, Bayas-Rea, Erazo, & Zapata Mena, 2022). Food­
borne diseases occur in most households (Chen et al., 2021; Draeger
et al., 2019; Mullan et al., 2015), and 30–40% of these diseases are
attributed to inappropriate food-handling practices (Bai et al., 2014),
according to domestic and international research. Compared to urban
households, foodborne diseases exhibit a higher prevalence in rural
Chinese households, as demonstrated by epidemiological analyses con­
ducted in provinces such as Jiangxi, Yunnan, and Liaoning (Diao et al.,
2021; Yang et al., 2022; Zeng et al., 2022). According to a nationwide
sample survey (Gong et al., 2016), the level of food-handling knowledge
among rural households in China was significantly lower than that

* Corresponding author.
E-mail addresses: bl@jlu.edu.cn, bai_ly@126.com (L. Bai).

https://doi.org/10.1016/j.foodcont.2023.110280
Received 18 April 2023; Received in revised form 26 December 2023; Accepted 29 December 2023
Available online 3 January 2024
0956-7135/© 2024 Elsevier Ltd. All rights reserved.
Z. Guo and L. Bai
among urban households. Consequently, it becomes imperative to
enhance the knowledge of food handling among rural residents, given
the high incidence of foodborne diseases. Nonetheless, there is currently
no research available on interventions aimed at improving the under­
standing of food safety and handling among Chinese rural residents.
Many studies have shown that knowledge interventions can effec­
tively improve the behavior of food handlers (Reynolds & Dolasinski,
2019; Yin et al., 2019; Young et al., 2020). Changes in knowledge of food
safety were the most common outcome assessed in non-experimental
studies (Bass et al., 2022). Randomized experiments, most often
testing the effects of different types of messages on food safety behav­
iors, predominantly assess the perceived risk of foodborne illness. Pre­
vious studies have categorized intervention programs into different
types, such as one-time interventions and tracking interventions (Pog­
giogalle et al., 2021), laboratory-based interventions, and field-based
interventions (Zhou et al., 2022), as well as online and offline in­
terventions (Yeung et al., 2019). Evidence indicates that educational
interventions can effectively enhance food safety knowledge and be­
haviors ((Darlow & Heckman, 2017; Lustria et al., 2013; Tong et al.,
2021). Specifically, for fruit and vegetable consumption and hand hy­
giene, one-time interventions have demonstrated significant effects on
food safety knowledge (Diplock et al., 2018; Tzelepis et al., 2021; von
Lengerke et al., 2019). Online and offline interventions represent the
primary methods for enhancing the knowledge of household food han­
dlers. There are many differences between online and offline interven­
tion channels, such as intervention costs and convenience of attendance.
With the advancement of communication technologies, such as smart­
phones and the Internet, online interventions, including food safety in­
terventions, have become an important way to provide various types of
interventions. For example, Gomez-Galan et al. (2020) observed that,
compared with offline interventions, online educational interventions
offer advantages such as reduced temporal and spatial requirements,
relatively low intervention costs, flexible scheduling options, and
enhanced targeting of participants. However, other studies have shown
that online interventions lack interactions with instructors and are thus
less effective than offline interventions (Martínez López et al., 2022;
Piccoli et al., 2001).
To the best of the authors’ knowledge, no prior research has been
conducted to design interventions aimed at enhancing the food safety
and handling practices of household food handlers in China or to assess
the impact of such interventions. Consequently, this study focused on
rural residents in China, a high-risk group for foodborne diseases, as
indicated by recent research (Zeng et al., 2022). The primary objective
of this study was to assess the impact of consecutive knowledge-based
interventions delivered to food handlers in rural households by evalu­
ating improvements in their food safety and handling knowledge after
receiving ten consecutive interventions. Additionally, the study aimed
to compare the effectiveness of online and offline intervention channels.
Throughout the interventions, knowledge scores were measured on four
occasions through questionnaires to examine the variations in inter­
vention effects between the two channels. These findings lay the
groundwork for relevant government agencies to develop targeted
educational interventions focused on enhancing food safety knowledge
among rural residents.
2. Methods
2.1. Continuous experimental design
This study’s continuous interventions focused on the food handlers
of rural households in three provinces of Northeast China: Liaoning (42
households), Jilin (52 households), and Heilongjiang (45 households).
Before the intervention, researchers recruited undergraduate and grad­
uate students from these provinces and trained them to be qualified
experimenters. All the research participants provided informed consent
to participate in this study.
2
Food Control 159 (2024) 110280
During the summer vacation, spanning from July to August, in­
terventions were conducted on food handlers in rural households. These
households were selected from among the experimenters’ own families,
their relatives, or their friends. In order to maintain the quality of the
intervention, each student was assigned to intervene in only three
households, either online or through face-to-face interactions. The ex­
perimenters approached the food handlers in these households under
the guise of participating in a summer practice activity, aiming to reduce
their vigilance and increase their cooperation. Throughout the inter­
vention stages, the first and corresponding authors utilized WeChat
groups to offer real-time guidance to the experimenters responsible for
conducting the interventions. Upon the completion of the interventions,
each experimenter was awarded a practical certificate and received
material rewards. In the case of online interventions, the experimenters
utilized WeChat groups to provide materials and real-time interaction
information to their participants. Conversely, for offline interventions,
all training sessions were conducted in person. Each participant in both
the online and offline groups received a total of 10 training sessions over
a two-month period, all aimed at enhancing household food safety and
handling knowledge. These ten training materials (for additional details,
please refer to Appendix I) comprised promotional materials sourced
from the official website of the National Health Commission, as well as
relevant materials pertaining to the field of food safety. It is worth noting
that all these materials underwent discussion, screening, and approval
by eight experts who specialized in research related to consumer food
safety behavior, food economics, and consumer health education. Sub­
sequently, all intervention materials were tested among 12 rural resi­
dents in Jilin Province, with a few sentences being modified and
adjusted to ensure their comprehensibility to rural residents.
Both the online and offline channels distributed the same interven­
tion materials during each session, albeit in different manners. For on­
line interventions, each experimenter established a WeChat group and
shared the materials with group members. Participants were required to
respond with “Read” or “Watched” after going through the intervention
materials, and they were encouraged to engage in discussions about the
content within the WeChat group. Experimenters were responsible for
promptly addressing any questions posed by the participants. In the case
of offline interventions, experimenters either handed out printed ma­
terials to their participants face-to-face or watched videos with them,
followed by requesting participants to sign their names on the printed
materials after completing the readings. Ten training sessions were
conducted in each channel, with a one-week interval between each
session. Before the intervention and after the fourth, eighth, and tenth
interventions, a face-to-face questionnaire survey on food safety and
handling knowledge was administered.
2.2. Knowledge questionnaire design and data collection
The questionnaire comprised two parts. The first part measured the
participants’ food safety and handling knowledge. The items used to
assess consumer food safety and handling knowledge in the studies of
Gong et al. (2011), Hassan and Dimassi (2014), Kennedy et al. (2005),
Lazou et al. (2012), and Stratev et al. (2017) were referred to when
developing the questionnaire. The second part assessed the participants’
demographic characteristics.
To evaluate the questionnaire’s content validity, we invited six ex­
perts (two professors, one assistant researcher, and three Ph.D. students)
to review the scale items. The six experts were involved in consumer
food safety behavior, food economics, and consumer health education.
First, we organized a focus group discussion with the experts. A focus
group is usually understood as a group of people brought together by
researchers to interact. We began by explaining the research objectives,
the domains that the questions aimed to evaluate, and the data collec­
tion and analysis procedures to the experts. The experts evaluated the
scale items on their relevance and representativeness to the range of
knowledge they aimed to assess. The scale was modified based on the
Z. Guo and L. Bai Food Control 159 (2024) 110280

comments of the expert group. For example, the item “Would you buy
infant food, such as infant soy sauce, for your kids?“, was deleted
because the experts did not consider this question relevant to food safety
and handling knowledge. Second, a presurvey was administered to 48
food workers who lived in rural areas of Jilin Province and were aged 18
years or older. The Cronbach’s alpha coefficient of the presurvey data
was 0.8, which was higher than the acceptable criterion of 0.7 (DiIorio,
2006), indicating that the internal consistency of the questionnaire was
acceptable. The final questionnaire included 41 items, i.e., 36 knowl­
edge questions and 5 demographic questions. Participants were awarded
one point for each correct answer to a knowledge question, for a
maximum possible score of 36 points.
Initially, 180 rural households participated in the study. Of these,
139 households (74 in the online intervention group and 65 in the offline
intervention group) completed all the sessions, yielding a completion
rate of 77.22%. The food safety and handling knowledge of the 139
participants were assessed four times: prior to the intervention and
subsequently after the fourth, eighth, and tenth interventions. The same
questionnaire was utilized for each assessment. In total, 556 validated
questionnaires (139 × 4) were collected and used for subsequent anal­
ysis. Ethical approval was obtained from the Academic Committee of the
College of Biological and Agricultural Engineering, Jilin University.
cook in China (Wang et al., 2020). Nearly two-thirds of the participants
(61.9%) were aged between 35 and 54 years. Table 1 presents the
characteristics of the participants.
3.2. Percentage of correct responses to the knowledge questions before
intervention
Table 2 shows the percentage of correct answers to the knowledge
questions before the intervention. A lower percentage of food handlers
from rural households provided correct answers, particularly concern­
ing “functions of food additives” (10.07%), “what foods are potentially
contaminated with Listeria” (12.7%), and “the meaning of the SC code”
(13.58%).
3.3. Knowledge scores before and after the interventions
Before the intervention, the total knowledge scores of 139 partici­
pants ranged from 4 to 25 points, with an average score of 13.71 (of 36
points). After four interventions, the knowledge scores ranged between
6 and 31 points, with an average score of 17.35 points. After eight in­
terventions, the average score was 19.34 points, and after 10 in­
terventions, the average score was 21.43 points. Further details are
presented in Table 3.

2.3. Data analysis

3.4. Knowledge scores before and after online interventions

In this study, data analysis was performed using MS Excel 2020 and
A total of 74 rural households participated in the online intervention
SPSS 22.0. The analysis involved calculating the percentage of correct
experiment. The knowledge scores were as follows: 13.54 points (of 36
answers for each question and determining the average and standard
points) before intervention, 17.14 after the fourth intervention, 18.66
deviation of the participants’ food safety knowledge scores. The study
after the eighth intervention, and 20.93 after the tenth intervention. Post
employed ANOVA to analyze the knowledge scores, which exhibited a
hoc tests revealed significant differences in knowledge scores between
normal distribution. To compare the differences in food safety and
different numbers of interviews, and further details are presented in
handling knowledge scores before and after each intervention, one-way
Table 4.
analysis of variance (ANOVA) was conducted, followed by post hoc tests
employing the least significant difference (LSD) method for homoge­
3.5. Knowledge scores before and after offline interventions
neous variance and the Tamane method for heterogeneous variance.
Additionally, the study assessed the average knowledge scores of the two
Before the intervention, the average knowledge score was 13.89
intervention channels, online and offline, using a t-test to evaluate the
points. After the fourth, eighth, and tenth offline interventions, their
intervention effects. The significance level for this study was set at 95%,
average knowledge scores increased by 3.71, 2.51, and 1.89 points,
and a p-value less than 0.05 was considered indicative of a significant
respectively. Although their knowledge increased with the number of
difference between the variables.
interventions, the growth rates slowed. Due to the limited number of
interventions, the expected vertex or inflection point did not appear in
3. Results the current study. ANOVA and post hoc tests revealed significant dif­
ferences in knowledge scores between patients with different numbers of
3.1. Profile of the study participants interviews (p < 0.05). Further details are presented in Table 5.

Of the 139 participants in the study, 90 were women (64.7%). The 3.6. Comparison of knowledge scores after online or offline intervention
reason for this difference is that women are traditionally the ones who
As shown in Table 6, we compared the change in knowledge scores
Table 1 between the participants who received the online intervention and those
The characteristics of participants. who received the offline intervention. First, the differences in the
Demographic Characteristics Category n. Percent (%) changes in knowledge scores after the fourth online intervention (after
Gender Men 49 35.3% the fourth online intervention minus the score before intervention) and
Women 90 64.7% after the fourth offline intervention (after the fourth offline intervention
Age 18~24 18 12.9% minus the score before intervention) were considered to indicate sta­
25~34 21 15.1% tistical significance (denoted as OL4 vs. OF4-stage 1 in Table 6). Second,
35~44 45 32.4%
45~54 41 29.5%
the differences in the changes in knowledge scores after the eighth on­
Above 55 14 10.1% line intervention (after the eighth online intervention minus the fourth
Educational level Junior school or below 115 82.8% online intervention) and after the eighth offline intervention (after the
High school 17 12.2% eighth offline intervention minus the fourth offline intervention) were
University or above 7 5.0%
statistically significant (denoted as OL8 vs. OF8-stage 2 in Table 6).
Monthly family income <3000 53 38.1%
3000~7000 62 44.6% Third, the differences in the changes in knowledge scores after the tenth
>7000 24 17.3% online intervention (after the tenth online intervention minus the score
Marital status Married 114 82.0% after the eighth online intervention) and after the tenth offline inter­
Unmarried 22 15.8% vention (after the tenth offline intervention minus the score after the
Separated or divorced 3 2.2%
eighth offline intervention) were statistically significant (denoted as

3
Z. Guo and L. Bai Food Control 159 (2024) 110280

Table 2 Table 3
Percentages of correct responses to knowledge questions before intervention. Knowledge scores before and after the interventions (n = 139).
Domains Items Percentage Interventions Mean standard 95% confidence Min. Max.
scores deviation interval
Food purchase Which foods are not allowed to be produced 27.00
through genetic engineering? Lower Upper
Which foods are produced with reduced 38.65 bound bound
chemical pesticides and fertilizers?
Before the 13.71 4.47 12.96 14.45 4 25
In which foods is the use of persistent, high- 39.02
interventions
toxicity pesticides forbidden?
After four 17.35 5.05 16.51 18.20 6 31
During summer, what’s the best way to 50.74
interventions
transport raw meat and seafood?
After eight 19.34 5.47 18.42 20.26 6 31
What’s the right order to buy fruits, raw meat, 19.14
interventions
and seafood at a market?
After ten 21.43 5.78 20.46 22.40 6 32
What is the meaning of the identification code 13.58
interventions
that food packages bear and comprises of the
alphabets “SC” * and 14 digits? Note: the maximum score is 36 points.
In what order are ingredients listed on food 50.59
labels?
Which information is not included in the 54.01
nutrition facts labels?
Table 4
What are the primary functions of food 10.07 Food safety and handling knowledge scores before and after online interventions
additives? (n = 74).
Do you agree with the statement: “As long as 33.80 Interventions Interventions Mean Sig. 95% confidence
food is before its expiration date, it is safe to be scores interval
consumed”?
Food storage and What is the recommended method for storing 59.20 Lower Upper
thawing large cuts of raw meat? bound bound
Can freezing at − 18 ◦ C eliminate bacteria in 24.41
Before the After fourth 17.14 0.00 − 5.5 − 1.59
food?
intervention intervention
What is the optimal freezing temperature for a 51.93
After eighth 18.66 0.00 − 7.15 − 3.09
refrigerator?
intervention
How should a meal be handled if it will be 23.74
After tenth 20.93 0.00 − 9.60 − 5.18
consumed 3 h after preparation?
intervention
If meat was not thawed in refrigerator, can it be 43.92
After fourth After eighth 18.66 0.38 − 3.81 0.76
refrozen again?
intervention intervention
Which method is the least safe to thaw raw 40.43
After tenth 20.93 0.00 − 6.24 − 1.35
meat?
intervention
On which shelf should raw meat be stored in a 67.43
After eighth After tenth 20.93 0.09 − 4.74 0.20
refrigerator?
intervention intervention
What’s the proper temperature of a freezer? 42.14
Leftover handling What is the proper method for handling 57.55 Note: Analysis of variance (ANOVA) and LSD post hoc analysis were applied.
leftovers?
How long can leftovers be safely stored in 70.92
refrigerator?
Table 5
What is the recommended method for reheating 63.43
leftovers?
Food handling knowledge scores before and after offline interventions (n = 65).
Food preparation How should fruits be washed? 50.40 Interventions Interventions Mean Sig. 95% confidence
What is the proper procedure for cleaning 44.36 scores interval
vegetables?
How should kitchen countertops or stovetops be 74.00 Lower Lower
cleaned? bound bound
What is the correct method for washing dishes? 85.29 Before After fourth 17.60 0.00 − 3.24 − 0.76
How can fruits be safely cut on the chopping 61.58 intervention intervention
boards which have just been used to cut meats? After eighth 20.11 0.00 − 4.78 − 2.30
Is it safe to handle food if there is a wound on the 46.30 intervention
hand? After tenth 22.00 0.00 − 6.28 − 3.81
What is the correct way to wash hands? 55.90 intervention
How should one wash their hands after handling 73.50 After fourth After eighth 20.11 0.02 − 2.78 − 0.30
raw meat? intervention intervention
When preparing food, after contacting which of 93.85 After tenth 22.00 0.00 − 4.28 − 1.81
the following items should one wash their intervention
hands? After eighth After tenth 22.00 0.02 − 2.75 − 0.27
Under which circumstances is it not suitable for 48.06 intervention intervention
cooking?
Which one is the key to preventing food 57.42 Note: Analysis of variance (ANOVA) and Tamhane post hoc analysis were
poisoning? applied.
Which of the following methods can prevent 58.20
Salmonella contamination?
What foods are potentially contaminated with E. 18.70
OL10 vs. OF10-stage 3 in Table 6). Fourth, the differences in the changes
coli? in total knowledge scores after the online intervention (after the tenth
What foods are potentially contaminated with 12.70 online intervention minus the score before the online intervention) and
Listeria? after the offline intervention (after the tenth offline intervention minus
Which foods can potentially cause food 78.90
the score before the offline intervention) were compared for statistical
poisoning?
significance (detoted as OL vs. OF-total in Table 6).
Note: In China, food packages must bear an identification logo comprising SC As shown in Table 6, the results did not reveal a significant difference
and 14 digits. *SC is the abbreviation for “Sheng Chan”, which is the pinyin for between the changes in knowledge scores at either the different stages or
“manufacturing” in Mandarin. The 14 digits following the SC carry detailed
overall for the online and offline interventions. In the present study,
information on the production site, which can be retrieved.

4
Z. Guo and L. Bai
Table 6
Independent samples test.
Comparison Mean score Mean score T Sig.
difference (online) difference (offline)
OL4 vs. OF4- 3.60 3.71 0.15 0.88
stage 1
OL8 vs. OF8- 1.52 2.51 1.34 0.18
stage 2
OL10vs. OF10- 2.27 1.89 − 0.63 0.53
stage 3
OL vs. OF-total 7.39 8.11 0.65 0.52
both the online and offline interventions significantly improved food
safety and handling knowledge, but there was no significant difference
in the effectiveness of the two intervention channels.
4. Discussion
Two-month and knowledge-based interventions have been proven to
be effective at improving food safety and handling knowledge among
food handlers in Chinese rural households. There was a notable increase
in knowledge scores after 10 interventions, either online or offline.
Previous research has consistently indicated that Chinese rural
families possess inadequate knowledge concerning food safety and
handling, rendering them more susceptible to foodborne diseases (Bai
et al., 2014; Chen & Feng, 2021; Gong et al., 2011). In this study, the
participants’ initial low levels of knowledge prior to intervention un­
derscore the pressing necessity for educating rural residents in this re­
gard. The Chinese government agencies responsible for public health
management, disease prevention, and control should collaborate closely
with researchers to formulate targeted intervention strategies and
establish long-term, continuous interventions aimed at enhancing the
food safety and handling knowledge of rural households (Chidziwisano
et al., 2020).
This study also compared the effectiveness of online and offline
knowledge-based interventions and confirmed that, in the context of
knowledge-based interventions targeting Chinese rural households,
there was no significant difference in the effects of these interventions.
Many previous studies, such as that of Yeung et al. (2019), have also
indicated that both online and offline interventions positively impact
residents’ knowledge of food handling. These findings strongly suggest
that Chinese government agencies rely on online-based knowledge
training, such as using social networking platforms like WeChat plat­
form, to implement interventions for rural households since online
intervention has the benefits of cost and coverage (Jin & Yu, 2021; Wang
et al., 2020).
The study also revealed that, compared with a single intervention,
continuous interventions are more effective at improving knowledge;
however, regardless of whether an online or offline intervention was
used, the rate of knowledge growth decreased with increasing inter­
vention duration. On the one hand, these findings align with those of
other studies that noted greater growth in participants’ knowledge
levels following several interventions (Barjaktarovic-Labovic et al.,
2018; Bou-Mitri et al., 2018). On the other hand, although we cannot
determine the optimal intervention duration in the present study, the
findings remind stakeholders that small-scale experiments are necessary
and useful for determining the most efficient and optimal frequency and
intensity before launching large-scale knowledge-based intervention
campaigns.
This study comes with certain limitations that warrant consideration
when interpreting the findings. Firstly, the data relied on self-reporting,
which may introduce biases such as social desirability bias. Neverthe­
less, efforts were made to mitigate this bias by emphasizing the impor­
tance of providing honest and unbiased responses to ensure research
integrity. Participants were also assured that their responses would
remain anonymous, preventing researchers from linking responses to
5
Food Control 159 (2024) 110280
specific individuals. Secondly, it is worth acknowledging a limitation
related to the recruitment of family and friends for the study. Although
each experimenter approached food handlers under the pretext of
participating in a summer practice activity to minimize vigilance and
encourage cooperation, the influence of this factor should be
recognized.
Third, the study evaluated the effectiveness of only online in­
terventions based on the WeChat platform. The efficacy of interventions
via other online platforms has not been explored, and further research is
needed. Fourth, our focus was primarily centered on the changes in
knowledge before and after the interventions. Future research can
explore behavioral changes. Fifth, the repeated measurements of food
safety and handling knowledge could have contributed to an increase in
participants’ knowledge levels over time. In future studies, it is imper­
ative to account for these factors and work to mitigate their impact.
5. Conclusions
To the best of our knowledge, there are still no studies in the field of
food handler food safety training and educational interventions in the
Chinese context. Considering the high incidence of foodborne diseases in
rural China, our research initiated ten consecutive knowledge-based
interventions, either online or offline, targeting food handlers in rural
households and evaluating their effectiveness. First, the findings
demonstrated that the knowledge level of food handlers in Chinese rural
households is insufficient. Second, the findings revealed that there was
no significant difference in the effect of knowledge growth between the
online and offline interventions. Third, the findings, on the one hand,
highlighted the effectiveness of consecutive interventions on knowledge
growth; on the other hand, they revealed that the growth rate decreased
with increasing intervention time. Thus, related Chinese government
agencies can take full advantage of the WeChat platform to design high-
efficiency and full-coverage food safety knowledge-based interventions
and, furthermore, determine the optimal intervention frequency and
intensity through small-scale field experiments before launching large-
scale campaigns.
CRediT authorship contribution statement
Zaidi Guo: Writing – original draft, Visualization, Validation, Soft­
ware, Investigation, Formal analysis. Li Bai: Writing – review & editing,
Supervision, Resources, Project administration, Methodology, Funding
acquisition, Conceptualization.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Data availability
Data will be made available on request.
Acknowledgments
The study is supported by the Humanities and Social Science Fund of
Ministry of Education of China [Grant Number: 23YJAZH003], National
Natural Science Foundation of China [Grant Number: 71573103].
However, the opinions expressed here do not reflect those of the funding
agencies.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.foodcont.2023.110280.
Z. Guo and L. Bai Food Control 159 (2024) 110280

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