Master's Dissertation: Fresh Produce Consumer Awareness, Practices

This Master's dissertation in Public Health investigates consumers' awareness, knowledge, and practices concerning fresh produce, including pre-packaged fruits and vegetables, in Australia. The study aims to identify gaps in consumers' food safety knowledge and assess their associated risk of foodborne illness. The research involved an online survey of 433 participants across Australia, gathering data on their food handling practices and understanding of food safety risks. The findings reveal that, while some areas of food safety knowledge are good, there are significant gaps in detailed knowledge, particularly regarding handwashing practices and microbial risks. The dissertation also includes a literature review of relevant outbreaks, pathogens, and risk factors, along with an analysis of the methodology, results, discussion, and conclusions, offering recommendations for future research and improved consumer education.

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A Master Dissertation
Master’s in Public Health (Health Safety and Environment)
CONSUMERS’ AWARENESS, KNOWLEDGE AND PRACTICES LINKED TO FRESH PRODUCE (INCLUDING
PRE-PACKED FRUITS AND VEGETABLES)
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CONSUMERS’ AWARENESS,
KNOWLEDGE AND PRACTICES
LINKED TO FRESH PRODUCE
(INCLUDING PRE-PACKED FRUITS
AND VEGETABLES)
CONSUMERS’ AWARENESS,
KNOWLEDGE AND PRACTICES

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LINKED TO FRESH PRODUCE
(INCLUDING PRE-PACKED FRUITS
AND VEGETABLES)
DISSERTATION
by

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Acknowledgement:
I would like to thank my supervisor Belinda Davies for her immense support, constant
motivation, and guidance, without which It would have not been possible to complete my
dissertation. Her concern for her students is extraordinary, and her work and enthusiasm
regarding the field of Food Safety and Environmental Health s really inspiring. She has been an
amazing mentor and it was a blessing to work with her during this research report. I would also
like to thank my lovely family and all my friends for their support, understanding and patience
through this endeavor.

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Table of Contents
Abstract..........................................................................................................................................11
Purpose:....................................................................................................................................11
Design/methodology/approach:..............................................................................................11
Findings:...................................................................................................................................12
Research Limitations/Implications:.......................................................................................12
Originality/value:.....................................................................................................................12
Key Words:...............................................................................................................................12
Key Definitions:........................................................................................................................12
Fresh produce:..........................................................................................................................12
Fresh cut fruits and vegetables:..............................................................................................13
INTRODUCTION.........................................................................................................................14
Health benefit of fresh produce..................................................................................................14
Increase in consumption.............................................................................................................15
Increase in fresh produce grown................................................................................................16
Increase in Food borne illness....................................................................................................17
FBI impact and importance of customers practice.....................................................................19
Introduction of the research.......................................................................................................21
Organization of the study...........................................................................................................21
CHAPTER 2: Literature Review:..................................................................................................22
2.1 Introduction..........................................................................................................................22
2.2 Fresh produce washing practices.........................................................................................22
2.3 Demographics......................................................................................................................24
2.4 The role of education in improving knowledge and practices:............................................24
2.5 Knowledge and awareness...................................................................................................25
2.6 Knowledge of vulnerable population group:.......................................................................26
2.7 Consumers education...........................................................................................................26
2.8 Causes of Contamination of Fresh Produce.........................................................................27
Soil:........................................................................................................................................29
Water:....................................................................................................................................29
2.9 The importance of Hand hygiene linked with Foodborne illness:.......................................30
2. 10 Health belief model and their role in changing behaviour:...............................................31

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2.11 High-risk Population groups:.............................................................................................32
Chapter 3: The role of Bacterial agent’s pathogens and their association with fresh produce
producing foodborne illness..........................................................................................................36
3.1 Overview of Microbiological Data:.....................................................................................37
3.2 Previous Outbreaks Data of Foodborne illness in the previous 20 years linked to fresh
produce including pre-packed fresh produce:............................................................................40
3.3 Outbreak Critique:................................................................................................................44
3.4 Fresh test data:.....................................................................................................................45
Chapter 4: Methodology:...............................................................................................................48
Research Aim:..........................................................................................................................48
Statement of Research Objectives of the research:...............................................................48
Specific Objective 1:.............................................................................................................48
Specific Objective 2:.............................................................................................................48
Specific Objective 3:.............................................................................................................49
Specific Objective 4:.............................................................................................................49
Specific Objective 5:.............................................................................................................49
Methods:...................................................................................................................................49
Ethics Application:...............................................................................................................49
Type of Study/ Research design:.........................................................................................49
Literature search strategy:..................................................................................................50
Inclusion criteria:.................................................................................................................50
Study Quality:.......................................................................................................................50
Methods of review:...............................................................................................................51
Participants Overview:........................................................................................................51
Consumers Survey, Research design, and Implementation:................................................51
Demographics and presence of high-risk groups in the house:........................................52
People responsible for buying fresh produce:...................................................................53
Consumer’s current food handling practices:...................................................................53
Consumer’s perception of food safety risks associated with fresh produce:..................53
Consumers’ current food safety knowledge:.....................................................................53
Food safety information for pregnant women:..................................................................54
Instrument:...............................................................................................................................54
Setting and sample/ Data collection:......................................................................................54

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Analysis:....................................................................................................................................54
Prize Draw:...............................................................................................................................55
Risks associated with this project:..........................................................................................56
For participants:...................................................................................................................56
For researchers:....................................................................................................................56
How will the associated risk be minimized?..........................................................................56
For participants:...................................................................................................................56
For researchers:....................................................................................................................57
Chapter 5: Results..........................................................................................................................58
Results:...........................................................................................................................................58
Chapter 6: Discussion:...................................................................................................................68
Chapter 7: Conclusion and future recommendation:.....................................................................73
References......................................................................................................................................77
Appendix 1: Characteristics of outbreak studies included in the literature review having an
association of Consumers awareness, knowledge, behavior and food handling practices linked
with fresh produce.........................................................................................................................88
Appendix 2: Outbreak Summary linked with fresh fruits and vegetables around the globe in the
past 2 decades................................................................................................................................96
Appendix 3: Search strategy......................................................................................................106
3.1: Inclusion and exclusion criteria:.................................................................................106
3.2: Search string....................................................................................................................107
3.3: Search engines:..............................................................................................................109
Appendix 4- Ethics Approval:.....................................................................................................110
Appendix 5- Ethics Application:.................................................................................................112
Appendix 6 - Invitation email for consumer’s participation.......................................................129
Appendix 7 – Sample approach email.........................................................................................130
Appendix 8 –Facebook Advertisement.......................................................................................131
Appendix 9 – Participants Information sheet..............................................................................133
QUT Ethics Approval Number 1700000400...............................................................................133
Appendix 10: Terms and conditions of entry in the prize draw..................................................137
Appendix 11 – Online Survey.....................................................................................................139

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List of Tables
Table 1: Methods causing contamination of the fresh produce. Including both Pre-harvest and
post-harvest....................................................................................................................................29
Table 2: Approximation of the number of listeria cells linked with causes Listeriosis suggested
from the previous outbreaks..........................................................................................................33
Table 3: Most Common Pathogens, agents, and conditions linked to previous fresh produce
outbreaks recommended by experts for inclusion in Australian estimation of foodborne illness
circa 2010.......................................................................................................................................36
Table 4: Characteristics of some microbial pathogens that have been linked to outbreaks of
produce-associated illness.............................................................................................................37
Table 5: Type of Bacteria and associated fresh produce. Examples of the number of fresh
produce around the world in the past two decades that have been isolated from which particular
bacterial pathogen..........................................................................................................................39
Table 6: Summary of samples and number of fresh produce positive tests for microorganisms. .46
Table 7: Results for the samples for of fresh herbs tested for E. coli and Faecal coliforms.........46

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List of Figures
Figure 1: Conceptual framework of causes of foodborne illness in consumers linked to fresh
produce..........................................................................................................................................19
Figure 2: Sources and roots of contamination of fresh produce....................................................28
Figure 3: Diagrammatic representation of causes of contamination of fresh produce. Taken from
“A quantitative microbial risk assessment of water in the fresh produce chain”..........................30
Figure 4: An interactive model of Theory of Planned Behaviour.................................................32

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Abstract
Food-borne illness (FBI) is a serious threat towards consumers and a major public health
risk. In Australia, 4.1 million cases of gastroenteritis are estimated to occur annually (Milazzo
and et.al., 2017). Knowledge and understanding of how to handle fresh produce plays integral
role in reducing the risk of foodborne illness. As most of the fresh produce is consumed raw and
therefore, it does not involve the benefit of cooking or killing stage to remove the harmful
pathogens from the fresh produce. This highlights that appropriate food handling practices are
critical. Fresh fruits and vegetables including pre-packed fruits and vegetables has always been
overlooked as a source of foodborne illness until there is an outbreak. From 1998 to 2016 fresh
produce such as spinach, lettuce, rockmelon, berries, bean sprouts etc. have been associated with
several outbreaks in Australia. With a recent rockmelon outbreak, new strains of salmonella have
been identified highlighting current lack of knowledge and awareness among consumers’ while
handling fresh produce (Food Safety Australia and New Zealand, 2016).
Purpose:
This aim of the research study is to identify the current level of knowledge, awareness,
and food handling practices linked to fresh produce (including pre-packaged fruits, vegetables
and herbs) in the Australian population. This information is analysed to identify any gaps in their
current food safety knowledge and their associated level of risk for food-borne illness. Whilst
there has been an increase in the number of food-borne illness outbreaks associated with fresh
produce. There is no published research which details Australian consumers’ food safety
knowledge and handling practices in relation to fresh produce. Consequently, this research will
help establish baseline knowledge.
Design/methodology/approach:
A total of 433 people with all age groups from across Australia participated in the
research study. With a majority being female with 70.67% who are having at least an
undergraduate degree showcasing an educated respondent group with the majority living in the
developed areas of Australia. An online anonymous questionnaire was utilized to gather
information on consumers’ current knowledge, awareness and food handling practices along with
their microbial knowledge linked with fresh produce.

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Findings:
Food safety knowledge were reasonably good in some areas while lacking highlighted in
detailed knowledge among the respondents with major error highlighted in hand washing
practices prior consumption of fresh produce, along with minimal knowledge of microbes linked
to foodborne illness. A large amount of participation was from women with 71% and mostly
younger age group b/w 18-24 years of age.
Research Limitations/Implications:
Future research should include wide range of participation among all demographics that
can be considered as a representative sample group of the entire population. Furthermore,
Randomized Controlled Trials study design must be considered to reduce the risk of self-
reported bias along with getting better perception of consumers’ reflecting their actual practices.
Originality/value:
This is the first study conducted in Australia that looks at the current level of awareness,
perception, knowledge and fresh produce handling practices among Australian population.
Key Words:
Consumers awareness, Fresh produce, Food-safety, Food handling practices, Consumers
knowledge, behavioural practices, Perception, Fruits and vegetables, Outbreak, Microbes.
Key Definitions:
This dissertation is about fresh produce. Although ‘fresh produce’ is a commonly used
term, various definitions and classifications are available to define exactly what this term means.
This work draws on the definitions put forward by the International Association of Food
Protection (IFPA) and U.S Food and Drug Administration (FDA).
Fresh produce:
The term ‘fresh produce’ can be defined as “produce usually consumed raw without
undergoing processes that inactivate pathogens or inhibit microbial growth (i.e. cooking). Fresh

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cut fruits and 8 vegetables included those that have been peeled, sliced, chopped, shredded,
cored, trimmed or mashed with or without washing prior to being packaged”.
Fresh cut fruits and vegetables:
Fresh-cut fruits and vegetables are defined as “any fresh fruit or vegetable or any
combination thereof that has been physically altered from its original form, but remains in a fresh
state”.

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INTRODUCTION
Health benefit of fresh produce
In developing countries with the changing health trend many people striving towards a
healthy lifestyle has led people to an increase in demand and consumption of fresh fruits and
vegetables in their normal diet (Pee and Kankanhalli, 2016). Fresh produce consumption is an
essential part of healthy and balanced diet (Lunden and et.al., 2017). This has been proved and
supported by scientific literature to be vital in prevention of chronic disease (Wang et al., 2014;
Hu et., al 2014). This delineates the relation of consumption for fresh produce with decline in the
prevalence rates of Type 2 diabetes, cardiovascular disease, musculoskeletal disorders, dental
cavities and several types of cancers and this is supported by both current and previous studies
statement (The National Health and Medical Research Council, 2017). Their consumption is
encouraged by doctors, nutritionists, and government and public health agencies around the
world in order to protect consumers from possible range of illness such as high blood pressure,
type 2 diabetes, stroke, cardiovascular disease and including some forms of cancers (The
National Health and Medical Research Council, 2017).
However, with proven benefits against various forms of cancer and chronic illnesses along with
nutritional background to maintain healthy and balanced diet. In this context, with consuming at
least five serves of vegetables and 2 serves of fresh fruits for adults in their daily diet as
recommended by the Australian guidelines in order to reduce the prevalence of chronic disease
().
Scientific research proves that, by eating recommended serving of fresh produce and
following the diet recommended by the Australian guidelines has shown tremendous reduction in
chances of developing chronic disease (The National Health and Medical Research Council,
2017). This has also helped in reducing cardiovascular disease by 4% and the risk of type 2
diabetes by 14%. According to a study, low consumption of fruits and vegetables in Australian
diet (<4 serves/day) has accounted for 9% of prostate cancer, 17% of colorectal cancer, 9% if
breast cancer and, 2% of breast cancer (Milazzo and et.al., 2017). However, no recent evidence
is present that support the presented information.

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Increase in fresh produce consumption
Data collected from the past suggested that there has been an increase in fresh produce
consumption. (). (Pollard and et.al., 2016) This is due to strong influence from World Health
Organization and Food and Agricultural Organizations in promoting national programs for
consumers increasing education towards fresh fruits and vegetables consumption.
This shows that consumption of fresh produce is increasing and these are associated with fresh
produce outbreaks.
The rate of food borne illness is low when there are proper consideration made by people with
respect to cleaning of hands, washing of vegetables or fruits, etc. with time the rate of pollution
has increased and this has caused serious health related problems. There are many research that
are conducted and it is found when cleanliness is properly considered, then it helped in reduced
the rate of proper with health issues.
However, there is no current data available in this context that can justify the actual consumption
which is a bit limitation and one of the main elements of conducting this research to gather
current data and awareness among the consumers (Luu, Davies and Dunne, 2017).
Increase in fresh produce grown
Fresh fruits and vegetables, due to their natural habitat and growth in a natural open
environment with some of them having a direct contact with soil, with them having high
possibility of contamination from pathogens linked with several farming and processing
activities (Meyer and et.al., 2017). These are referred to as the risk factors that include soil. Use
of biological fertilizers and water quality are used during production, management of the
environment, transportation and different food handling practices (Evans and Redmond, 2016).
Secondly, most of the fresh produce are consumed raw, hence there is no killing step involved
prior their consumption so adequate cleaning and food handling awareness are essential. Some of
the fruits and vegetables have edible skin and rough surfaces which creates cleaning difficult,
and other produce is hard to clean with the simple rubbing of the produce under tap water. On
the other hand, attachment of pathogens to the outer surfaces and on internalization decreases the
useful action of different methods for sterilization that does prevent contamination of the
produce (Whiley, Clarke and Ross, 2017).

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Increase in Food borne illness outbreaks
It is important to understand that along with the health benefits it is equally important to
have sufficient knowledge along with appropriate fresh produce handling practices to reduce the
risk of foodborne illness. Consumers play a very important role in mitigating and immobilizing
the rates of foodborne illness. In Australia 5.4 billion people annually get sick and 3000 people
die from foodborne illness with a cost of $1.25 billion spent annually. Further, this rate if
increasing annually and one of the main reason is due to lack of awareness (Milazzo and et.al.,
2017). Subsequently, a majority of foodborne outbreaks are preventable by improving
consumers’ education. (Milazzo and et.al., 2017). Health belief identifies that this growing
burden of foodborne illness to be linked with poor knowledge and awareness of the consumers’.
This is supported by past studies that suggest increase in food hygiene education and awareness
among consumers’ will result in a comparative dive in foodborne illnesses. Along with other
studies that support good knowledge and education allow the consumers to be more confident
when dealing with food
One of the studies involved the meta-analysis of 35 in a comparable field and recognized
knowledge as being one of the most essential and strongest predictors while consuming fresh
produce (Smith, Ross and Whiley, 2016).
There is an increasing trend of health consciousness that has been identified due to the result of
this ongoing obesity crisis across the globe(Kirk and et.al., 2017), Including both developing and
developed countries that are quite alike (Milazzo and et.al., 2017). With an approximation in
Australia roughly 63.4% of adults and 27.4% of children are overweight or obese (Nutrition
Australia, 2015). According to the Cancer Council Australia, less consumption of fresh fruits and
vegetables in every fay diet are the major contributory factor to cardiovascular disease, diabetes
type 2, MSD and several cancers such as stomach, bowel and breast cancer is obesity (Garayoa
and et.al., 2017). This current generation with being the first one in which parents will be
surviving/living longer than their children (Griffith and et.al., 2017). However, with the current
change in health trend more consumers are now positively reinforced and incorporating fruits
and vegetables in their normal diet with the aim of wanting more wholesome, healthy foods on
the plate, As the fresh produce meet these requirements when compared with the traditional food
produce. This trend has increased the incidence of new foodborne outbreaks related with fresh

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produce as more people are striving for healthy food and utilizing more fruits and vegetables in
their daily diet when compared with the stats listed in the past.
Past collected data suggests that in 1998/1999, Australian population consumed 135kg of fruit
and 162kg of vegetables per person in a calendar year (Akomolafe and Awe, 2017). Statistically,
there is a 20% increase in fruit consumption and an 8% increase in vegetable consumption since
then. (Liu and Kilonzo-Nthenge, 2017). This means increase consumption shows that people are
able to deliver information to their child but still due to increase in pollution that can be termed
as one of the reasons due to which food borne illness has raised.. Consumption of fresh produce
is expected to have increased when compared with 1998/1999, this is due to national programs
promoting fruit and vegetable daily intake along with high emphasis made from World health
organization and Food and Agricultural Organization (Abrahams and et.al., 2017).

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Figure 1: Conceptual framework of causes of foodborne illness in consumers linked to fresh produce
From the above figure, it can be stated that there are different type of reasons due to
which different type of diseases that are cases. One of the main reason identified is due to lack of
knowledge among individuals. People should take proper care in which they maintain their
kitchen and make it clean. Washing hands and food products should be washed and then they
need to be used.
Foodborne illness impacts and burden
Statistics from the past few years highlight a slight decrease in foodborne illness with 4
million people getting affected annually (Victoria’s Department of Health figures, 2015). On the
other hand, there has been a drastic increase by 50% which is seen in Salmonella strains causing
foodborne illnesses by 2012 in Australia, with double the cases that was observed in Queensland
Foodborne
Illness
Poor knowledge
and awareness
linked with fresh
produce.
Poor knowledge of
bacterias linked
with fresh produce
contamination and
foodborne illness.
Use of dirty kitchen
utensils to cut fresh
produce that is
later consumed
raw..
Innadequate hand
washing practices
prior consuming
fresh produce.
High risk foods
Inadequate fresh
produce handling
and washing
practices.
Vulnerable
population group
including pregnant
ladies, children
under 5 and elderly
population above
65.

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(Victoria’s Department of Health figures, 2015). This highlights a serious threat for Queensland
population. Fresh produce has been a major highlight in the past years due to their link with the
rise in a foodborne outbreak in Australia and different parts of the world with their increase in
consumption was found. This increase in consumption has led to increase of foodborne illness
due to their change in the pattern of distribution including both domestic and international trade
in many different parts of the world (Crowe and et.al., 2017).
The increase in foodborne illness and increasing in number linked to fresh produce
outbreaks, it raises a lot of concerns for the consumers in the future. FDA published in 2011
suggesting that more work needs to be done in the fresh produce industry. In the past years, there
have been several outbreaks linked to foodborne illness. Foodborne illness outbreaks globally
have been associated with certain horticultural commodities that has been summarized in
appendix 2. The data provided by the European Union highlighted 5 food categories that have
been linked with around 80 percent of all food incidents. These included fresh green leafy
vegetables which were among the highest percentage among all with 36.4 percent, followed by
spices 19.7 percent, nuts and seeds 16.7 % and frozen berries 7.6 %.
Several databases supported with past studies show the involvement of Salmonella and
Noro virus as being the most common agents associated with most of the outbreaks linked to
fresh produce, as summarized in detail in appendix 2 and considered to be of a high-risk
potential. The pathogens were mostly found to be linked with fresh salads, fruits, and vegetables.
There have been increase in outbreaks associated with fresh produce i.e. It has been noted that
there are risks associated with salmonella causing fresh produce contamination and causing food
borne illness. As per the most updated food safety guidelines in 2015 it highlights that “While
salmonella bacteria are most commonly associated with livestock and chickens, they have also
been responsible for food safety outbreaks associated with fresh produce" (Fresh Produce Safety
Australia & New Zealand, 2015).
Recent evidence supports this statement, in 2016 with a registered rockmelon outbreak in
Australia linked with Salmonella with a total of 86 cases were reported in 2 weeks. This shows

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that new strains of salmonella have been identified with serious food poisoning after consuming
rockmelon. Food Safety Australia and New Zealand confirmed the presence of Salmonella in the
Red melon dirt farm (FSANZ, 2016). But the outbreaks have not been only limited to Australia
but have also been identified in the US. However, farming practices are different there were also
outbreaks in US.
Stats in FSC Compare 2015 and 2017
Importance of consumers’ practices/role in the research
Australia and New Zealand Food Standards Code does not prescribe any microbiological
limits for fresh produce that lies under ready to eat foods, other than the given requirement for
the absence of Salmonella in 25grams in cultured seeds and grains (bean sprouts, alfalfa etc.)
(Australia New Zealand Food Standard Code 1.6.1). According to the FSANZ guidelines any
presence of Salmonella spp. and Escherichia Coli while examination ready to eat foods along
with the range of >_102 cfu/g1 for Listeria monocytogenes is considered potentially hazardous.
It is important to highlight that the FSANZ guidelines do not cover raw fruits and vegetables,
especially the fresh produce that involve peeling, hulling or washing by the consumers prior to
their consumption. However, in the following research activities like peeling and hulling are not
included and the fresh produce may not be washed adequately prior consumption, reducing the
microbial quantity from the outer surface reducing the risk of causing illness. This is the main
aim of the research as the guidelines suggest the acceptable level of a microorganism to be
present in the fresh produce that limits the risk and potential for causing foodborne illness.
However, there is no specific method to justify and validate the level of bacteria after
various methods and practices. As consumers practices always vary from one person to another
which is also supported by previous consumers surveys and also supported by the current survey
done for this study (Aschemann-Witzel and et.al., 2017). This highlights the main aim of doing
the current research and a big limitation, as consumers practices always vary from the
recommended practices and guidelines that pose a significant threat.

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Introduction of the research
The results from previous research work with majority of them done in US are explained
in the literature review highlights poor knowledge and awareness among consumers while
handling fresh produce to play a significant role with fresh produce outbreaks. However, the
Australian agricultural practice vary from the agricultural practices in the other countries of the
world (Pearson and et.al., 2017). Further, no study has been done in the past in Australia that
highlights the current level of knowledge and awareness among Australian consumers.
This justifies the need of research to be done that implies totally on Australian population while
comparing previous outbreaks done in the past in different countries and finding any similarities
among these outbreaks.
The current research report aims to identify the current level of food safety knowledge and food
handling practices associated with fresh produce (including pre-packaged fruits, vegetables and
fresh herbs) among Australian consumers. This is done by utilizing an anonymous online survey
to identify gaps in consumers’ current knowledge and food handling practices which may place
consumers at risk of food-borne illness linked to fresh produce. It is envisaged that the research
findings will help food safety authorities target food safety messages to consumers, which could
help in reducing the number of food-borne illness outbreaks associated with fresh produce.
When hands are not washed and surface hygiene have also been highlighted as one of the biggest
contributory factors with an approximation of link with 39% of domestic food preparations
(Kaptan, Fischer and Frewer, 2017).
Organization of the study
In the next chapter, previous research linked with consumer’s awareness, behavior and
perception linked with fresh produce along with relevant literature has been reviewed and
summarized. It also outlines evidence based literature outlining consumers’ education, causes of
contamination, the importance of hand hygiene and high-risk population groups associated with
the health believe model. Chapter 3 clearly outline the most common bacteria, their
characteristics and their association with previous outbreaks from the past 20 years. Chapter 4
discusses the research methodology, aims, and risk of the research along with the methodological

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framework. Chapter 5 outlines the results of the research and compare and contrast any
identifiable relationships with past studies. Chapter 6 discusses and summarizes all the collected
information. Chapter 7 highlight the conclusion and enlists more future recommendations.

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CHAPTER 2: Literature Review:
2.1 Introduction
There are different research conducted by other researchers on similar topic. The
findings made by them are highly effective in order to come up with appropriate outcome. With
time there are changes identified in accordance with the topic. Health condition of people are
getting affected due to ignorance of basic thinks like washing hands, consuming fresh food, etc.
There are discussion, comparison, contrast and synthesize consumers’ awareness, knowledge,
behavioural, food handling practices and a possible link to previous fresh produce outbreaks
covered.
2.2 Fresh produce washing practices
All the included studies utilizes a self-administered online questionnaire with exception
of one study that utilized a phone based questionnaire. Aim of conducting questionnaire is to
understand consumers’ current fresh produce washing practices and to highlight any gap in their
current understanding and lacking towards fresh produce safety (Stenger, Ritter-Gooder and
Albrecht, 2014). All these studies were done after a major outbreak occurred in the country to
highlight consumers’ current practices. Studies involve both male and female with the majority
of population among 4 of the 5 included studies were female with more than 70%. As being
involved with most of the food purchasing and processing practices in the house and all
respondents were of age 18 and above. In most of the study, the sample size were quite less and
it will be of a town or area, not giving a brief knowledge of the entire population. One of the
studies was conducted on students between the age group of 18-24 which did not reflect the food
safety practices of all age group (Luu, Davies and Dunne, 2017).
Three of the studies identified that consumers’ have good knowledge of food safety with
the majority 81.9 % agreed on washing fruits and vegetables prior consumption (Marti, Ferrary-
Américo and Barardi, 2017). However, they were lacking detailed knowledge as 69% had no
understanding that fresh produce is linked to foodborne illness and 36% being unaware that
washing fresh produce isn’t sufficient to prevent foodborne illness (Tzortzakis and Chrysargyris,
2017). With one of the aspects of the research, in the study it asked questions related the correct
methods of washing fresh produce and it was highlighted that 77.6% of the participants knew the
best ways to wash fresh fruits and vegetables. However, no evidence supported that consumers

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are reflecting these practices in their daily routine while handling fresh produce (Chousalkar and
et.al., 2017). This also supports the evidence that majority of consumers have some knowledge
of food safety but lacking knowledge of fresh produce linked with food borne illness and ways to
prevent it.
With one of the major outbreaks around the globe have been linked with rockmelon
associated deaths with number of other outbreaks. Two of the included studies were inclined in
highlighting washing behaviour with produce that have inedible outer skin shell that was seen
with rockmelon (Farr‐Wharton, Foth and Choi, 2014). Approximately 45% of the consumers’
did not wash rockmelon before consumption. On the other hand, majority around 60% wash
rockmelon by just placing it under the running tap water and did not rub the produce while
cleaning. Interestingly the duration of cleaning was reported to be less than 10 seconds while
washing fresh produce and did not associate any scrubbing or soap used for washing.
Another fact highlighted through the study showcased a positive relation of washing
rockmelon rates with increasing age and that is older adults with 54% for 60 years and above in
comparison with 20-40 years’ old with just 34.5% (Newson, 2017). This suggests that aged
people tend focus more on their food safety compared with younger adults. However, more than
80% of the respondents in the research were above 60 years and does not reflect food handling
practices (Newson, 2017). Another relationship highlighted was linked with gender, with more
women washed cantaloupes and tomatoes when compared with men, reflecting good behaviour
(Newson, 2017). However, there are still link of biasness in relation as more than 70% of the
respondents were females.
It was also highlighted that good washing practices associated with fresh produce edible skin i.e.
in the first study an overall 98 % was the washing rate for tomatoes and strawberries, then the
rate of percentage reduced to 97% in second and in third study it became 81.9%. (Scanlan, R et
al., 2012; Verrill, L, et al., 2012; Worsley, Wang & Yeatman, 2011). This gives an average of
more than 87% of the consumers’ agreed and highlighting washing practices compared with non-
edible produce with average less than 55%. (Luu, Davies and Dunne, 2017). Moreover, with the
involvement of a very small sample group the majority being female and adult population, it
does not give a brief perception of behavioural practices for the entire population.

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2.3 Demographics
A study conducted in Philippines that was funded by Australian Centre for
International Research (ACIAR) utilized a structured questionnaire for analyzing the relationship
between opinion, attitudes and socio-economic characteristics of the consumers’ when buying
fresh vegetables (Meysenburg, Albrecht and Ritter-Gooder, 2014). The aim of the study was to
highlight how consumers define food safety and their buying habits. Lettuce, ampalaya (bitter
gourd) and pechay (bok choy) were the 3 vegetables that were selected for evaluation. It
involved 300 respondents for the household survey with 100 people equally divided among low,
middle and high-income groups with the majority of the population being married and with a
mean age of 39 years. It concluded that low-income group were the only price conscious and did
not care much about the cleanliness or labeling of the vegetables. With middle-income group
were more particular with the appearance of the produce and defined food safety as “clean
vegetables” and some were conscious about labeling. The high-income group, defines food
safety as “proper food handling” and thought food safety means vegetables being naturally
grown, organic and free from chemical residues and pesticides highlighting better understanding
and knowledge.
2.4 The role of education in improving knowledge and practices:
Two research articles showed a positive correlation of food safety practices linked to
fresh produce. Both these utilized educational programs in food safety with comparing results
before and after the educational campaigns to highlight existing knowledge gap with any
improvement to be highlighted after the program. In this context, the majority of the population
group were females and that was above 70% (Alimi, 2016). The first study included a total of 13
cycles with 8 seminars and the response was noted by questionnaires highlighted an increase
from 47.6% to 60.5% that was seen in pre-and post-results for food safety and from 43.3 % to
59.2% for nutritional safety was shown in consumers (Milazzo and et.al., 2017). The second
study conducted a systemic review and meta-analysis by including 50 Uncontrolled studies and
29 controlled studies (Randomized and non-randomized controlled trials, studies included from
all around the world with the majority from the US) showcasing positive relation of education in
controlled trials and very heterogeneous results in non-controlled trials. This shows a variation in

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results and does not justify education as a positive factor linked with good food safety practices
(Young, I et al., 2015). Further details of the study are enlisted in appendix 1.
Hence, it proves that still, a major part of the population around the globe have poor
food safety knowledge in relation with fresh produce and higher ratio of students and young
population; with some predilection with cultures, traditions and different tribe showcasing
different food and safety practices, with maximum cases registered in the USA (Pee and
Kankanhalli, 2016).
2.5 Knowledge and awareness
The following article was published in 2013 and detailed reporting of foodborne illness
in consumers and health professionals. Centre for Disease Control and Prevention (CDC)
reported in 2011 as 48 million people annually got in contact with foodborne illness. The report
suggested that in California more than 90% of the people were confident about their education in
food safety and think foodborne illness contact is delivered from any place other than home
(Stancu, Haugaard and Lähteenmäki, 2016). A self-administered questionnaire was utilized that
involved all the age group of people from 18- 80 years. That also with roughly equal
participation of all age groups. This resulted in 57 % of the population who were concerned or
eating away from home compared with Health professionals with a higher percentage and that
was 68%. This identified that there is a requirement to increase the knowledge of both health
professionals and the general public (Lunden and et.al., 2017).
Two of the included studies identified poor knowledge and awareness among consumers
linked with fresh fruits and vegetables. First research study conducted a Systemic literature
review gathered all the information from peer reviews and journal articles from 2014 to 2017 in
Canada to develop a baseline level knowledge to identify consumer’s current awareness in
washing of fresh produce prior consumption. The frequency of washing of poultry fruits and
vegetables along with the frequency of hand washing are also considered (Gong, Wang, Yang
and Bai, 2016). A total of 26 publications with including questionnaire to identify the perception
level of people in regards to food safety knowledge (Nesbitt, A et al., 2014). The second study
conducted in Turkey on university students with a total number of 1,340 people volunteered in
the study with 55% being male with an overall age range of 18-24 years. Results highlighted that

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an overall 67.8 % of students agreed on if they think food is rotten it is alright to boil it and
consume it showcasing poor knowledge and awareness (Chapman and Sellheim, 2017).
An interesting study that focused on linkage of cross-contamination by microbial
pathogens through two of the most common utensils used in the kitchen including knifes and
graters. This was during the slicing of fresh produce highlighted the high risk of cross
contamination with the usage of unclean utensils that has increased due to lack of awareness
among consumers. Highlighting, that two of these most common utensils had the potential to
cross contaminate pathogens to fresh cut vegetable and fruits. (Erickson, M. C., Liao, J.,
Cannon, J. L., & Ortega, Y. R, 2015). It has also been supported by other studies that machinery
can be contaminated during the harvest of low-lying produce like i.e. Baby spinach as both the
soil and plant material can get stuck in the machinery. Similarly, Salmonella was persistently
found on shredders used for cutting lettuce through outbreak investigation.
2.6 Knowledge of vulnerable population group:
A study conducted in Cassino, Italy included 1000 random volunteers recruited and
involved in the questionnaire based interview to highlight food safety practices and knowledge
of consumers considering all aspects from purchasing, storing, preparation of food. Aim of the
study was to identify knowledge and food handling practices among the vulnerable population
group including children, pregnant women, and older person (Cates, Kosa and Fraser, 2015).
Results identified lack of knowledge linked to pathogens, food-borne diseases and implementing
poor food hygiene handling practices among consumer groups. Further, information need to be
provided to improve food safety knowledge as well (Milazzo and et.al., 2017). Same results were
identified in another study done in US highlighting poor knowledge of microbes among
consumers’ (Pollard and et.al., 2016).
2.7 Consumers education
One of the major consumers’ awareness drives to review their current educational level
started in 2006 after the serious E. coli O157: H7 outbreak linked to fresh Spinach in the US.
Consisting of 203 registered cases of severe food poisoning along with 3 deaths (Reddi, Kumar
and Rao, 2015). This case was a major turnaround and got intensive media coverage raising a lot
of concerns with microbial risks linked with fresh fruits and vegetable consumption mainly
involving leafy vegetables.

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Recent research was done on Consumers awareness both in Australia and New Zealand
by FSANZ. This highlighted the surge in growing concerns of consumers linked with fresh fruits
and vegetables along with increased risk of their associated microbial hazards (Luu, Davies and
Dunne, 2017). Previous studies were conducted in the UK that inspected consumers’ knowledge,
perception, perceived behaviour and fresh produce handling practices which identified a big gap
purring them at risk while handling fresh produce.
Consumers play a vital role in mitigating the growing burden of food-borne outbreaks.
The aim of consumers’ education was to raise awareness about microbial hazards linked with
fresh produce without causing any alarm or damaging consumers’ confidence in consuming fresh
produce next time as they are packed with nutrition (Bornkessel, Bröring and van Trijp, 2014).
Secondly, it helps consumers to develop knowledge and skills while handling fresh produce with
making them feel more responsible for protecting themselves from causing contamination and
preventing food-borne illness with the help of appropriate fresh produce handling. Lastly,
developing appropriate cultural messages on fresh produce targeting high-risk food safety
behaviors.
2.8 Causes of Contamination of Fresh Produce
Fresh fruits and vegetables become contaminated with pathogens at any stage along the
farm to fork continuum. Due to their growth in natural open environment, they possess high
potential for contamination from pathogens. Contamination occur in fields, at the time of
harvesting, transportation, processing, packaging, distribution and marketing for restaurants,
food services facilities and the home which is clearly explained in figure 3 (Meyer and et.al.,
2017). One of the major risk factors is soil, in which most of the fresh produce grown has the
potential to harbor harmful pathogens like salmonella etc. Other risk factors include the use of
biological fertilizers, untreated animal manure and use of irrigation water are sources of
pathogens contamination which are clearly detailed in table 1 (Evans and Redmond, 2016).
Furthermore, poor sanitation in fresh produce processing facilities possesses a serious
risk. Most of the fresh produce is consumed raw, hence there are no cooking process involved
prior to consumption. So, adequate cleaning and essential fresh produce knowledge are necessary
to reduce the likelihood of contamination (CDC, 2014). Moreover, CDC recommends adequate
washing of hands for at least 20 seconds with soap or warm water before and after handling fresh

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produce and all the produce should be prior to eating, cutting, or cooking. Fresh produce such as
melons must be cleaned along with scrubbing using a brush, followed by drying with a paper
towel to remove bacteria (CDC, 2014).
Some of the researchers in the USA at the University of Illinois College of Agricultural,
Consumer and Environmental Sciences (ACES) looked at the adherence pattern of pathogens to
leafy vegetables and how viruses can stick to vegetables. No study before this has ever tested the
relationship between the surface texture and chemistry of the adherence of the pathogens to fresh
produce. Considerations were at 24 most commonly consumed salad vegetables (New South
Wales Food Authority, 2014). The researchers expected to find that pathogens can hide in
between the rough surfaces of the hard leaves and structures of the cuticle. The waxy layer that
protects plant against disease and causes water loss. The results were quite surprising for the
researchers as the opposite of what they were expecting it to be were found. Instead, vegetable
and green leafy salad with three-crystalline wax-structures on the leaf cuticle which were
expected to have many pathogens harboured a fewer number of pathogens and viruses after
rinsing of the produce. (Lu, Lu et al., 2015).
The chief researcher Juvik was surprised and said “normally, viruses adhere to oxygen
groups, like OH, which are associated with proteins and carbohydrates on the surface. When the
wax completely covers the surface, it becomes totally hydrophobic. This renders the whole leaf
surface harder for viruses to attach. Furthermore, rinsing those leaves with water, gave the
viruses to what they are looking for, so they’re easier to wash away” (Lu, Lu et al., 2015).
Figure 2: Sources and roots of contamination of fresh produce

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Source: Daniele F. Maffei ,Erika Y ,Batalha , Mariza Landgraf ,Donald W. Schaffner Bernadette
D.G.M. Franco, 2016, Brazilian journal of Microbiology vol.47
There are different reasons due to which food gets contaminated. With this respect, one
of the reason is pre harvest and post-harvest stages and this mainly raises from human or
environmental sources. Further, sources for post-harvest includes human handling, rinse water,
packaging, improper storage, etc. On the other hand, pre harvest sources contains irrigation
water, raw animal manure, insects, etc.
Soil:
Evidence-based studies provide information that pathogenic enteric bacteria like
Salmonella, Listeria, Campylobacter, and Cryptosporidium can survive for relatively longer
periods of time in soil getting contaminated with human or animal manure from weeks to months
and even years varying with different microbes i.e. with salmonella that has survival rate up to 2
years. A total list of all outbreaks linked with soil is detailed in appendix 2.
Water:
Water used for irrigation purposes can transfer human pathogens to fresh produce has
been confirmed through several experimental evidence. Data collected from studies done around
the globe have provided evidence that bacterial diseases like cholera are endemic in population
group that consumes raw vegetables which were irrigated with raw or untreated sewage
(National Health and Medical Research Council, 2017). A number of outbreaks of fresh produce
have been linked with untreated water usage with a Large outbreaks of E. coli linked to
contaminated lettuce in Sweden was also linked to contaminated water quality, Salmonella and
Vibrio cholera on lettuce leaves, Campylobacter in watercress that was harvested and grown
from contaminated water, Listeria monocytogenes positive in cabbage sample along with a
number of recorded outbreaks linked to contaminated water are listed in appendix 2.
Table no.1— Methods causing contamination of the fresh produce. Including both Pre-harvest
and post-harvest
Table 1: Methods causing contamination of the fresh produce. Including both Pre-harvest and post-
harvest
Preharvest/ Methods causing contamination of fresh produce before harvesting
Soil

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Irrigation water
Air (dust particles)
Wild and domestic animals
Inadequate human handling practices.
Animals waste and inadequately composted manure.
Fertilizers
Postharvest/ Methods causing contamination of fresh produce after harvesting
Human handling (farmers, workers, consumers)
Through different means of transportation
Improper storage
Inadequate cleaning
Harvesting equipment
Adapted from “Microbiological Safety of Fresh and Fresh‐Cut Produce: Description of the
Situation and Economic Impact,” by Whiley, H., Clarke, B., & Ross, K. (2017). Knowledge and
Attitudes towards Handling Eggs in the Home: An Unexplored Food Safety Issue?. International
journal of environmental research and public health.14(1). 48.
Figure 3: Diagrammatic representation of causes of contamination of fresh produce. Taken from “A quantitative
microbial risk assessment of water in the fresh produce chain”

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Source: “A quantitative microbial risk assessment of water in the fresh produce chain”, by Ir.
Kevin Holvoet & Imca Sampers, n.d., University of Gent, Department of Industrial Biological
Sciences.
From the above figure, it can be stated that there are many number of process that take
place in order to reach the finished food products to customers or consumers. Further, there are
many ways that are shown, due to which food gets contaminated. In this context, it causes
serious health related issues when proper steps are not taken before consumption.
2.9 The importance of Hand hygiene linked with Foodborne illness:
Correct handling of fresh produce is essential during all the stages of food preparation,
production, transportation, and storage etc. in order reduce the incidence of foodborne illness
(Milazzo and et.al., 2017). Facts and figures suggest that 10- 20 percent of all the foodborne
illness were estimated due to poor knowledge and unsafe food handling behavior both in
Australia and UK. Correct food handling is essential and prior consuming fresh produce as most
of the fresh produce are consumed raw (does not involve any killing or cooking process to kill or
reduce the number of bacteria to a suitable level limiting the risk of foodborne illness). Hence
adequate fresh produce handling is required by people.
Previous studies have highlighted that consumers commonly implement unsafe food
handling behaviour and practices during domestic food preparations that also reflect poor
perception of consumers linked with food safety. In the year 2002, a study conducted in US used
an online survey “Home Food Safety... It‘s in Your Hands” also identified large gaps in
consumers’ knowledge of which they were unaware of the common causative factors, agents
associated and any specific recommendations that helped in reducing the risk of foodborne
illness (Stancu, Haugaard and Lähteenmäki, 2016). Another extensive study done on consumers’
fresh produce handling practice highlighted approximately half of all the respondents in the
study did not wash hands before using fresh produce.
This highlights 2 important aspects, First, People may believe that they are followed and
already implementing good food hygiene practices. But the matter of fact that they are not, and
good knowledge of foodborne illness is essential in reducing the risk and growing burden (Van
Boxstael, Devlieghere and Uyttendaele, 2014). Secondly, Poor knowledge of food handling
practices is highlighted from studies in done around the globe that reflect consumers’ inadequate

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knowledge around the world and more work need to be done to reduce the growing burden of
outbreak and illness.
2. 10 Health belief model and their role in changing behaviour:
Past research has identified attitude towards behavior as an individual’s personal
evaluation of action. Subjective norms are an individual’s perception of the society’s normative
opinion about an action. Perceived behavior control, which is similar to the concept of self-
efficacy (Dermesonluoglu, Fileri and Taoukis, 2016), is an individual’s perception of own ability
to execute an action. HBM is a model specially designed to explain and predict behaviours
related to health.
The original model suggests four constructs on which an individual’s health behaviours
are based and include perceived susceptibility (an individual’s evaluation of how easy he/she
could involve in one condition), perceived severity (an individual’s evaluation of how serious a
condition and its subsequent consequences would be), perceived barriers (an individual’s
assessment of the cost of performing a health action), and perceived benefits (an individual’s
assessment of how positive the outcome of a health action would be).
Some other components acting as mediating factors were incorporated into the model,
such as demographic values, social economic status and cues to action (Varoquaux and Wiley,
2017). TPB and HBM haven’t been extensively used in empirical studies aiming at
understanding people’s beliefs and practices of food safety.

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Figure 4: An interactive model of Theory of Planned Behaviour
Source: Pinterest Health belief model”, by Nejad, L. M., Wertheim, E. H., & Greenwood, K,
2005
In accordace with above figure, it can be stated that planned behavour of any individual’s
behaviour is determined to be the intention that is enact the behaviour. There are three different
type of components that are associated with this, they are attitude towards specific behaviour,
subjective norms and perceived behavioural control.
Attitude: This can be determined to be the overall evaluation done for the behaviour.
These consist of two components they are the belief that afre carried out by people regarding
consequences of behaviour. Other one is corresponding negative or positive judgements
regarding feature of the behaviour.
Subjective norms: These are persons own estimate for social pressure in order to perform
the target behaviour. It is dependent on beliefs that are developed by a person different things.
Perceived behavioural control: This is the extent to which a person is able to enact the
behaviour. Not all individuals are able to present the type of feeling that they have within to
others.

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In accordace with the research, it can be stated that there are different se tof percetion that
are carried out by individuals in order to wash their hands or to consume fresh produce.
Generally individuals have subjective norms in which they have developed their own set of
percetion for this area.
Health Belief model is a type of psychological model that enables to predict health
behaviours. It can be done with the help of focusing on the beliefs and attitudes of individuals.
This model is similar to TPB as it also focus mainly on the type of percetion that are carried out
by people for certain aspects.
2.11 High-risk Population groups:
Foodborne illness linked to fresh produce is a risk towards consumers. However, it can
cause some serious illness in the vulnerable population as compared with normal population
groups. These group of people include anyone with decreased immune system/defense system or
with an underline medical condition that increases their risk of getting foodborne illness. This
includes children under 5 years of age (infants and preschool-age children). Old age people
(elderly people) above 65 years of age, pregnant ladies or anyone with an underline medical
condition, i.e. cardiac condition, HIV Aids, transplant recipients, undergoing chemotherapy etc.
(Smith, Ross and Whiley, 2016).
Pregnancy and Listeria:
During pregnancy, the immune system of a woman is weak, making her baby and herself
in having an increased risk of contracting to bacteria, viruses, and parasites that cause foodborne
illness. Pregnant women are among the most vulnerable population group of contracting the
disease. Foodborne illness during pregnancy can have a direct impact on the new-born or
developing fetus and can cause severe health implication (Delbeke, Ceuppens, Jacxsens and
Uyttendaele, 2015). Symptoms of illness vary with no symptoms at all in some cases to minor
flu-like symptoms reported with ache, nausea, fever, chills etc. may be present to severe
symptoms with the spread of infection to the central nervous system, headaches, stiff neck,
meningitis, confusion, loss of balance, or convulsions.
In extreme cases of foodborne illnesses have higher variability and may also affect the
newborn including miscarriage, stillbirth, premature delivery, low birth babies, and in most

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severe cases even infant death has been reported (Kirk and et.al., 2017). As reported by the New
South Wales Government Food Authority “Pregnant women are up to 13 times more likely to get
Listeriosis from a contaminated food than an ‘average’ healthy adult with no underlying illness”
(2014).
Table 2: Approximation of the number of listeria cells linked with causes Listeriosis suggested from the previous
outbreaks
Consumed number of
Listeria cells
% of how often is this
number consumed in a
regular meal
Percentage of cases of
Listeriosis caused by this
number.
Less than 1 99.18 0.03%
10 0.43 0.03
100 0.21 0.13
1,000 0.10 0.60
10,000 0.05 2.85
100,000 0.02 13.47
>1,000,000 0.01 82.89
Consumed number of
Listeria cells
% of how often is this
number consumed in a
regular meal
Percentage of cases of
Listeriosis caused by this
number.
Less than 1 99.18 0.03%
10 0.43 0.03
100 0.21 0.13
1,000 0.10 0.60
10,000 0.05 2.85
100,000 0.02 13.47
>1,000,000 0.01 82.89
Milazzo, A. & et.al., (2017). Factors Influencing Knowledge, Food Safety Practices and Food
Preferences During Warm Weather of Salmonella and Campylobacter Cases in South Australia.
Foodborne pathogens and disease.14(3). 125-131.

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Foodborne illnesses like Listeria and Toxoplasma gondii, can infect the fetus even
without causing any illness to the mother. Due to these factors highlighted above, pregnant
women are prescribed by care providers to follow a specific diet and guidelines which detail
what food to utilize or not to utilize during pregnancy. Moreover, pregnancy-associated Listeria
has a very large incubation period varying in between 17-67 days according to one of the
scientific studies (Garayoa and et.al., 2017).
Previously registered data also suggests that Listeriosis most often results from very high
levels of listeria in the food (Mebdoua, Lazali and Ounane, 2017). Estimation of more than 96%
of the cases have seen to have caused Listeriosis with 100,000 per serve of Listeria cells was
seen by an analysis done on German food contamination data and people who get sick (Friis,
Skov and Perez-Cueto, 2017). Scientific data have consistently supported the fact that ready-to-
eat (RTE) foods (fresh fruits and vegetable including pre-packed fresh produce) have increased
risk of Listeriosis with their potential for supporting and growing environment for higher levels
as with the quality of having a longer shelf life cells.
Special advice need to be given to pregnant women including adequate rinsing of fresh
produce prior consumption. Special precautions are required to be taken with fruits like
rockmelon that require peeling or cutting and with damaged and bruised produce as bacteria and
other pathogens can thrive in such places. No consumptions of raw sprouts for all kind as they
have high potential to harbour bacteria through many crack and are impossible to clean.
Consumption of fresh produce juices must be avoided as they are not pasteurized (NSW Food
Authority, 2014).

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Chapter 3: The role of Bacterial agent’s pathogens and their association with
fresh produce producing foodborne illness.
This chapter gives background information and insight on the most common pathological
agents linked with cross contamination of the food in the past recorded outbreaks outlined in
table no.3. This also covers along with their characteristics and affected population group in table
no.4. Moreover, high-risk produce associated with these bacteria are detailed in table no.5.
Table 3: Most Common Pathogens, agents, and conditions linked to previous fresh produce outbreaks
recommended by experts for inclusion in Australian estimation of foodborne illness circa 2010
Viruses Bacteria Protozoa
Rota virus Bacillus cereus Toxoplasma gondii
Norovirus Shigella Cryptosporidium spp
Hepatitis A Staphylococcus aureus Giardia lamblia
Vibrio parahaemolyticus
Shiga toxin-producing E.
coli
Other pathogenic E. coli
Listeria monocytogenes
Salmonella, non-
typhoidal
Salmonella Typhi
Yersinia enterocolitica

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Adapted from” Foodborne illness in Australia circa”, by. Kirk, M., Glass, K., Ford, L., Brown,
K., & Hall, G, 2014, Canberra: Australian Government Department of Health.
3.1 Overview of Microbiological Data:
Table 4: Characteristics of some microbial pathogens that have been linked to outbreaks of produce-associated
illness
Microorganism Typical
incubatio
n period
Symptoms Infectious
dose
Affected
Population
Source
Bacteria
Clostridium
botulinum
12 to 36
hours
Nausea, vomiting, fatigue,
dizziness, dryness
intoxication soil, lakes,
streams, of mouth and
throat, muscle paralysis,
difficulty growth and toxin
decaying vegetation,
swallowing, double or
blurred vision, drooping
production in food
reptile’s eyelids, and
breathing difficulties
Production
of toxin in
the food
and growth
intoxication
Escherichia coli
O157: H7
2 to 5 days Bloody diarrhea,
abdominal pain. Can lead
to 10 to 1000 animal feces,
especially hemolytic
uremic syndrome and
kidney failure especially in
10-1000 Animal and
human feces

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children and the elderly
Salmonella spp. 18 to 72
hours
Abdominal pain, diarrhea,
chills, fever, nausea, and
vomiting
10 to
100,000
Human feces
Shigella spp. 1 to 3 days Abdominal pain, diarrhea,
fever, vomiting
About 10 Soil, food
processing
environments.
Listeria
monocytogenes
1 day to 5
or more
weeks
Febrile gastroenteritis in
healthy adults; may lead to
spontaneous abortion or
stillbirth in dependent
environments pregnant
women; severe septicemia
and meningitis in neonates
and immunocompromised
adults; mortality may be
20 to 40%
Unknown
usually
depend
upon the
health of an
individual
Most
commonly
affect the
pregnant
ladies and
people
with
decreased
immune
system i.e.
elderly,
infants,
people
with the
underline
medical
condition.
Parasites
Cryptosporidium
spp.
1-12 days Profuse watery diarrhea,
abdominal pain, anorexia,
vomiting
About 30 Animal and
human feces

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Cyclospora spp./
Cyclospora
cayetanensis
1-11 days Watery diarrhea, nausea,
anorexia, abdominal
cramps (duration 70- 40
days)
Specific
environmental
sources,
unknown at
this time.
Viruses
Hepatitis A 25-30 days Fever, malaise, anorexia,
nausea, abdominal pain,
jaundice, dark urine
10-50 Human feces
and vomitus
Norwalk/Noro
Virus
12-48
hours
Vomiting diarrhea,
malaise, fever, nausea,
unknown, human feces,
vomitus abdominal cramps
Unknown
probably
low.
Human feces
and vomitus
Adapted from “Microbiological Safety of Fresh and Fresh‐Cut Produce: Description of the
Situation and Economic Impact,” by Griffith, C. J. & et.al., (2017). The food safety culture in a
large South African food service complex: Perspectives on a case study. British Food
Journal.119(4). 729-743..
Table 5: Type of Bacteria and associated fresh produce. Examples of the number of fresh produce around the world
in the past two decades that have been isolated from which particular bacterial pathogen.
Pathogens Fresh produce
Bacillus cereus Alfalfa sprouts, cress sprouts, cucumbers,
mustard sprouts, soybean sprouts
Campylobacter jejuni green onions, lettuce, mushroom, potato,
parsley, pepper, spinach
Clostridium botulinum cabbage, mushrooms, pepper
E. coli O157: H7 Alfalfa sprouts, cabbage, celery, cilantro,

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coriander, cress sprouts, lettuce
Listeria monocytogenes Rockmelon, bean sprouts, cabbage, chicory,
cucumber, eggplant, lettuce, mushrooms,
potatoes, radish, salad vegetables, tomato,
corn, chopped celery.
Salmonella Rockmelon, alfalfa sprouts, lettuce,
artichokes, beet leaves, celery, cabbage,
cauliflower, chili, cilantro, eggplant, endive,
fennel, green onions, mung bean sprouts,
mustard cress, parsley, pepper, salad greens,
spinach, strawberries, tomato, watermelon
Shigella Celery, rockmelon, lettuce, parsley, scallions
Staphylococcus Alfalfa sprouts, carrot, lettuce, onions sprouts,
parsley, radish
Vibrio cholerae Cabbage, lettuce
Adapted from “Microbiological Safety of Fresh and Fresh‐Cut Produce: Description of the
Situation and Economic Impact,” by Akomolafe, O. M., & Awe, T. V. (2017). Microbial
contamination and polyethylene packaging of some fruits and vegetables retailed at Akure and
Ado Ekiti, South Western Nigeria. Journal of Stored Products and Postharvest Research.8(6).
65-72.
3.2 Previous Outbreaks Data of Foodborne illness in the previous 20 years linked to fresh
produce including pre-packed fresh produce:
Source of the foodborne illnesses and associated outbreaks are normally determined
through the association of microbiological or epidemiological data linked with outbreaks
investigations. The difficulty in identifying an outbreak is through the existing surveillance
system. It enables to develop an investigation of the current system and then proceed through the

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process that makes it quite challenging and it is the critical control point in identifying the
previous outbreaks and this includes:
*Time delays in notifying or recognition of the outbreak, including:
- Obtaining stool samples.
- The required time is taken for the infected person to seek medical attention (appropriate
medical treatment).
- Laboratory results and confirmation of the presence of the pathogenic organisms.
- Notification of appropriate public health authorities.
- Investigation of the outbreak.
*Inability to trace down the food source and the likely cause of the associated outbreak.
*No involvement of the vulnerable population (immune system of the exposed population
group).
*Long incubation period of the pathogen e.g. Listeria monocytogenes.
*Large variation in the characteristics of the outbreak.
It is very important to understand that the outbreak data is the information collected
from a very small population group and does not reflect on outbreak association of the entire
population. It is just to give an idea or to set a baseline information associated with the outbreak
which help in the future outbreak investigation and surveillance (Silva and Lidon, 2016). In
addition to that many of the foodborne illness are not reported and are unrecognized as most of
the population does not seek medical attention. So, most of them do not get registered or are
reported to the public health authorities. This reflects that currently available data still does not
reflect the correct values and statistics.
Between the duration of 1995-2000, most of the outbreaks are associated with lettuce
that has average association of 30-50 cases other than one large outbreak in the UK with 392
cases registered (Verghese, Lewis, Lockrey and Williams, 2015). Associated outbreaks were
linked with the use of contaminated water or poor handling of fresh produce causing cross-
contamination. During this period, one of the largest outbreak was linked with raspberries linked
with Cyclospora and this includes 850 registered cases. The causes included ill workers, use of

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dirty utensils for cleaning raspberries and poor handling practices with raspberries and prepared
dishes.
Between 2001-2011, there were 93 registered outbreaks associated with produce that
was reported in Australia. These entire 93 outbreaks represent 7 percent out of the total of 1291
cases that were suspected cases of an outbreak during that time duration. In addition to that, 11%
were highlighted as confirmed, 29% (27/93) were classified as suspected and the remaining 60%
(59/93) were listed as possible outbreaks (Liu and Kilonzo-Nthenge, 2017).
The summary of the listed 93 outbreaks highlighted a total of 2.822 people who became
ill, 321 were hospitalized, and 7 people among them died because of the serious foodborne
illness. On the other hand, by considering only the confirmed cases of outbreaks, it highlighted a
total of 44% (1247/2822) of all the illnesses. In addition to that, 77% (234/321) were denoted as
hospitalized and 57% (94/70) and 57% (4/7) were deaths recorded (Liu and Kilonzo-Nthenge,
2017).
Foodborne outbreaks linked to fresh produce were noted to be highest in the restaurants
which was 34% (32/93) followed by 18% of the foodborne occurrence in a community
residence, and 12% in private residences (Tirkey, Pal and Panda, 2014;Cox and Poelman, 2015).
Out of all the produce, vegetables had the highest percentage linked to outbreaks with 22%
(26/93), and fruits associated were 19% (18/93). However, a bigger ratio of 48% was listed to be
associated with other produce and ingredients. Out of all these lists, the number of confirmed
outbreaks were (14/37) in fruits, fooled by vegetables (11/37).
One of the major consumers’ awareness drives to review their current education level
started to get highlighted in 2006 after the E. coli O157: H7 outbreak linked to fresh Spinach in
the US. Comprising of 203 registered cases of severe food poisoning along with 3 deaths (Artes
and Allende, 2014). This case was a turnaround for lot of countries to review the current
practices of their population and devise preventative ways to prevent any type of future
outbreaks. If highlight the statistics shown in the past from the start of the beginning of the first
foodborne outbreak from fresh produce. This resulted in hundreds of people hospitalized due to
consumption of fresh produce and posed a big question on people’s awareness and food handling
practices linked to fresh produce, which could create a serious risk tandem resulting in outbreak
(Liu and Kilonzo-Nthenge, 2017).

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Another major outbreak involving in the fruit category was caused by salmonella 2006
that was associated with rockmelon, resulting in a total number of 100 people who got ill and 9
were admitted to the hospital due to severe food poisoning (De Roos, Binacchi and Sneddon,
2017). This outbreak involved 2 deaths which raised a lot of health concern towards health and
safety of people. One of the largest fresh produce-related outbreaks were captured in the fruit
category in the year 2009 and it was caused by hepatitis A associated with semi-dried tomatoes.
Total number of 392 suspected and confirmed cases were identified with 165 people hospitalized
and among them, all people died (Abrahams and et.al., 2017). Another major Cyclospora
outbreak associated with Melon (possibly a rockmelon, lettuce and mint dish in 2014) in
Australia resulted in 314 illnesses (Crowe and et.al., 2017).
On the other hand, highlighting the vegetable category, were two large outbreak caused
by Salmonella Oranienburg associated with alfalfa sprouts, that involved 133 suspected and
confirmed cases of foodborne illness with 32 got hospitalized. The second outbreak was related
to baby corn, notifying total of 100 cases with 3 hospitalizations (Aschemann-Witzel and et.al.,
2017). Details of all the previous outbreaks are enlisted in appendix 2.
Moreover, highlighting the past documented data outbreaks from Australian population
two of the reported outbreaks were linked to the fresh produce imported from overseas that
included sun-dried tomatoes that were involved with a large outbreak of Hepatitis A (Pearson
and et.al., 2017). The second outbreak was associated with baby corn that was imported from
Thailand and was liked with a large outbreak of shigellosis (Ferguson, O'dea and Brimblecombe,
2017).
On the other hand, all the other three remaining outbreaks were caused by locally
produce rockmelon, honeydew melon (Kaptan, Fischer and Frewer, 2017) and papaya (Luu,
Davies and Dunne, 2017). The reported outbreak in 2006 of Salmonella Saintpaul has
microbiologically linked to the rockmelons that were processed and grown in the Northern
Territory (NT). Similarly, it was linked with the rockmelons from Queensland that were later
found to be contaminated with non-outbreak linked strains of Salmonella species. Investigations
and associated inspections of the 6 processors at Queensland and northern territory highlighted
critical food safety issues in the production and processing of the rockmelons was highlighted to
be linked or they had contributed in causing contamination of the produce. In addition to that,

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other factors including untreated water usage and incorrect use of disinfectants were also
highlighted to be a factor linked with the contamination.
Furthermore, between 2012-2016, there has shown a slight incline in foodborne
outbreaks linked to fresh produce. With recent rockmelon outbreak, new strains of salmonella
have been identified, followed by a severe warning issued by the government for vulnerable
groups (infants, pregnant women, and elderly people) to avoid eating rockmelon (FSANZ, 2016).
Total number of 86 cases were reported in two weeks with serious food poisoning after
consuming rockmelon, with 2 reported deaths. Food Safety Australia and New Zealand
confirmed the presence of Salmonella in the Red melon dirt farm (FSANZ, 2016).
There is an increase identified when compared with the two cases a month on average in
New South Wales within the duration of the past five years. On the other hand, recent traces of
salmonella were discovered in lettuce that have raised a lot of concerns over food safety risk
towards the consumers (Akomolafe and Awe, 2017). These past outbreaks have raised a lot of
concerns for the current food and safety knowledge and awareness among fresh produce in the
Australian population. Furthermore, with more people striving towards a healthy lifestyle and
with an increase in fresh produce, more work needs to be done to provide sufficient fresh
produce knowledge and awareness among consumers.
3.3 Outbreak Critique:
The new food safety guidelines say “Salmonella bacteria are most commonly associated
with livestock and chicken, they are also responsible for food safety outbreaks associated with
fresh produce" (Fresh produce safety Australia and New Zealand, 2015). This highlights a risk
with fresh produce safety for the Australian consumers.
All the outbreaks related to fresh fruits and vegetables including pre-packed fruits,
vegetables and fresh herbs around the world from the duration of 1995-2016 that meet the
eligibility criteria of the research (that include no meat products, cooked fruits and vegetables
and any outbreaks associated with them) and these are attached per appendix 2. With the main
emphasis on large outbreaks and more to have occurred in Australia.
In all the listed outbreaks the causes of contamination vary at different occasion but are
also linked with a number of outbreaks around the world. The most common are associated with

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use of untreated water usage with possible source of animal or human waste, Inappropriate or
incorrect food handling practices, inadequate cleaning of the produce prior consumption, use of
dirty equipment’s for preparing the produce, cross-contamination of RTE fresh salads and
produce with raw meat products, and incorrect usage of disinfectants for cleaning fresh fruits and
vegetables were also shown to be linked to the contamination (Smith, Taylor and Lavender,
2016).
There are several possible reasons for increase in outbreak
- Enhanced ability from different agencies groups to detect and investigate the multistate
outbreaks i.e. OzFoodNet.
- New knowledge and information of the role of bacteria their biological characteristics
and their attachment to different produce
- The increase in trade around the world along with centralized growing and distribution
increases in the potential of contamination.
3.4 Fresh test data:
For the verification of the wholesaler’s quality, assurance and their safety to minimize the
food safety risk, Fresh Test Australia conducts, manages and collates maximum residue and
microbial test results. Sample are drawn from the central markers from all over the country
including, Sydney, Brisbane, Melbourne, Adelaide, and Perth. Independent facilitators than
further select appropriate sample as representative samples for the future testing and sent to the
National Associated of Testing Authorities (NATA) accredited laboratory to analyze the
representative sample groups.
Microbial testing of the fresh produce via fresh test 2006-2010 a total of 3507 unique
fresh fruits and vegetables samples were identified with some exclusion criteria of water,
environmental swabs, processed salads, meat products and noodles and rich dishes. The tested
produce samples included both domestic and international with a noted sample biased of more
emphasis on lettuce and salad leaves over other fresh produce (Mørk, Grunert and Tsalis, 2017).
The microbiological testing included both pathogens: Listeria spp., Salmonella spp., coagulase
positive Staphylococci and Bacillus cereus, and indicator microorganism including Total plate
count, Escherichia coli, faecal coliforms and Enterobacteriaceae. The sampling cannot be

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recognized as a representative survey for all the fresh produce grown in Australia and reflects
verification of the Australian production system (Marti, Ferrary-Américo and Barardi, 2017).
The results of the tested samples and summary of tests microorganism are listed in Table 6.
Subsequently, the test results of the samples of fresh herbs tested for indicator microorganism are
listed in Table 7.
Table 6: Summary of samples and number of fresh produce positive tests for microorganisms
Microorganisms No. of samples tested No. of positive samples.
E. coli 3388 133
Salmonella spp. 2003 4
Listeria monocytogenes 2480 3
Coagulase positive
Staphylococci
1396 7
Faecal Coliforms 1404 173
Taken from “Review of foodborne illness associated with selected ready-to eat fresh produce”,
December 2014, Food Safety Australia and New Zealand, (15), 13-37.
Table 7: Results for the samples for of fresh herbs tested for E. coli and Faecal coliforms
Fresh produce No. of samples tested No. of positive samples for
E. coli and Faecal coliforms.
Basil 49 4
Chervil 1 1
Coriander 60 11
Dill 26 3
Mixed Herbs 11 0
Lemon Thyme 8 3
Marjoram 8 4
Mint 24 9
Oregano 14 3

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Parsley 99 18
Rosemary 28 1
Sage 8 1
Tarragon 9 4
Thyme 11 3
Taken from “Review of foodborne illness associated with selected ready-to eat fresh produce”,
December 2014, Food Safety Australia and New Zealand, (16), 13-38.

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Chapter 4: Methodology:
Research Aim:
The main aim of the study is to identify importance of knowledge, awareness of
consumers regarding fresh produce and practices linked to fresh produce in Australia. In the
literature review researcher has focused on consumers’ current level of food safety knowledge
and food handling practices associated with fresh produce, including pre-packaged fruits and
vegetables. This research has focused on Australian population and their current handling
practices with the aim to find the answers of two important questions.
 What is the current level of knowledge of people and what are the common food handling
practices among consumers in Australia in relation to fresh produce (including pre-
packaged fruits and vegetables)?
 Are there any gaps in consumer knowledge and food handling practices that causes risk
of food-borne illness (from the consumption of fruit and vegetables including pre-
packaged fruits and vegetables)?
The report will help in analysing gaps between consumer current knowledge and food
handling practices in Australia. This gap increases risk of food-borne illness and other
diseases. This study will be beneficial in identifying the perception of consumers and lacking
points in the food production system. By this way researcher will be able to give
recommendation in order to minimise these issues. Moreover, Dissertation will support in
making people aware with the importance of fresh food. Furthermore, it will be beneficial in
increasing knowledge of concern authorities for handling fresh fruits and vegetables safely prior
to their consumption.
Statement of Research Objectives of the research:
Specific Objective 1:
To identify gaps between current fresh production knowledge and awareness in
consumers’. It is envisaged that the research findings will help food safety authorities to improve
production system and to provide fresh food to consumers so that number of food-borne illness
can be minimised in Australia.

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Specific Objective 2:
To understand current practices of food produce in Australia, Reinvigorate the safety and
suggest strategies to mitigate current risk in order to minimise food borne illness.
Specific Objective 3:
To identify effectiveness of fresh produce food and setting a baseline knowledge of the
current attitude, fresh produce knowledge of Australian consumers’.
Specific Objective 4: Providing effective strategies in order to conduct research in future on
the topic associated with foodborne illness.
Specific Objective 5:
To provide an opportunity to consumers to take part in the survey, give their review and
analyze their current information with suitable information provided at the end of the survey.
Methods:
Ethics Application:
Ethical consideration is most essential part of the dissertation. As the study was based on
human behaviour thus, an ethical approval was required to conduct this research. It was non-
negligible low-risk application and the QUT Committee Office of Ethics in Human Research has
approved the ethics application on the 29th of May 2017, it is attached in appendix 4. Standard
procedures were applied in respect to disclosure, confidentiality, and storage of data collection.
As it is an anonymous survey, there was no personal information collected in the first survey.
The major data was collected in the second survey with the consent of people those who were
selected as participants for the investigation. During this process, there has been significant
supervisor assistance and further amendments were made on the bases of school research
supervisor's comments.
Type of Study/ Research design:
Research is the process of presenting the findings of the gathered information in line of
research aim. There are different type of research design which can be used by researcher for
the present study that is descriptive, exploratory and explanatory. The descriptive research design
is used to support the characteristics of population which are considered in the study. While

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explanatory design is used for identifying which are not discovered yet. On the other side
explanatory research design is help in exploring uncover issues which assist in getting valid
outcome related to aim and objectives. In present dissertation descriptive research design is used
in respect to reach the aim of study.
The present dissertation is qualitative type, Researcher has used online questionnaire
technique as Quantitative research design in order to collect data from Australian consumers.
Questions were related with the perception of consumers’ current knowledge, behaviour and
fresh produce handling practices. Any anonymous survey was utilized to reduce risk of bias of
highlighting consumers’ actual practices along with the aim to get maximum participation with
no disclosure of personal information for consumers to reflect their true and genuine selves.
Literature search strategy:
For literature review published articles and reports have been gathered from electronic
search databases which include, PubMed, EBSCO, Scopus, QUT library database, Google
scholar and some grey literature were systematically searched with the help of appropriate text
words and thesaurus terms to find evidence based research articles linked with fresh produce
awareness and handling practices in the past 20 years. It also included hand searches with
previously highlighted hand reference lists.
Inclusion criteria:
Including all the duplicates initial search from the electronic database engines returned
1109 hits that were first filtered per being evidence-based research, appropriateness by title
linked and associated outbreaks in relation to fresh produce awareness, knowledge and handling
practices. The review also excluded fresh produce outbreaks which have an association of meat
along with fresh produce or any outbreak linked with cooked produce. After the first filtration,
81 publications were remained left , remaining were examining and measured under the
inclusion criteria. It is mentioned below with only 12 articles to be included in the finalized
literature review. Mostly all the studies included in the literature review are published in the
journal articles except the one publication by Stevie Schrier regarding consumers’ knowledge of
fresh produce safety and the Food Safety Modernization Act in the USA that was relied upon a
self-administered online questionnaire.

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Study Quality:
Overall studies that were included in the research are cross-sectional studies conducted in
the past 20 years along with some systemic reviews and meta-analysis. Mostly all the studies
utilized a self-administered questionnaire in order to gather information regarding consumer’s
knowledge and awareness linked to fresh produce. Furthermore, few research studies used in this
dissertation are from overseas data mainly from Canada and United States. There is no
Australian data available that can highlight current level of knowledge, awareness, food handling
practices and behavioural approach of consumers linked to fresh produce. The aim of this
research is to highlight the perception of current knowledge of consumers in respect to fresh food
produce and food production practices of the Australian population.
Methods of review:
All the searched articles were reviewed by scholar through reading abstracts of the
studies to find any relevance with the inclusion criteria attached in Appendix 3.1. All the selected
articles have been read by the scholar along with their framework. Relevant methodology and
assessment to be included in the study.
Participants Overview:
Research study included participants those who are above 18 years age and currently
residing in Australia. Potential participants were invited to complete an anonymous 10-minute
online survey. To encourage participations, one $50 Coles vouchers will randomly draw and will
be given to the winner (the draw will be conducted in accordance with the guidelines attached).
After completing the anonymous survey, participants were also asked if they wish to
participate in the prize draw and if they would like to gain more information of fresh produce
safety. For food safety resources in case the survey questions have created interest in the topic
and they would like to learn more about the safe handling of fresh produce.
Consumers Survey, Research design, and Implementation:
With the aim of identifying and highlighting consumer's current behaviour, knowledge,
and food handling practices, an online survey was conducted which consisted of 38 multiple
choice questions with a separate option of other enlisted throughout the survey to highlight any
other practices followed by the Australian consumers. The survey used in this study was created
and distributed through Key survey software. The survey questions were based on publication

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Stevie Schrier regarding consumers’ knowledge of fresh produce safety and the Food Safety
Modernization Act in the United States of America (USA) in 2011. After the result of a large
foodborne outbreak linked to fresh produce in Iowa Ohio researcher found that 631 cases of
people were being infected with food illness along with 49 hospitalizations (CDC, 2013). This
highlighted poor knowledge and fresh produce handling of the consumers. Through this study
scholar has paid attention on knowledge and awareness of consumers in respect to fresh food
produce and has provided strategies to prevent population from these risks related to fresh
produce linked outbreaks and food illness.
The survey was modified to suit the Australian context, researcher has removed such
questions from the survey which were not relevant to Australia context. Furthermore, scholar has
modified some of the wording in order to make the survey more align with Australian literature
and understanding. Recent publications regarding fresh produce safety (particularly the New
South Wales Food Authority which is a leader in the field of food safety) informed the
development of additional questions regarding the handling and storage of fresh produce.
Furthermore, high-risk populations were also included in the questionnaire to make it more in
context with Australian literature and make the survey more valid. It was hard to justify
reliability of the questionnaire as participants were only advised to fill the survey once. However,
the question outlined are structured in different heading to highlight the consumers’ perception
and strictly based on consumed current behaviour and practice. By frequent survey testing it was
found out that results were quite similar as first time results, after re-participating in the study by
filling the same questionnaire twice. This highlighted that the questionnaire was quite reliable,
however, limited number of test surveys cannot justify reliability thus, and it will be conducted
on large number of a population group.
The survey was structured and divided into 5 sections so the participants can move
logically in these five sections. With 38 multiple choice questions with a separate answer option
researcher has highlighted the practices related to fresh food produce. These 5 sections cover
wide range of topics; perception of knowledge, behaviour, food safety-related knowledge and
practices of Australian consumers’ while utilizing fresh produce. The different section headings
and details reason of including these questions in the study are given below. The survey is
attached in Appendix 11.

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The first set of questions includes 2 questions in total that will help to determine if the
person meets the eligibility criteria in the research study or not. As this research is solely based
on Australian population and to highlight their current knowledge, perception and food handling
practices, researcher has allowed people to participate in the research. Detailed outline of the
inclusion criteria is attached per appendix 3.1.
Demographics and presence of high-risk groups in the house:
This section has included total number of 8 questions that reflected information regarding
consumers’ current demographics and their association with people at higher risk of food-borne
illness are in the households surveyed. These set of questions will highlight relation of foodborne
illness with the age group of the population, their current income, the level of qualification etc.
and does any of these factors have an association with the increasing foodborne illness. These
questions are also included in the questionnaire so the researcher can identify whether specific
groups need targeted education in relation to the safe handling of fresh produce or not. In
addition to that, their likelihood of risk associated has also been included in this section.
People responsible for buying fresh produce:
Next set of questions identified who is primarily responsible person for most of the
purchasing and food preparations in the house. It was important in the research that to identify if
poor knowledge and/or practices are associated with people who are primarily responsible for
food safety in the household, or if another person (who may have some knowledge and food
handling practices) is going to have a greater influence over food safety in the household. A total
of 3 questions were asked in this section to gain all the required information.
Consumer’s current food handling practices:
Questions regarding the sources of fresh produce, current food handling practices, food
safety knowledge and consumers’ perception of food safety risks that are associated with fresh
produce are included to gather data about existing comprehensions and practices. The researcher
will compare this data with known causes of food-borne illness and other information to
determine if there are common gaps in understandings or poor food handling practices which
should be addressed through targeted education.

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Consumer’s perception of food safety risks associated with fresh produce:
The next set of questions reflected consumers’ current perception and knowledge related
to fresh produce, and to highlight if the fresh produce has any potential chances of
contamination? Or if it is safe in regard to the current practices and behaviour.
Consumers’ current food safety knowledge:
A total of 9 questions were applied in this section to gather information on the
consumers’ awareness about current fresh produce along with their knowledge of microbes. It
was important to perceive microbiological related information from consumers’ as most of the
microbes are linked with different produce and are responsible for spreading diseases, having a
good knowledge and perception of different type of bacteria’s and their association with different
food can improve people food handling practices also knowing these factors can drastically
reduce the risk of food borne illness.
Food safety information for pregnant women:
The final few query were related to the advice given to pregnant women to reduce the
likelihood of Listeriosis (i.e. a food-borne illness which can cause miscarriage or birth defects).
These examination had been included to determine whether this information are provided to
pregnant women in Australia or not, it mostly includes advice about fresh produce, in particular
of pre-packaged salads and sources behind it. It was to see women getting benefited from this
provided information which can reduce their risk of likelihood of food borne illness.
Instrument:
An online anonymous questionnaire was employ to gather data. A specific questionnaire
was adapted from the US modernisation Act which was further modified in accordance with the
Australian context that will reflect consumers’ awareness and knowledge associated with fresh
produce handling practices. All the enquiry was unique and has been divided into 5 sections to
judge the level of knowledge related to fresh produce washing and bacteria associated to fresh
produce contamination.
Three (3) surveys will be applied in the research. The survey was also pre-tested prior to its
publish date to verify the completion time and to check if the participants found this quiz
sensible. The results of the pre-tests were not included in the final findings and discussion. The
questionnaire is attached as an Appendix 4.

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Setting and sample/ Data collection:
QUT Key survey software version 8.31 was put to create the online survey and was also
used to publish the collected information gather during survey.
Analysis:
The data from survey results were collected and was analysed using the SPSS (Statistical
Package for the Social Sciences) Statistics 20.0 (IBM SPSS Statistics 20.0) software.
Descriptive statistics were used during the data analysis. Cross-tabulation and Chi-square
were performed when looking for relationships among the qualitative variables. The significance
level was set at 5% (p < 0.05). The results were examined on the basis of total amount of
participation (descriptive analysis) and then they are further compared to the independent
variable to highlight any difference in knowledge or the perception highlighted through any of
the independent variables (p values less than 0.05 considered statistically significant).
Prize Draw:
The prize draw was conducted on the 30th of June. The winner was approached via email.
3 samples were randomly drawn out from survey 2 with the help of the SPSS software to reduce
the risk of bias. In case if the first winner did not respond in two days’ time the next random
sample will be picked as a default winner. The Voucher to the one lucky winner was sent by
Australia Post.
Risks associated with this project:
The identified potential risk included:
For participants:
- There were no risks beyond normal day-to-day living associated with consumers’
participation in this research study.
- Risk for the participants were quit low in this project, as researcher has used online
survey technique in order to collect information about the subject matter. Scholar has not
targeted any potentially vulnerable groups, i.e. no groups mentioned in the National
Statement are targeted. Investigator has randomly select the participants so that partiality
can be avoided.

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For researchers:
- It is the responsibility of the scholar to maintain the confidentiality during the
investigation. Researcher was having risk to access researcher’s personal mobile number by the
potential participants, it can produce a safety risk for the researcher. As, the principal researcher
did not have regular access to a landline phone number. The inclusion of mobile phone number
may create a safety risk for the principal researcher. As the survey was online, thus, scholar has
to make communication with respondents properly and at the same time individual is required to
protect data. Scholar has to include only email address so that person can protect data and can
maintain confidentiality.
How will the associated risk be minimized?
There are various ways through which risk of the project can be minimized. These are as
following:
For participants:
- Researcher has to maintain privacy and confidentiality as detailed in this application.
- Scholar should not highlight names of participants. All the collected information was
anonymous, not highlighting any potential names of the participants with highlighted
information.
- It was an online based anonymous survey so researcher needs to pay attention on
reducing the risk of transmitting any personal information of the participant.
- Names of the participants for the lucky draw were collected in a separate second survey
only if the participant wished to participate in the lucky draw, and were erased from the
system after random allotment of the prize to the one lucky winner.
- Only the research team had access to see the collected information so that confidentiality
can be maintain and data do not get leaked in the market.
- All the information was saved in QUT server and files are protected by password.
For researchers:
- Mobile number of the principal researcher was not included in this investigation in the
contact information, it was done to minimize the potential safety risk of the principal
researcher.
-

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Chapter 5: Results.
Results:
The survey was published online by using key survey software and links were distributed
all around the states and territories of Australia with the help of social media. A formal
application request was made to the Research and Ethics Team of QUT. The survey link was
distributed via email among all the QUT staff members to gather information about consumers’
knowledge, perception and food handling practices linked to fresh produce.
Table no.8: Demographic characteristics of respondent's group.
Characteristics n %
Age (n=433)
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65-74
- 75 or older
- Prefer not to say
256
103
39
20
11
2
1
1
58.12%
23.79%
9.01%
4.62%
2.54%
0.46%
0.23%
0.23%
Gender
- Male
- Female
- Other
- Prefer not to say
122
306
2
3
28.18%
70.67%
0.46%
0.69%
The Highest level of qualification completed
- Primary school
- High school
- Certificate or trade qualification (e.g. Tafe, diploma)
- Undergraduate university (e.g. Bachelor degree)
- Postgraduate university (e.g. Masters, PhD)
- Prefer not to say
1
160
49
141
77
5
0.23%
36.95%
11.32%
32.56%
17.78%
1.16%
Average house hold income
- Less than $500
- $500-$999
- $1,000-$1,499
- $1,500-$1,999
- $2,000-$2,499
- $2,500 or more
- Prefer not to say
90
87
63
45
33
49
66
20.79%
20.09%
14.55%
10.39%
7.62%
11.32%
15.24%

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State or territory currently residing in
- Australian Capital Territory
- New South Wales
- Northern Territory
- Queensland
- South Australia
- Tasmania
- Victoria
- Western Australia
- Prefer not to say
1
6
2
396
2
2
7
14
3
0.23%
1.39%
0.46%
91.46%
0.46%
0.46%
1.62%
3.23%
0.69%
The data showed that 433 people participated in the research, with a response rate of
74.9% with 337 among them also took part in the prize draw. However, 24 people did not meet
with eligibility criteria and were unable to participate in this survey. Gender disbursement of the
participants highlighted 70.67% which covers approximately ¾ of total participants. In this
investigation of the there were maximum females candidates and the remaining 28.18% being
male, with a minority marked as other and prefer not to say as showcased in table 8.
The majority of the participants were between the age group of 18-24 which is 59.12%.
Remaining major portion of participants are between the age group of 25-43 which is 23.79%
and the other 9.01% lies b/w 35-44 and 4.62% within the range of 45-54. Rest of the respondents
were below 3% from all the remaining age groups, with only one respondent from the age group
of 75 or older as highlighted in table 8.
This showcased that majority of participants are young adults with 36.95% having at least
a high school degree, 11.32% having a diploma or certification, and 32.56% of the participants
having an undergraduate degree. The remaining 17.78% had masters or post-doctoral degree and
they are educated and knowledgeable respondent group as clear in table 8. Assuming that
maximum participants are having high level of food safety awareness and knowledge in respect
to their level of qualification.
Consumers’ from all across Australia have participated in the research, maximum people
among those were currently living in Queensland with 91.34% (390 respondents) followed by

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Western Australia and Victoria with 3.28% (14 respondents) and 1.64% (7 respondents)
respectively, with approx. 1.4% participation from SA with 1.43% 6 participants with under 1%
participation from Tasmania, Northern Territory, South Australia, and NSW (Less than 4
respondents each). With (20.79%) have a household income less than $500 with very similar
(20.09%) respondents have income b/w $500-$900. 63 respondents (14.55%) marked it b/w
$1000-$1999 with 10.39% have an income between $1500-1999. Interestingly (15.24%) 63
participants preferred not to say as clearly highlighted in table 8.
As highlighted from the survey 83.61% respondents did not have any household member
with the ongoing underline medical condition, with only 14.05% that includes the remaining big
portion marked age group 18-65 having a current medical condition showcasing younger
population group are at a increase risk of a chronic condition and medical illness. However, the
majority of the participants were belonging from young adult group that does not justify a
legitimate current Australian data. Also, small group of high-risk population was identified
through survey, in this survey 10.07% people for house hold members were above 65 years and
8.43% for house members below the age of 5 years.
It was showcased that primary grocery shoppers were approximately equally divided
among the housing member, self, and partners etc. with the same results highlighted for the food
preparation and cooking procedures to be divided in the house with 37.65% Self 36.94% shared
equally and 24.71 another adult.
Table 9: Summary of the food handling practices highlighted by the survey.
Behavioural practices n %
Do you clean and dry your hands before consuming fresh
produce? (select all that apply)
- No
- I wash my hands with water
- I wash my hands with soap and warm water
- I use hand sanitizer
- I use a towel or t-towel to dry my hands
- I wipe my hands on my clothing to dry them
- I use paper towel to dry my hands
- Other (please specify) ……………….
90
143
216
30
163
52
44
8
20.76%
33.03%
49.89%
6.93%
37.64%
12.01%
10.16%
1.85%
Do you clean food preparation surfaces (e.g. cutting boards)

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before preparing fresh produce?
- No
- I use cutting boards/plates and utensils which have already
been cleaned
- I clean cutting boards/plates and utensils immediately before
use
- I clean cuttings boards/plates and utensils with water
- I clean cuttings boards/plates and utensils with warm water
and detergent
- I clean cutting boards/plates and utensils in the dishwasher
- Other (please specify) ……………….
21
360
41
31
116
87
4
4.87%
83.53%
9.51%
7.19%
26.91%
20.19%
0.93%
Do you clean kitchen benches before preparing fresh produce?
- No
- I use benches which have already been cleaned
- I clean the bench immediately before use
- I clean the bench with a damp cloth
- I clean the bench with an anti-bacterial wipe
- I clean the bench with an anti-bacterial spray
- Other (please specify) ……………….
65
268
80
99
19
49
7
15.08%
62.18%
18.56%
22.97%
4.41%
11.37%
1.625
Do you clean fresh produce before consuming it?
- Never
- Only if it looks dirty
- Most of the time
- Always
- Other (please specify) ……………….
9
102
167
153
2
2.08%
23.56%
38.34%
35.34%
0.46%
How do clean fresh produce before consumption? (select all that
apply)
- Rinse under running water
- Wash under running water while rubbing the surface
- Rinse in a container of cold water
- Soak the produce in water which contains a product designed
to kill bacteria
- Use a damp cloth to wipe the outer surface
- Use paper towel to wipe the outer surface
- Use a brush to scrub the skin of hard vegetables (e.g.
potatoes)
- Use a brush to scrub the skin of fruit with rough surfaces (e.g.
rockmelon)
- Wipe the dry product (e.g. rubbing an apple against clothing)
- Other (please specify) ……………….
232
317
53
21
12
28
65
11
54
5
54.85%
74.94%
12.53%
4.97%
2.84%
6.62%
15.37%
2.6%
12.77%
1.18%

P a g e | 64
As showcased in table 10. That 21.08% respondents do need clean and dry their hands
prior consuming fresh produce, on other hand 33.26% candidates wash their hands only under
running water. However, 49.65% of the respondents wash their hand with warm water and soap
among which 37.47% use a towel or towel for drying their hands and reflecting good practices.
Whereas, 13.33% that dry their hands with their own clothes and 10.37 using a paper towel. This
highlights that a major participant do not clean their hands and dry them afterward adequately.
51% of the respondents were unaware with the importance of hand hygiene that highlights a
serious concern for consumers’ utilizing fresh produce.
81.92% of the respondents use preparation surfaces which was already cleaned, 11.08%
population clean their surfaces just before use. On the other hand, 18.37% participants are here
those who clean kitchen benches just before use and 59.48% respondents use kitchen benches
that have already been cleaned varying with cleaning behaviour with 23.32% utilizing just a
damp cloth with no use of any soap or antimicrobial agent with 16.75% of the participants use
either an antibacterial spray or bacterial wipe to clean the surfaces. However, 16.33% do not
practice to clean preparation surfaces on a regular basis.
It was quite surprising to know that only 35.34% of population group per survey always
wash their fresh produce prior consumption with 38.57 recognizing that they wash their produce
most of the time. Also, 23.56% of the respondents marked they only clean it if it looks dirty and
2.32%, marked never. However, the major highlight of the survey was that 54.85% of the
consumers to wash their produce just under the running water and did not associate any rubbing
or other procedure to clean the outer surface of the produce. 74.94% respondents sometimes
wash produce under running while rubbing the surface highlighting they don’t always follow this
practice. 15.37% use a brush to scrub skin of the fruits with a rough surface and, 12.77% also
utilized their clothing to dry their produce.
As highlighted from the survey 88.08% respondents store pre-packed fruits and
vegetables in the refrigerator. Remaining 4.14% left it on the bench top (room temperature).
7.77% people marked other and mentioned, Vegetables go in the fridge and fruits on the bench,
depends on the type of produce, depending on the quantity, follow both, don’t buy them at all,
fruit such as bananas/apples/mandarins on the bench, vegetables in the fridge.

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Surprisingly, respondents showcased good knowledge with the majority of replies that
refrigerate Berries (83.83%), tomatoes (84.76%), spinach (89.84%), lettuce (93.76%) Cut
vegetables (90.76%), cut fruits (89.61%). Along with Apples and Stone fruits e.g. peaches with
53.12% and 54.04%. Interestingly some respondents also marked to refrigerate bananas (16.4%),
potatoes (22.86%), onions (27.71%) that do not need to be refrigerated.
As clearly evident in graph 2, the majority of respondents 93.53% determine the
disposing of produce by appearance. Other major groups of respondents mostly relied upon the
smell (74.37%) and when produce start getting mouldy (71.36%). However, 10.86% said after
one week and 6.01% said after one month. This highlights that the consumers are not constant
with their practices.
93.53
74.37
71.36
10.86 6.01 1.16
Disposing behaviour for fresh produce
Apperance Smell Start going mouldy
One week One month Other
Graph 1: Disposing behaviour of fresh produce as highlighted in the survey.
Similarly, 57.51% respondents said organic fresh produce is safer and 42.49% said it is
not safe. With majority answered yes with the perception of being more natural and less or no
chemical used 83.65% with 12.32% said yes on how it is grown. Subsequently, the majority said

P a g e | 66
no (73%) use of chemicals, pesticides. With other mentioned pesticides vs shelf life, the process
of production. Interestingly some also said, they don’t know difference or they don’t care and
some mentioned that both organic and inorganic are dangerous and good on how you use it with
only 3%.
Table no. 10: Summary results of Consumers’ perception of food safety risk associated with
fresh produce as highlighted through the survey results.
Knowledge/perception linked with fresh produce associated
risks
n %
At what stages do believe contamination of fresh produce can
occur? (select all that apply)
- While growing in fields, orchards, etc.
- During harvesting
- During processing/packaging
- During distribution (e.g. transporting to retailers)
- In markets
- In food businesses (e.g. supermarkets, restaurants, cafes)
- In homes
- None of the above
- Other (please specify) ……………….
329
296
358
334
313
326
291
6
11
75.98%
68.36%
82.68%
77.14%
72.29%
75.29%
67.21%
1.39%
2.54%
How do you believe fresh produce can be contaminated? (select all
that apply)
- Soil
- Irrigation systems
- Contaminated / unclean surfaces
- People (e.g. food handlers, customers)
- I do not believe that fresh produce can be contaminated
- Other (please specify) ……………….
293
308
367
378
6
15
67.67%
71.13%
84.76%
87.3%
1.39%
3.46%
Table 11 clearly outlines the survey responses linked with consumers’ perception on risk
factors. This shows majority participant had good knowledge, with an average above 70%
believed fresh produce can be contaminated through all given activities. Similar results were
highlighted among respondents with an average of 70% marked all factors associated with its
contamination, with only 1.39% believed that fresh produce can be contaminated. This
Highlights good knowledge among participants as showcased in table 11.
The survey concluded poor knowledge of microbes among the population group with
30.02% (130 respondents) had no knowledge which microbes are linked to contamination of

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fresh produce. With majority marked Salmonella and E. coli with 63.51% and 61.43%
respectively. 40.10% thought Hepatitis A followed by Listeria with 28.415 among the
respondents. However, only a fewer % of the population think Clostridium perfringens and
Staphylococcus aureus also have a link with 19.63% and 23.01% respectively as showcased in
graph 1.
E.coli
22%
Salmonella
23%
Hep A
14%
Listeria
14%
Clostridium
7%
Don’t know
11%
Step. Aureus
8%
Knowledge of pathogens linked with fersh
produce contamination.
E.coli Salmonella Hep A Listeria Clostridium Don’t know Step. Aureus
Graph 2: Knowledge of pathogens linked with fresh produce contamination.
However, on rating their knowledge on microbe separately, only 47.34% knew a little
about Hepatitis A, 40.42% respondents have only heard of Hep A. With E. coli 42.49% knew
little and 37.41% have just heard about it. The best response was noted with Salmonella that
60.28% knew a little and 14.32 you have heard of it. Interestingly, people were least aware of
Listeria with 48.96% who have never heard of Listeria with only 23.79 % who had heard of it
previously. A complete overview of the results is summarized in table no.9. It was highlighted
that only 7.39% knew a lot about Hep A and only 5.08% knew a lot about Listeria with the rates

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being even less than 10%. On the other hand, 12.47% knew a lot about E. coli and 19.63% with
Salmonella. This highlights poor microbial knowledge among consumers. Moreover, it identifies
that respondents were not confident about their knowledge linked to pathogens when asked.
Table no.11: Knowledge of pathogens (Bacteria and viruses) among consumers’ showcased in
the survey.
Pathogen n %
How do you rate your knowledge of e. coli?
- I know everything
- I know a lot
- I know a little
- I have heard of e. coli
- I have never heard of e. coli
3
54
184
162
30
0.69%
12.47%
42.49%
37.41%
6.93%
How do you rate your knowledge of Hepatitis A?
- I know everything
- I know a lot
- I know a little
- I have heard of Hepatitis A
- I have never heard of Hepatitis A
6
32
205
175
15
1.39%
7.39%
47.34%
40.42%
3.46%
How do you rate your knowledge of Listeria
monocytogenes/Listeriosis?
- I know everything
- I know a lot
- I know a little
- I have heard of Listeria monocytogenes or Listeriosis
- I have never heard of Listeria monocytogenes or Listeriosis
8
85
261
62
17
1.85%
19.63%
60.28%
14.32%
3.93%
How do you rate your knowledge of Salmonella?
- I know everything
- I know a lot
- I know a little
- I have heard of Salmonella
- I have never heard of Salmonella
8
85
261
62
17
1.85%
19.63%
60.28%
14.32%
3.93%

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The survey results that only 18.65% among the female group had previous pregnancies
and only 2 respondents (0.68%) were currently pregnant. With 57.14% among the total 19.33%
marked doctors etc. where they receive information regarding Listeria. 15.71% said family
members, 24.29% from government agencies with similar 24.29% highlighted none (from
nowhere).
Moreover, Majority marked pre-packed sliced of fruits (fruit salads) and pre packed
salads as among the high-risk food during pregnancy food with 65.15% and 66.67% respectively.
Followed by Frozen fruits, sprouts and frozen vegetables used raw with 45.46%, 42.42%, and
39.39%. Surprisingly frozen vegetables and frozen fruits who were used after been cooked were
also highlighted as high-risk food by 9.09% and 10.61% respondents.

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Chapter 6: Discussion:
Foodborne illness has caused approximately 120 deaths annually in Australia with an
estimation of sickness linked to food-borne illness, it is as high as 1 in 10 people. The recent
rockmelon outbreak with 92 people hospitalised and 2 deaths recorded in Australia, highlighted
that many population groups are still unaware of how to handle fresh-produce safely. Moreover
it showed that people are less concerned about the bacteria that are residing on the surface and
have limited knowledge related to fresh produce
To sum up, it was the first study conducted in Australian population that was based on
the consumers’ knowledge, awareness and food handling practices linked with fresh produce
using models and theory. Here, Health Belief Model and Theory of Planned Behaviour was
applied for better understanding. Through the study it was found that attitude toward actions and
self-efficacy were significant indicators of safe food handling behaviours. From the survey
results, it is quite clear that even the highly educated population group living in the most
developed areas of Australia are not aware of food safety as well as fresh produce handling
practices. Moreover, associated problem was more with knowledgeable people reflecting in-
adequate fresh produce handling and washing practices. Beside this, poor microbial knowledge
was also identified among the majority of the respondents. Another notable finding was that a
higher score in food safety knowledge did not lead to more positive safe food handling
techniques. The survey clearly indicates that results was not consistent throughout this report and
highlighted in several other previous studies investigating different behaviours. However,
previous studies highlights this evidence and knowledge as key indicator in improving
behavioural changes.
Washing fruits and vegetables through oxidation process prior to consumption may
reduce the level of attached pathogens, pesticides, and soil residues etc. Along with this, there
are other methods of fresh produce contamination discussed in table no. 7 that impose risks
toward consumers. As most fresh produce, including pre-packed fruits, vegetables, and fresh
herbs are consumed raw and are not associated with any killing step. The CDC recommends
using clean hands when handling fresh produce (Ramachandran & et. al. 2017). For this, hands
should be washed for at least 20 seconds with soap and warm water. Furthermore, washing of all
the pre-packaged produce thoroughly that do not indicate that they have been washed on the

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packaging, must be washed under running water by scrubbing (for firm-skinned produce) or
rubbing (for delicate-skinned produce) prior to consumption (Thompson & et. al. 2017). There
are cases that during the time of storage due to insect, rats and other small animals excretion
bacterial activities may increase. However, the survey results also showed only 22.19% people
wash their hands before handling fresh produce, and 35.45% wash their hands only with water,
highlighting that only 47.55% of the respondents wash their hands with warm water and soap as
suggested by the CDC. It clearly indicates that half of the respondents are unaware about the
food-borne diseases and they do not consider CDC suggestion important.
The major risks were highlighted with fresh produce washing practices summarised in
table 10 with only 35.34% of the population that always wash produce, and 2.6% (11
respondents) among those who clean their produce by scrubbing the skin of hard fruits like
rockmelon, prior consumption. While the majority of the population group were unaware of
washing produce effectively. This evidenced that more than 50% of respondents are at higher
risk of fresh produce contamination. There have been three major rockmelon outbreaks, one in
the US in 2011 with 28 registered deaths and two in Australia, with one in 2006 along with the
most recent outbreak with 2 registered deaths, that were linked with poor washing practices.
(FSANZ, 2016, O'Brien & et. al., 2016). Similarly, only 25.51% of respondents had lacked
adequate knowledge to use hot water and detergent to clean the cutting board and plates. The
number is reasonably low and poses high significant risk.
The online survey reveals that answers from all 5 different sections shows inadequate
fresh produce, bacterial knowledge, awareness, poor hand washing and produce washing habits
prior to consumption. There was a severe lack of knowledge of bacteria identified among all the
participants as reflected in table no.9 and graph no.1. Poor results showcased that with less than
8% of people knowing a lot about Hepatitis A and Listeria with 12.47% for E. coli and 19.63%
for Salmonella. The best response identified was with Salmonella with 60.28% knowing a little
bit and the worst outcome was with listeria, where 48.96% respondents had never heard of
bacteria previously. With improved knowledge seen mostly in post graduate and Ph.D.
respondents. Similarly, results were identified in the consumers' awareness survey in the US,
identifying poor knowledge of pathogens among consumers' that supports the results of the
current research report (Shamsi, 2016, Moffatt, & et. al., 2016).

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One of the important points highlighted through the findings of the survey and previous
studies is that knowledge and education plays an important role in improving food safety
practices and hence, reducing the risk of getting foodborne illnesses. Interestingly, at the same
time, having adequate knowledge about bacteria and fresh produce handling does not always
show a significant effect on consumers displaying good practices as seen through previous
research (Moffatt & et. al., 2016, Milazzo, & et. al., 2016). As highlighted in this survey, more
than 54% of the population have at least a diploma, undergraduate or higher qualification with
the remaining 45% having a high school qualification representing an educated population group
with a majority living in the developed areas of Australia. This discrepancy is also found by
some other researchers in their previous studies as detailed in the literature review. However,
current results support education being a strong variable with good microbial knowledge. This is
also noted among the participants with post graduate qualification compared with participants
having an undergraduate and high school degree.
Earlier research also suggests that education and knowledge may be important and
necessary but at the same time is not sufficient for food related behavioural change (Lajhar,
Brownlie & Barlow, 2017, Milazzo, & et al., 2017). A recent intervention done in Australian
university students samples also supported knowledge to be unsuccessful in improving food
hygiene. Although a minor knowledge improvement was found during the study (Moffatt & et.
al., 2017). Beside this, a previous systemic review on interventions based on food hygiene
highlighted behaviour as modifiable. At the same time, it is not sufficient to support the evidence
as the study quality was poor and relied upon self-reported changes (Glass & et. al. 2016,
Milazzo & et. al. 2017). Previous data signifies that self-reported data are not very reliable, and
does not reflect consumers' actual practices (Hald & et. al., 2016, Kurtböke & Bowater, 2016).
Survey results highlighted that respondents had good general understanding and
knowledge of fresh produce and handling behaviour in certain areas. However, they were lacking
in-depth knowledge on how to handle fresh produce safely to that precautions can be taken as
early as possible. However, poor hand washing habits were identified with the minority of the
population, drying hands appropriately prior to consuming fresh produce. Additionally, only a
minor group with 35.65% of the respondents reported washing fresh produce always,
highlighting poor fresh produce linked knowledge prior consumption. This also identifies that

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approximately three-quarters of the respondent group were at an increased risk of food borne
contamination with not employing fresh produce washing practice.
The majority of participants in the survey were female with 70.67% and were linked with
most of the buying and preparation of fresh produce in the household with better food safety and
microbial linked knowledge compared to men. However, it would be hard to analyse any relation
among both the genders and justify the knowledge gap, as only 28.18 % of the respondents were
male. In addition to this, previous studies suggest better knowledge linked with food safety in
female (Gibney & et. al., 2017, Kirk & et. al., 2017). Moreover, poor knowledge and handling
practices linked to that were identified in both the genders.
Education is major highlight in previous studies showcasing positive and reasonably
significant correlation with food safety knowledge and practices. However, the current study
includes participants that belongs to developed areas of Australia with a higher ratio of educated
respondents. A wider participation from all areas of the country from all age groups and
education levels could have given a wider perception and link of fresh produce linked knowledge
with education. Still, with the current survey results, good fresh produce and microbial
knowledge are identified in postgraduate students, showcasing a positive relation.
Participants age has not shown a strong correlation with the food safety knowledge in the
current study as most of the participants are among the younger population group with 59.12%.
A wide variation has been seen in the food safety knowledge among all the age groups.
However, previous literature suggests poor knowledge among the younger population group
compared with the old age group. This is hard to analyse in the current study with the majority of
participants from young adults with less than 10% participation among people above 45 years of
age.
Interestingly, the income groups in the current study were nicely divided among 6
provided option groups, with the majority living in developed areas of Australia and did not
show any association with food safety knowledge or washing practices. However, previous
studies have identified low-income groups to be associated with poor food safety knowledge and
consumers to be less concerned about the food safety labels or cleanliness along with their
associated risks, and more concerned about the price (Boxman & et. al., 2016, Devi & et. al.
2016, Ford & et. al., 2016, Coutts & et. al., 2017). This is not identified in the current study as

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most of the participants are educated and living in developed areas of Australia. On comparing
the results of the referenced study that was done in very low-income population groups living in
under developed areas of Philippines . So, it would be really biased to compare the results of
both studies as there is a big gap between the educational background and income level of
participants in the current study.
There are several issues highlighted that weaken the strength of the research study.
Firstly, the sample size is relatively small and has less participation ratio from all states of
Australia. The majority of respondents are from Queensland with 91.34% with higher
participation under the age group of 18-24 with 59.49% and having at least an undergraduate
degree with mostly living in the developed areas of Australia. Thus, this highlights participant
group not being representative enough, not giving an overall perspective of a general Australian
population. Secondly, a questionnaire was distributed online which was convenient but did not
get enough participation and may have perceived with the less formal participation of the
consumers that may be leading to inaccurate answers (not highlighting their actual followed
practices). Out of 564 participations, only 427 completed the survey, with the completion rate of
74.8%.
The overall results from the survey highlight lack of knowledge of pathogens (bacteria,
viruses, and parasites) and awareness of fresh produce among young population group along
with the minority group of old age respondents participating in the research. However, with the
sample size being small it is hard to justify the results with the entire Australian population
context. Moreover, to better understand consumers’ current level of awareness and fresh produce
handling practices a larger scale study with the more representative sample is required.

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Chapter 7: Conclusion and future recommendation:
While the sample size in the current research was reasonably small with more
participation from the younger population group and the majority of all the respondents residing
in Queensland. However, the results from the current study provide a general insight of the
Australian consumers’ current level of knowledge and awareness linked with fresh produce
handling practices. From the finding it can be clearly identified that consumers have good
knowledge in certain areas but lack specific knowledge on fresh produce linked with food borne
illness and bacteria. Moreover, respondent’s knowledge was very low related to the bacteria and
their types. Additionally, they were unaware about the diseases that person can gain from such
bacteria’s.
Further, it is concluded that there are many people who do not have knowledge related to
bacteria, viruses and parasites. Due to this reason, they suffer from illness. People eat food
without washing their hand as because of lack of knowledge this lead to give chances of increase
in illness. Along with this consumer play significant role in mitigating the growing burden of
food-borne outbreaks. Therefore, it is important to raise awareness of microbial hazards linked
with fresh produce without causing microbial hazard which is linked with the fresh fruits and
vegetables in generally involved leafy vegetables. It is important to have knowledge related to
handling fresh produce food so that chances of getting ill can be reduced.
To help consumers in increasing their awareness linked to fresh produce and to increase
their knowledge in food safety practices and behavioural approaches, more research is required
in this area. Appropriate, research methods must be used so that more customers can take part in
such dissertation. This will allow study results to provide effective education to the consumers
group. Although the current review showcased that these foods safety interventions are
somewhat effective with bringing in food safety changes in awareness, knowledge, and attitudes
of consumers supported by many past studies discussed previously in the review. However, some
past research shows only partial improvement in post interventions. This highlights the need for
further research in this area with broad participation among all demographics across Australia to
get a better understanding. Secondly, Randomized Controlled Trials are the best type of studies
to analyse and highlight consumers’ behaviour practices as ten of the twelve included studies in

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the literature, and, the current research relies on self-reported data. This associate a self-reported
bias not justifying the results and may not be highlighting actual behavioural practices.
From the discussion chapter, it is concluded that washing fruits and vegetables before
consuming them assist in minimising the level of attached pathogens and soil residues. There are
many young generation people who do not wash their hands and does not take care of bacterial
problem before consuming foods. Along with this it is also identified that people who have
knowledge regarding spreading bacteria but they not take it seriously.
With the recent rock-melon outbreak resulting in 2 deaths and 86 people hospitalised
around Australia, it is quite clear that consumers are willing to learn about correct fresh produce
handling practices. The results of this study can help future researchers and environmental health
officials to make better educational programs helping Australian consumers by providing them
with a better understanding of how to handle fresh produce safely.
To conclude the review by information collected thorough the report along with various
studies included from the past that consumers around the world are at an increased risk of
foodborne illnesses. With recorded poor fresh produce handling knowledge, behavioral in
competencies and poor perception of handling fresh produce. The survey results from Australian
respondents and studied included in the literature review highlighted that much work needed to
be done to increase awareness by utilizing educational programs for general public increasing
their fresh produce linked knowledge, awareness, and behavioural practices.
To sum up the recommendations future study should utilize a randomized
controlled trial study design to get the actual perception of awareness and fresh produce linked
safety practices in consumers. Moreover, with a sufficient sample size that would be considered
as more of a representative group for the population unit getting a wide participation from all
demographics. This should also include pre-and post-evaluation of the participant group with six
monthly recalls gathering the current level of perception with any recorded change to reduce the
risk of reporting bias. More modification must be made in the food production and processing so
that pathogenic bacteria cannot enter the food cycle.
Secondly, fresh produce and microbial knowledge linked educational seminars must be
provided to the general public on regular basis, highlighting the risks associated with it and ways

P a g e | 77
to counter those risks. As still, a major population is lacking basic fresh produce linked
information. With major emphasis, should be made on the vulnerable population especially the
pregnant ladies that with still a major portion among them don’t get listeria linked information.
There are various other areas, sources and transmission which can be controlled through
awareness and other practices. Moreover, food-borne chemicals, pathogens and toxin are the
areas where further research can be carried out. These are the areas where importance is given to
the public health. Carrying out epidemiological, food and laboratory investigation of food-borne
diseases can help in getting more detailed results related to the topic and study.
A final recommendation is made to use info graphic posters in different areas of the super-
markets, farmer’s markets and local stores, and place them in areas which are easily sighted by
consumers. Providing information there can help the participants to understand the concept and
guidelines more clearly. Such activities will allow customers to get some quick suggestion prior
buying their fresh produce. Moreover, awareness as well as fresh produce handling practices
posters and charts can be used so that they can get aware about how to use their fresh produce.
An Infogram is developed shown in figure 5, targeting some of the important areas that are
lacking among the consumers as identified through the survey results and supported by the
previous literature. This highlight basic practices that must be followed by consumers as shown
in figure 5. These quick tips will highlight some of the most common practices that a consumer
must follow to reduce their risk of getting a food borne illness and also encourage consumers to
learn more.

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Figure 5: Infogram displaying Quick tips for consumers’ prior buying their fresh produce.

P a g e | 79
The above info graph shows that to avoid foodborne illness it is important for people to wash
vegetables before preparing it. Along with this it is essential to choose fruits and vegetables
which are free of bruise spots. Further, for cutting the fresh fruits it is important to wash knife so
that bacteria can be removed and lead to create any illness after eating food.

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References
Ababio, P. F., & Lovatt, P. (2015). A review on food safety and food hygiene studies in
Ghana. Food Control. 47. 92-97.
Abrahams, M. & et.al., (2017). Factors determining the integration of nutritional genomics into
clinical practice by registered dietitians. Trends in Food Science & Technology.59. 139-
147.
Akomolafe, O. M., & Awe, T. V. (2017). Microbial contamination and polyethylene packaging
of some fruits and vegetables retailed at Akure and Ado Ekiti, South Western
Nigeria. Journal of Stored Products and Postharvest Research. 8(6). 65-72.
Alimi, B. A. (2016). Risk factors in street food practices in developing countries: A review. Food
Science and Human Wellness. 5(3). 141-148.
Artes, F., & Allende, A. (2014). Minimal processing of fresh fruit, vegetables, and
juices. Food. 4. 121-128.
Aschemann-Witzel, J. & et.al., (2017). Key characteristics and success factors of supply chain
initiatives tackling consumer-related food waste–A multiple case study. Journal of
Cleaner Production.155. 33-45.
Aschemann-Witzel, J., de Hooge, I., & Oostindjer, M. (2015). Consumer-related food waste:
causes and potential for action. Sustainability. 7(6). 6457-6477.
Azevedo, I., Albano, H., & Teixeira, P. (2014). Food safety in the domestic environment. Food
Control. 37. 272-276.
Beske, P., Land, A., & Seuring, S. (2014). Sustainable supply chain management practices and
dynamic capabilities in the food industry: A critical analysis of the
literature. International Journal of Production Economics. 152. 131-143.
Bornkessel, S., Bröring, S., & van Trijp, H. (2014). What determines ingredient awareness of
consumers? A study on ten functional food ingredients. Food Quality and Preference. 32.
330-339.
Boxman, I. L., & et. al. (2016). International linkage of two food-borne hepatitis A clusters
through traceback of mussels, the Netherlands, 2012. Eurosurveillance. 21(3).
Buil, I., Martínez, E., & de Chernatony, L. (2013). The influence of brand equity on consumer
responses. Journal of consumer marketing. 30(1). 62-74.
Cates, S. C., Kosa, K. M., & Fraser, A. (2015). Consumer education needed on norovirus
prevention and control: findings from a nationally representative survey of US
adults. Journal of food protection. 78(3). 484-490.

P a g e | 81
Chapman, D. D., & Sellheim, D. O. (2017). Assessment of Teaching and Learning Activities in
Pediatric Physical Therapy: Factors Influencing Knowledge Development and
Confidence. Journal of Physical Therapy Education. 31(2). 108.
Chousalkar, K. K. & et.al., (2017). Salmonella Typhimurium in the Australian egg industry:
multidisciplinary approach to addressing the public health challenge and future
directions. Critical reviews in food science and nutrition.57(12). 2706-2711.
Coutts, S. P., & et. al. (2017). An outbreak of foodborne norovirus gastroenteritis linked to a
restaurant in Melbourne, Australia, 2014. Western Pacific surveillance and response
journal: WPSAR. 8(2). 12.
Cox, D. N., & Poelman, A. A. (2015). Towards greater vegetable consumption: Change the
product or change the person? Case studies of two vegetable commodities. Food
Research International. 69. 348-356.
Crowe, R. & et.al., (2017). Culture and healthy lifestyles: a qualitative exploration of the role of
food and physical activity in three urban Australian Indigenous communities. Australian
and New Zealand Journal of Public Health.
De Roos, B., Binacchi, F., & Sneddon, A. A. (2017). Differences in expenditure and amounts of
fresh foods, fruits and vegetables, and fish purchased in urban and rural Scotland. Public
health nutrition. 20(3). 524-533.
Delbeke, S., Ceuppens, S., Jacxsens, L., & Uyttendaele, M. (2015). Microbiological analysis of
pre-packed sweet basil (Ocimum basilicum) and coriander (Coriandrum sativum) leaves
for the presence of Salmonella spp. and Shiga toxin-producing E. coli. International
journal of food microbiology. 208. 11-18.
Dermesonluoglu, E., Fileri, K., & Taoukis, P. (2016). Modelling the microbial spoilage and
quality decay of pre-packed dandelion leaves as a function of temperature. Journal of
Food Engineering. 184. 21-30.
Devi, A. & et. al. (2016). Prevalence of Campylobacter spp. in diarrhoea samples from patients
in New South Wales, Australia. International Microbiology. 19(1). 33-37.
Erickson, M. C., Liao, J., Cannon, J. L., & Ortega, Y. R. (2015). Contamination of knives and
graters by bacterial foodborne pathogens during slicing and grating of produce. Food
microbiology, 52, 138-145. Retrieved from:
http://ac.els-cdn.com/S0740002015001306/1-s2.0-S0740002015001306-main.pdf?
_tid=43b21c84-6d27-11e7-91aa-
00000aab0f02&acdnat=1500540286_38a9d0ca0171f073b08149f6ecaf753f
Evans, E. W., & Redmond, E. C. (2016). Older Adult Consumer Knowledge, Attitudes, and Self-
Reported Storage Practices of Ready-to-Eat Food Products and Risks Associated with
Listeriosis. Journal of food protection.79(2). 263-272.

P a g e | 82
Farr‐Wharton, G., Foth, M., & Choi, J. H. J. (2014). Identifying factors that promote consumer
behaviours causing expired domestic food waste. Journal of Consumer Behaviour. 13(6).
393-402.
Feldmann, C., & Hamm, U. (2015). Consumers’ perceptions and preferences for local food: A
review. Food Quality and Preference. 40. 152-164.
Ferguson, M., O'dea, K., & Brimblecombe, J. (2017). Food and beverage price discounts to
improve health in remote Aboriginal communities: mixed method evaluation of a natural
experiment. Australian and New Zealand journal of public health. 41(1). 32-37.
Ford, L. & et. al. (2016). Increasing Incidence of Salmonella in Australia, 2000-2013. PloS one.
11(10). e0163989.
Friis, R., Skov, L. R., & Perez-Cueto, F. J. (2017). Comparison of three nudge interventions
(priming, default option, and perceived variety) to promote vegetable consumption in a
self-service buffet setting. PLoS One. 12(5). e0176028.
Garayoa, R. & et.al., (2017). Essential tools for food safety surveillance in catering services: On-
site inspections and control of high risk cross-contamination surfaces. Food Control.75.
48-54.
Gibney, K. B., & et. al. (2017). [PDF] Burden of Disease Attributed to Waterborne Transmission
of Selected Enteric Pathogens, Australia, 2010. Available through:
<http://www.ajtmh.org/content/journals/10.4269/ajtmh.16-0907>. [Accessed on 5
September 2017]
Glass, K. & et.al. (2016). Bayesian source attribution of salmonellosis in South Australia. Risk
Analysis. 36(3). 561-570.
Gong, S., Wang, X., Yang, Y., & Bai, L. (2016). Knowledge of food safety and handling in
households: A survey of food handlers in Mainland China. Food control. 64. 45-53.
Griffith, C. J. & et.al., (2017). The food safety culture in a large South African food service
complex: Perspectives on a case study. British Food Journal.119(4). 729-743.
Hald, T. & et. al. (2016). World Health Organization estimates of the relative contributions of
food to the burden of disease due to selected foodborne hazards: a structured expert
elicitation. PLoS One. 11(1). e0145839.
Hassan, H. F., & Dimassi, H. (2014). Food safety and handling knowledge and practices of
Lebanese university students. Food Control. 40. 127-133.
Kaptan, G., Fischer, A. R., & Frewer, L. J. (2017). Extrapolating understanding of food risk
perceptions to emerging food safety cases. Journal of Risk Research, 1-23.
Kirk, M. D. & et.al., (2017). Diarrhoeal disease in children due to contaminated food. Bulletin of
the World Health Organization. 95(3). 233.

P a g e | 83
Kirk, M. D., Angulo, F. J., Havelaar, A. H., & Black, R. E. (2017). Diarrhoeal disease in children
due to contaminated food. Bulletin of the World Health Organization. 95(3). 233.
Kurtböke, İ., & Bowater, L. (2016). Microbial diseases of travel. Microbiology Australia. 37(4).
157-158.
Lajhar, S. A., Brownlie, J., & Barlow, R. (2017). Survival capabilities of Escherichia coli O26
isolated from cattle and clinical sources in Australia to disinfectants, acids and
antimicrobials. BMC microbiology. 17(1). 47.
Langiano, E., Ferrara, M., Lanni, L., Viscardi, V., Abbatecola, A. M., & De Vito, E. (2012).
Food safety at home: knowledge and practices of consumers. Journal of Public Health,
20(1), 47-57. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/22347771
Liu, S., & Kilonzo-Nthenge, A. (2017). Prevalence of Multidrug-Resistant Bacteria from US-
Grown and Imported Fresh Produce Retailed in Chain Supermarkets and Ethnic Stores of
Davidson County, Tennessee. Journal of Food Protection.80(3). 506-514.
Lunden, A. & et.al., (2017). A systematic review of factors influencing knowledge management
and the nurse leaders’ role. Journal of Nursing Management.
Luu, P. H., Davies, B., & Dunne, M. P. (2017). The association between factors which affect the
food safety practices of seafood distributors within the southern domestic distribution
chains in Vietnam. Food Control.73. 332-340.
Marilyn C. Erickson, , Jean Liao, Jennifer L. Cannon, Ynes R. Ortega. (2015). Center for Food
Safety and Department of Food Science and Technology, University of Georgia, 1109
Experiment St., Griffin, GA 30223-1797, USA. Retrieved from:
http://www.sciencedirect.com/science/article/pii/S0740002015001306
Marti, E., Ferrary-Américo, M., & Barardi, C. R. (2017). Viral disinfection of organic fresh
produce comparing Polyphenon 60 from green tea with chlorine. Food Control.79. 57-61.
Mebdoua, S., Lazali, M., & Ounane, G. (2017). Evaluation of pesticide residues in fruits and
vegetables from Algeria. Food Additives & Contaminants: Part B. 10(2). 91-98.
Meyer, S. B. & et.al., (2017). In the interest of food safety: a qualitative study investigating
communication and trust between food regulators and food industry in the UK, Australia
and New Zealand. BMC public health.17(1). 189.
Meysenburg, R., Albrecht, J. A., & Ritter-Gooder, P. K. (2014). Food safety knowledge,
practices and beliefs of primary food preparers in families with young children. A mixed
methods study. Appetite. 73. 121-131.
Milazzo, A. & et. al. (2017). The effects of ambient temperature and heatwaves on daily
Campylobacter cases in Adelaide, Australia, 1990–2012. Epidemiology & Infection. 1-8.

P a g e | 84
Milazzo, A. & et.al., (2017). Factors Influencing Knowledge, Food Safety Practices and Food
Preferences During Warm Weather of Salmonella and Campylobacter Cases in South
Australia. Foodborne pathogens and disease. 14(3). 125-131.
Milazzo, A., & et. al. (2016). The effect of temperature on different Salmonella serotypes during
warm seasons in a Mediterranean climate city, Adelaide, Australia. Epidemiology &
Infection. 144(6). 1231-1240.
Moffatt, C. R. & et. al.. (2016). Salmonella Typhimurium and outbreaks of egg-associated
disease in Australia, 2001 to 2011. Foodborne pathogens and disease. 13(7). 379-385.
Moffatt, C. R. M., & et. al. (2016). A large outbreak of Campylobacter jejuni infection in a
university college caused by chicken liver pâté, Australia, 2013. Epidemiology &
Infection. 144(14), 2971-2978.
Moffatt, C. R. M., & et. al. (2017). The campylobacteriosis conundrum–examining the incidence
of infection with Campylobacter sp. in Australia, 1998–2013. Epidemiology & Infection.
145(4). 839-847.
Mørk, T., Grunert, K. G., & Tsalis, G. (2017). An analysis of the effects of a campaign
supporting use of a health symbol on food sales and shopping behaviour of
consumers. BMC public health. 17(1). 239.
National Health and Medical Research Council. (2017). NHMRC Dietary Guidelines for
Australian Adults. A Guide to Healthy Eating. Retrieved from:
https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/
n55a_australian_dietary_guidelines_summary_book.pdf
Nesbitt, A., Thomas, M. K., & Bienefeld, M. (2014). Baseline for consumer food safety
knowledge and behaviour in Canada. Food Control. 38. 157-173.
Nesbitt, A., Thomas, M. K., Marshall, B., Snedeker, K., Meleta, K., Watson, B., & Bienefeld, M.
(2014). Baseline for consumer food safety knowledge and behaviour in Canada. Food
Control, 38, 157-173. Retrieved from:
New South Wales Food Authority. (2014). Listeria and pregnancy The foods you should avoid
and why. Retrieved from:
http://www.foodauthority.nsw.gov.au/_Documents/foodsafetyandyou/listeria_and_pregna
ncy.pdf
Newson, J. P. (2017). Salmonella in Australia: understanding and controlling infection.
Microbiology Australia.38(3). 112-115.
O'Brien, S. J., & et. al. (2016). Modelling study to estimate the health burden of foodborne
diseases: cases, general practice consultations and hospitalisations in the UK, 2009. BMJ
open. 6(9). e011119.
Pearson, D. & et.al., (2017). Reframing communications that encourage individuals to reduce
food waste. Communication Research and Practice. 3(2). 137-154.

P a g e | 85
Pee, L. G., & Kankanhalli, A. (2016). Interactions among factors influencing knowledge
management in public-sector organizations: A resource-based view. Government
Information Quarterly.33(1). 188-199.
Phillips, A., & et. al. (2016). Whole genome sequencing of Salmonella Typhimurium
illuminates distinct outbreaks caused by an endemic multi-locus variable number tandem
repeat analysis type in Australia, 2014. BMC microbiology. 16(1). 211.
Pollard, S. & et.al., (2016). Identification of Risky Food Safety Practices at Southwest Virginia
Farmers’ Markets. Food Protection Trends.36(3). 168-175.
Ramachandran, P. & et. al. (2017). Adult food borne botulism in Australia: The only 2 cases
from the last 15 years. Journal of Clinical Neuroscience.
Ramachandran, P. & et. al. (2017). Adult food borne botulism in Australia: The only 2 cases
from the last 15 years. Journal of Clinical Neuroscience.
Reddi, S. L., Kumar, R. N., & Rao, V. S. (2015). Microbiological quality of street vended fruit
juices in Hyderabad, India and their association between food safety knowledge and
practices of fruit juice vendors. Int. J. Curr. Microbiol. App. Sci. 4(1). 970-982.
Schrier, S. (2014). Consumer Knowledge of Fresh Produce Safety and the Food Safety
Modernization Act. Retrieved from:
https://vtechworks.lib.vt.edu/bitstream/handle/10919/51517/Schrier_Consumer_Knowled
ge_of_Food_Safety.pdf?sequence=1
Shamsi, S. (2016). Seafood-borne parasitic diseases in Australia: how much do we know about
them?. Microbiology Australia. 37(1). 27-29.
Silva, M. M., & Lidon, F. C. (2016). Food preservatives-An overview on applications and side
effects. Emirates Journal of Food and Agriculture. 28(6). 366.
Smith, D. M., Taylor, W., & Lavender, T. (2016). Behaviour change techniques to change the
postnatal eating and physical activity behaviours of women who are obese: a qualitative
study. BJOG: An International Journal of Obstetrics & Gynaecology. 123(2). 279-284.
Smith, J., Ross, K., & Whiley, H. (2016). Australian Food Safety Policy Changes from a
“Command and Control” to an “Outcomes-Based” Approach: Reflection on the
Effectiveness of Its Implementation. International journal of environmental research and
public health.13(12). 1218.
Stancu, V., Haugaard, P., & Lähteenmäki, L. (2016). Determinants of consumer food waste
behaviour: Two routes to food waste. Appetite. 96. 7-17.
Stenger, K. M., Ritter-Gooder, P. K., & Albrecht, J. A. (2014). A mixed methods study of food
safety knowledge, practices and beliefs in Hispanic families with young
children. Appetite. 83. 194-201.

P a g e | 86
Thompson, C. K. & et. al. (2017). Epidemiology and whole genome sequencing of an ongoing
point-source Salmonella Agona outbreak associated with sushi consumption in western
Sydney, Australia 2015. Epidemiology & Infection, 1-10.
Tirkey, B., Pal, U. S., & Panda, M. K. (2014). Evaluation of physico-chemical changes of fresh-
cut unripe papaya during storage. Food Packaging and Shelf Life. 1(2). 190-197.
Tzortzakis, N., & Chrysargyris, A. (2017). Postharvest ozone application for the preservation of
fruits and vegetables. Food Reviews International.33(3). 270-315.
Van Boxstael, S., Devlieghere, F., & Uyttendaele, M. (2014). Understanding and attitude
regarding the shelf life labels and dates on pre-packed food products by Belgian
consumers. Food Control. 37. 85-92.
Varoquaux, P., & Wiley, R. C. (2017). Biological and biochemical changes in minimally
processed refrigerated fruits and vegetables. In Minimally processed refrigerated fruits
and vegetables (pp. 153-186). Springer US.
Verghese, K., Lewis, H., Lockrey, S., & Williams, H. (2015). Packaging's role in minimizing
food loss and waste across the supply chain. Packaging Technology and Science. 28(7).
603-620.
Whiley, H., Clarke, B., & Ross, K. (2017). Knowledge and Attitudes towards Handling Eggs in
the Home: An Unexplored Food Safety Issue?. International journal of environmental
research and public health.14(1). 48.
New South Wales Food Authority. (2014). [Online]. Available through:
<http://www.foodauthority.nsw.gov.au/_Documents/foodsafetyandyou/listeria_and_preg
nancy.pdf / >. [Accessed on 14 th September 2017].
National Health and Medical Research Council. (2017). [Online]. Available
through:<https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/
n55a_australian_dietary_guidelines_summary_book.pdf / >. [Accessed on 14 th
September 2017].
Young, I., Waddell, L., Harding, S., Greig, J., Mascarenhas, M., Sivaramalingam, B., ... &
Papadopoulos, A. (2015). A systematic review and meta-analysis of the effectiveness of
food safety education interventions for consumers in developed countries. BMC public
health, 15(1), 822. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548310/pdf/12889_2015_Article_2171.
pdf

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Appendix 1: Characteristics of outbreak studies included in the literature review having an association of
Consumers awareness, knowledge, behavior and food handling practices linked with fresh produce.
Study Country Study
Design
Research Questions Sample Interventions Results
Losasso, C et
al., 2012.
Italy cross-
sectional
study
Questions included.
-Food and safety
knowledge.
-Knowledge of cross
contamination.
-Adequate cooking of
food.
-Nutritional safety.
80 percent of
respondents
were females
with a median
age of 66.
Questionnaire based pre and
post survey to see the
consumers educational and
awareness knowledge.
Increase in all the sectors with
Food safety from 47.6% to
60.5%.
Nutritional safety 45.3% to
59.2%.
Avoid cross contamination
increase from 26.1% to 38.2%
Adequate cooking from 46.0% to
50.4%.
(Young, I.,
Waddell, L et
Canada Systemic
review
More than 70%
of the
Self-administered
questionnaire before and
Results showcased positive
relation of education in controlled

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al., 2015). and
meta-
analysis.
respondents
were female.
after treatment to identify
the gaps.
trials and very heterogeneous
results in non-controlled trials
Odwin, R., &
Badrie, N,
2008
West
Indies
Pilot
study
Focused more on if
someone has knowledge
on food safety, do they
think they have
knowledge of safe
practices and if they or
any of their family
members have
experienced any
foodborne illness in the
last 3 months?
More than 81 %
of the
respondents
were women
who are
responsible for
buying and
cooking food.
The sample size was
relatively small but gave an
overall perception of poor
knowledge of food safety
practices of people in
Trinidad a compared with
Barbados.
To sum up, the people of
Barbados had better knowledge
and had some sort of training of
safe food practices with 45.6 % of
the population and compared with
Trinidad with 28.4 % of the
people assuming safe practices.
This highlighted a big knowledge
gap in the food safety practices
among participants.
Verrill, L.,
Lando, A.
M., &
O'Connell,
K. M, 2012
USA Cross-
sectional
study
Questions included
washing and drying
practices of
Cantaloupes.
638 respondents
with the
majority of the
participants
were Caucasians
92%. With 80%
The self- administered
questionnaire was utilized
among volunteers to
highlight the washing and
drying practices utilized.
Around 45% of the participants
reported washing the cantaloupe
prior preparing and consuming,
with most common method was
rinsing under tap water without
scrubbing.

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of among them
being women.
Furthermore, among the 45%, the
majority of among them 60% only
reported washing cantaloupes for
less than 10 seconds and 53%
were not drying cantaloupes after
rinsing.
Sanlier, N.,
&
Konaklioglu,
E, 2012
Turkey Cross-
sectional
study
There were 35 questions
in total with
-4 focusing on
demographic profile.
-12 questions on food
hygiene knowledge.
-8 on personal hygiene
and kitchen hygiene
knowledge.
-10 on food handling
practices.
-3 on food safety
attitude.
1,340 students
volunteered
including both
males and
females with the
age duration of
18-24 years.
With 652
students were
studying
education
sciences, 652 on
social science
and remaining
346 were
A self-administered
questionnaire was utilized.
-67.8 students agreed if food is
rotten boiling and consuming is
alright.
-81.9 % agreed on washing fruits
and vegetables prior consumption.
-80.4 agreed on meat must be
washed prior cooking.
- 19.9 % of students sometimes
broke and utilize dirty eggs, and
did not wash those 41.8% times.
Which indicate a lack of
knowledge and awareness in food
knowledge and hygiene.

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studying natural
science.
Nesbitt, A.,
Thomas, M
et al., 2014
Canada Cohort
Study
Previous Questionnaires
included
- The temperature of
food.
- Separation of raw and
cooked food.
-Washing of fresh
produce prior
consumption.
-The frequency of
washing of poultry fruits
and vegetables.
-The frequency of hand
washing.
First Canadian study which
gathered all the surveys
since 1998 to 2011.
Included 26 Canadian
publications.
In spite of different study methods
and design utilized by each study,
Overall, it was concluded that
Canadian population had a good
general awareness of food safety
practices and principles.
However, certain limitations were
identified as all the responses
were based on consumers self-
administered responses and there
were high chances of bias
involved in the studies.
Verrill, L.,
Lando, A.
M., &
O'Connell,
K. M, 2012.
USA Cross
sectional
study
Questions asked
consumers regarding
their washing habits
prior utilizing their fresh
produce.
Phone based Questionnaire. 56% of the consumers just place it
under tap water and not rub the
fruit while cleaning. On the other
hand, more than 50.5% of the
people considered pre-packed

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lettuce as being pre-washed and
did not wash them before use
Langiano, E.,
Ferrara, M et
al., 2012
Italy Cross-
sectional
study
1000 individuals
participated, that
were randomly
recruited to
reduce bias.
Part A, included one on one
interviews with 50 families
to develop a questionnaire.
Part B, a self-administered
questionnaire was utilized
in 100 randomly recruited
volunteers.
Key findings included lack of
knowledge on food storage and
preparation practices.
Schrier, S,
2014.
USA Cross-
sectional
study
Questions included,
-Food safety knowledge.
-Is washing important in
fresh produce?
-Does fresh produce
have a potential to
spread foodborne
illness.
-Cleaning practices.
-Knowledge about
Modernization Act.
-Knowledge about some
400
questionnaires
were distributed
with only 166
responded from
the survey. All
age 18 years and
over.
A self-administered
questionnaire was utilized.
Around 69 % of the respondents
did not know any association of
foodborne illness with fresh
produce, highlighting poor
knowledge, and awareness in
fresh produce.
On the other hand, CDC
recommended washing of hands
and fresh produce prior to eating,
cooking or cutting along with the
thorough scrubbing of the fruit

P a g e | 93
potential bacteria linked
with foodborne illness.
while cleaning followed by
appropriate drying.
Erickson, M.
C., Liao, J
ET AL., R,
2015.
USA Cross-
sectional
study
NA Targeted two
most commonly
used utensils in
the home
kitchens, knifes
and graters.
Different samples from
different contaminated
surfaces of knife and graters
were identifying the
microbial activity.
A study conducted one of the
most important and effective
methods to reduce the
contamination of residues of
pathogens from knifes and graters
is to swab the surface utilizing a
moistened wipe.
Results noted that there was
higher substantial risk after
cutting a tomato or strawberries
getting contaminated with either
E.coli or Salmonella comparison
with cucumbers and melons.
Worsley,
Wang and
Yeatman,
Food
Australia Cross-
sectional
study
The survey was done to
reflect a general
perception of food
safety practices and
2022 adults
participated in
the research.
The self- administered
online survey was utilized
to highlight the correct
washing technique of fresh
77.6% of the participants knew
the best ways to wash fresh fruits
and vegetables. However it does
not provide any evidence that

P a g e | 94
knowledge
Survey.
(2011).
knowledge and
awareness among
consumers’ which does
not fit in the research
inclusion criteria. Hence
only one of the aspects
of the research that
asked questions related
the correct methods of
washing fresh produce
results are included in
the research to see if
participants knew the
best ways to wash fresh
fruits and vegetables
produce. these consumers having good
knowledge are actually utilizing
these practices while handling
fresh produce.
Marjie L.
Aban1,*,
Sylvia B.
Concepcion1,
and Marilou
O. Montiflor.
(2009).
Philippines Cross-
sectional
study
The aim of the study
was to highlight
consumers’ criteria of
food safety and how
consumers define food
safety and their buying
habits compared with
300 household
survey
respondents.
With the
majority of
population being
married and
The study utilized a
sturtured questionnaire. By
collected both quantitave
and qualititave data to
analyze the results.
The overall result concluded with
all the income groups being more
inclined toward the looks and
appearance of the produce and
with more food safety knowledge
seen to be present in the higher
income groups with more

P a g e | 95
different income groups. with a mean age
of 39 years old.
purchase from the supermarkets
on compared with the wet markets
and vice versa with low income
groups

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Appendix 2: Outbreak Summary linked with fresh fruits and vegetables around the globe in the past 2
decades.
Outbrea
k Year
Commodit
y
Aetiologica
l
factor
Contributing factor No. of
Outbrea
ks
Cases (Linked
deaths)
Country/
State
Reference:
1995 Lettuce
leaf
E.coli
0157:H7
Irrigated water and poor handling at
grocery store
1 29 USA
(Montana)
Cited by De Roever, 1998
1995 Lettuce
Iceberg
E.coli
0157:H7
Possible cross-contamination from
meat
1 30 USA
(Maine)
Cited by De Roever, 1998
1996 Lettuce
Iceberg
E.coli
0157:H7
Not known 1 B/w 20-26 USA
(Illinois)
USA
(Connecticut)
Cited by De Roever, 1998
1996 Lettuce Campyloba
cter jejuni
Suspected cross contamination with
chicken
1 14(0) USA CDC,1998
1996 Raspberrie
s
Cyclospora
cayetanensi
s
Staff workers were ill and 11- 13
stool positive laboratory confirmed
faecal samples for cyclospora were
Not
known
850 reported
cases.
USA (South
Carolina)
CDC 1996a; CDC 1996b; Caceres
et al., 1998

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identified.
Secondly, raspberries were washed
in the same strainer as potatoes.
Cross-handling of raspberries with
finished dishes were also reported.
1997 Lettuce,
iceberg
E.coli
0157:H7
Unknown Unknow
n
Unknown Canada CCDR, 1997
1997 Lettuce,
mesclun
(mixed)
C.
Cayetanensi
s
Unidentified 2 Not known USA CDC, 1997a; Cited by De Roever,
1998
1997 Basil was
likely to be
the
causative
agent; basil
pesto used
in a variety
of food
dishes
Cyclospora
spp.
One common distributor was found
among all the cases linked with
Basil pesto
Unknow
n
185 in a total
of 20 clusters
USA CDC, 1997b

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1998 Lettuce
Iceberg
Y.
pseudotuber
culosis O.3
Likely contamination from
contaminated from irrigation water
and animal faeces
1 47(1) Finland Nuorti et al., 2004
1998 Parsley Shigella
sonnei
Use of unchlorinated water for ice
in packing shed. Parsley was grown
in Mexico
8 437 USA Cited by Harris et al., 2003
1999 Lettuce E.coli 0157 Not reported. Lettuce was imported
from central Europe
1 37 Sweden Welinder-Olsson et al., 2004
1999 Fresh salad
vegetables
Norovirus No physical separation between
infected food and ready to eat
prepared salads.
1 159 Israel Grotto et al., 2004
1999 Basil Cyclospora
spp.
Contaminated basil imported both
from Mexico and home grown in
USA.
- 62 USA Lopez et al., 2001
2000 Lettuce Salmonella
Typhimuriu
m DT104
Could not be confirmed, problem
occurred in traceability.
Not
known
361 United
Kingdom
(UK)
Horby et al., 2003
2000 Lettuce
and iceberg
Salmonella
Typhimuriu
m DT104
Imported lettuce 2 392 England,
Wales;
Scotland;
Iceland;
Germany the
Crook et al., 2003

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Netherlands
2000 Salads
(lettuce
and fresh
green leafy
herbs)
C.
Cayetanensi
s
Possible contaminated of produce
with human waste. Imported
lettuce.
1 34 Germany Doller et al., 2002
2001 Lettuce (in
salad mix)
Salmonella
Bovismorbi
ficans
Inappropriate equipment cleaning;
Traces of salmonella was found in
lettuce shredder
1 41 Australia
(Queensland)
Stafford et al., 2002
2001 Basil C.
cayetanensi
s
Imported Thai basil - 17 Canada Hoang et al., 2005
2001 Ready to
eat pre-
packed
salads
Salmonella
Newport
Not known 1 9 UK O’Brien and Fisher, 2001
2002 Watercress
commercia
l
Fasciola
hepatica
“Snail host present in growing
beds, cattle grazing nearby, no
flood protection, poor control”
1 18 France Mailles et al., 2006
2003 Salad
vegetables
Norovirus
(3
genotypes),
The poosible cause was imported
fresh produce from the Middle
East.
1 37 At sea
(British Navy
ship)
Gallimore et al., 2005

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sapovirus,
rotavirus
Northern
Arabian Gulf
2003 Lettuce Salmonella
Braenderup
Imported lettuce from Spain
seemed like the likely cause
1 40+ UK Little & Gillespie, 2007
2003 Lettuce E. coli
O157: H7
Not known 1 57 USA No reference was found
2004 Lettuce Salmonella
Newport
Imported lettuce from Spain
seemed like the likely cause
1 375 UK Little & Gillespie, 2007
2004 Rocket
leaves
Salmonella
Thompson
Imported from Italy 1 20 Norway
(Likely
possibility of
presence of
cases in
Sweden,
England &
Wales)
Nygård et al., 2004
2005 Lettuce,
iceberg
E. coli
O157
Local grown lettuce, crop irrigated
from a stream
1 120 Sweden Soderstrom et al., 2005
2005 Lettuce
(Various
mixes of
romaine
E. coli
O157
Not known 1 >18 USA FSnet, 2005a

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lettuce, red
cabbage,
carrots)
2005 Parsley E. coli
O157
1 >12 USA FSnet, 2005b
2005 Lettuce,
iceberg
Salmonella
Typhumuriu
m var
Copenhagen
DT104
Imported from Spain 1 60 Finland Takkinen et al., 2005
2005 Lettuce Salmonella
Typhimuriu
m DT104
Imported from Spain 1 96 UK Little & Gillespie, 2008
2006 Alfalfa
sprouts
Salmonella
Oranienbur
g
Not known 133 ill and 32
hospitalized
Australia
(Multi-states)
OzFoodNet unpublished data,
2010; OzFoodNet unpublished
data, 2011
2006 Lettuce,
iceberg
E. coli
O121: H19
Contaminated lettuce use at fast
food outlets
1 4 USA FSnet, 2006
2006 Spinach E. coli
O157: H7
Contamination of the spinach
through contaminated fields of feral
swine faeces.
1 in 26
states
205 cases and
3 registered
deaths.
USA CDC, 2006; Jay et al., 2007
2006 Rockmelon Salmonella Domestic, due to use of untreated 115 Australia Munnoch et al., 2009.

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saintpaul water and incorrect use of
disinfectant agents.
2006 Green
salad
Norovirus Not known. 29 Australia
(Western
Australia)
OzFoodNet unpublished data,
2010; OzFoodNet unpublished
data, 2011
2006 Papaya Salmonella
Litchfield
Use of untreated river water and
incorrect use of chemical
disinfectants.
1 26 Australia
(Qld and
WA)
Gibbs et al., 2009
2007 Lettuce,
iceberg
E. coli
O157: H7
Unknown 35 Not known No reference was found
2007 Basil Salmonella
Senftenberg
Imported from Israel Unknow
n
UK (33),
Netherlands
(2),
Denmark(3),
USA (not
known)
UK,
Netherlands,
Denmark,
USA
Pezzoli et al., 2007
2007 Baby corn Shigella Imported 1 55 Australia OzFoodNet, 2008; Lewis et al.,
2009
2007 Mixed-
salad
Noro-virus Domestic 1 24 Australia(Qld
)
OzFoodNet unpublished data,
2010; OzFoodNet unpublished
data, 2011
2009 Semi-dried Hepatitis A Imported 1 >500 with 392 Australia OzFoodNet unpublished data,

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tomatoes suspected and
confirmed
cases. Out of
these 165
became
hospitalized
2010; OzFoodNet unpublished
data, 2011; Donnan et al., 2011
2009 Pawpaw Salmonella
Saint Paul
Not known 1 17 ill and 3
hospitalized
Australia
(WA)
OzFoodNet unpublished data,
2010; OzFoodNet unpublished
data, 2011
2010 Semi-dried
tomatoes
Hepatitis A Imported 1 13 Netherlands Petrignani,M et al., 2010a;
Petrignani,M et al., 2010b
2010 Semi-dried
tomatoes
Hepatitis A Imported produce 59 France Gallot et al., 2011
2010 Possibly
cantaloupe,
lettuce and
mint
Cyclospora
species
Not known 1 314 Australia
(WA)
OzFoodNet unpublished data,
2010; OzFoodNet unpublished
data, 2011
2007 Baby corn Salmonella
sonnei
Not known 215 laboratory
confirmed
cases in
Denmark and
55 cases in
Australia and
Denmark
Lewis et al., 2009

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Australia
2010 Rockmelon Listeria
monocytoge
nes
Domestic 115 Australia OzFoodNet, 2010a; Astridge,
2011
2011 Rockmello
n
Listeria
monocytoge
nes.
Domestic, 1 130 cases with
29 deaths.
US
(Colorado)
CDC, 2011
2016 Rockmelon Salmonella Contamination of rockmelon due to
contamination in irrigated water in
the farms.
1 86 with 2
reported deaths
Australia,
cases were
reported from
across
Australia
(Qld, NSW,
SA)
FSANZ, 2016
Adapted from: FAO/WHO. 2008a. Microbiological Risk Assessment Series. Pre-publication version. Microbiological hazards in fresh
fruits and vegetables. Meeting Report; FSANZ, the review of Foodborne illness associated with selected ready to eat fresh produce
(December 2011).

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Appendix 3: Search strategy
3.1: Inclusion and exclusion criteria:
Initial search returned 1109 hits that were first filtered in accordance with the inclusion
criteria being evidence based research, appropriateness by title, link with consumers’ awareness
and outbreaks in relation with fresh produce. Secondly, then filtered with the exclusion criteria
with fresh produce outbreak not link with meat or any cooked products. After the first filtration
81 publications remained and were examining and measured under the inclusion criteria
mentioned in figure 6 with only 12 articles to be included in the finalized literature review.
32 Articles were excluded which
did not fit in the inclusion
criteria.
-No focus on consumer’s
awareness.
-Not evidence based literature.
-Language difference (3 articles
were in Spanish).
-No practical guidelines.
23 Articles were assessed for the
eligibility criteria.
81 Articles were published in
duration between 1996- 2016
period
15 Duplicate articles were
removed.
81 relevant articles and reports
were identified and selected for
the literature from the following
databases distributed as,
PubMed =13, EBSCO=18 Scopus
=21, Google scholar =19, QUT
library search engine=10
9 grey literature article were
also included
13 of the articles were excluded
after final full text review.
-No methodology framework
-Less focus on consumer’s
awareness rather than food
safety.
12 Articles included in the final
literature review.

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Figure 6: Inclusion criteria of the search strategy.
3.2: Search string
Pathogens list Commodity List Outcome list
Cyclospora
Giardia Lamblia
Cryptosporidium
Campylobacter
Escherichia coli
Salmonella
Listeriosis monocytogenes
Bacillus cereus
Staphylococcal aureus
Shigella
Hepatitis A virus
Norovirus
Leafy vegetables
Cucumber
Lettuce
Herb
Kale
Rockmelon
Cabbage
Parsley
Basil
onion
Oregano
Rocket
Cilantro
Tomato
Arugula
Coriander
Capsicum
Dill
Raspberries
Foodborne Illness
Consumers awareness
Knowledge
Perception
Behavior
Food handling practices.
Outbreak
“Fresh produce”
“Risk factor
“Case control”
Case Investigation

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Berries
Strawberries
Watermelon
Papaya
Spinach
Blueberries
Honeydew
Muskmelon
Mango
Raspberry
Fruit Shoot
Pre-packed fruits and
vegetables.

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3.3: Search engines:
1. PubMed (http://www.pubmed.org)
Simple search with date limits (01/01/1996 – 31/12/2016)
2. EBSCO (Food Science Source; FSTA – Food Science and Technology Abstracts;
Medline; Medline with Full text)
Boolean phrase simple search
Limiter: 1996-2016; Peer reviewed
Source type: Periodicals
3. QUT library data base search engine.
4. Scopus
5. Google scholar.
6. Grey literature.

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Appendix 4- Ethics Approval:
Ethics application - approved – 1700000400
Research Ethics (HUMAN)
Dear Ms. Belinda Davies and Mr. Murtaza Ahmed Makhdoom
Project Title: Consumers' awareness, knowledge and practices in relation
to fresh produce (including pre-packaged fruits and vegetables)
Ethics Category: Human - Low Risk
Approval Number: 1700000400
Approved Until: 29/05/2019
(subject to receipt of satisfactory
progress reports)
We are pleased to advise that your application has been reviewed and
confirmed as meeting the requirements of the National Statement on Ethical
Conduct in Human Research (2007).
I can therefore confirm that your application is APPROVED.
If you require a formal approval certificate please advise via reply email.
CONDITIONS OF APPROVAL
Please ensure you and all other team members read through and understand
all UHREC conditions of approval prior to commencing any data collection:
> Standard: http://www.orei.qut.edu.au/human/manage/conditions.jsp
> Specific: None apply

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Decisions related to low risk ethical review are subject to ratification at
the next available UHREC meeting. You will only be contacted again in
relation to this matter if UHREC raises any additional questions or
concerns.
Whilst the data collection of your project has received QUT ethical
clearance, the decision to commence and authority to commence may be
dependent on factors beyond the remit of the QUT ethics review process. For
example, your research may need ethics clearance from other organisations
or permissions from other organisations to access staff. Therefore the
proposed data collection should not commence until you have satisfied these
requirements.
Please don't hesitate to contact us if you have any queries.
We wish you all the best with your research.
Kind regards
Janette Lamb / Debbie Smith
on behalf of Chair UHREC
Office of Research Ethics & Integrity
Level 4 | 88 Musk Avenue | Kelvin Grove
[phone] / 3138 4673
[e-mail]
http://www.orei.qut.edu.au

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Appendix 5- Ethics Application:
University Human Research Ethics Committee (UHREC)
APPLICATION FOR REVIEW OF NEGLIGIBLE / LOW RISK
RESEARCH INVOLVING HUMAN PARTICIPANTS Nov 2016
NOT
E
 All answers should be written in simple and non-technical language that can be easily understood

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by the lay reader. You must provide an answer to each question – N/A is not acceptable.
SECTION A: RESEARCH PROPOSAL OVERVIEW
A1 Summary Information
A1.1 Project title (200 character limit including spaces)
Consumers' awareness, knowledge and practices in relation to fresh produce (including pre-packaged
fruits and vegetables).
A
1.
2
Brief project summary in LAY LANGUAGE
(i.e. in plain English and ensure when using acronyms you spell them out in the first instance)
Environmental health focuses on preventing disease by managing biological, physical and chemical
hazards in the built and natural environment. Understanding existing knowledge and practices among
the public enables environmental health professionals to assess the current level of risk associated
with particular hazards.
This research project aims to identify the current level of food safety knowledge and food handling
practices associated with fresh produce (including pre-packaged fruits and vegetables) among
Australian consumers. An anonymous online survey will be used to gather relevant data from
consumers.
The survey data will be analysed to identify gaps in consumer knowledge and food handling practices
which may place consumers at risk of food-borne illness.
It is envisaged that the research findings will help food safety authorities target food safety messages
to consumers, which could help reduce the number of food-borne illness outbreaks associated with
fresh produce.

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A
1.
3
Provide an overview of your research participants and their involvement (max 250 words)
The purpose of this question is to gain a sense of who the participants will be, and what you expect them to do within the research
Participants must be 18 years of age or older and currently residing in Australia. No other selection
criteria will be used. Potential participants will be invited to complete an anonymous 10-minute
online survey.
To encourage participation, one $50 Coles voucher will be will be randomly drawn and given to the
winner. After completing the online survey, participants will be asked if they want to go into the
draw for the $50 Coles voucher. A link to a separate second survey will be provided so participants
can register their name and contact details for the prize, whilst ensuring the initial survey remains
anonymous.
At the end of the survey, participants will also be offered links to consumer food safety resources in
case the survey questions have created interest in the topic and they would like to learn more about
the safe handling of fresh produce.
A
1.
4a
Provide a summary of the merits of this proposed research (in LAY LANGUAGE) including the aims / hypotheses
/ research questions (refer to Section 1 of the National Statement, NS1.1, when preparing your response).
 Include potential contributions to the body of knowledge and methodological rigor (max 250 words).
 Briefly provide evidence that the proposed research is based on knowledge of the relevant literature, and provide a list of key
references.
 You may also attach a research plan / methodology which does not substitute for the summary above – this attachment should be
no longer than 6 pages.
 NOTE: Unless proposed research has merit (and the researchers who are to carry out the research have integrity) the involvement
of human participants in the research cannot be ethically justified.
Foodborne illnesses are a serious threat to consumers. In Australia, 4.1 million cases of
gastroenteritis are estimated to occur annually with a cost of 1.2 billion dollars spent every year
(OzFoodNet Annual report, 2011). On the other hand, there has been a drastic increase by 50 percent
seen in salmonella strains causing foodborne illnesses by 2012 in Australia, with double the cases

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observed in Queensland. This highlights a serious threat for Queensland population (Victoria’s
Department of Health figures, 2015).
The new food safety guidelines say “While salmonella bacteria are most commonly associated with
livestock and chickens, they have also been responsible for food safety outbreaks associated with
fresh produce" (Fresh produce safety Australia New Zealand, 2015).
The current research will have the following merits:
- Identify gaps in the current fresh produce knowledge, and awareness of the consumers’. It is
envisaged that the research findings will help food safety authorities target food safety
messages to consumers, which could help reduce the number of food-borne illness outbreaks
associated with fresh produce.
- Reinvigorate the safety and mitigate the current risk of future surge in foodborne illness.
- Setting a baseline knowledge of the current attitude and fresh produce knowledge of Australian
consumers’.
- Provide useful information for the future researchers to create better strategies and awareness
programs for consumers’ future risks of foodborne illness associated with fresh produce.
- Providing an opportunity for the consumers to take part in the survey and further review and analyze
their current information with suitable information provided at the end of the survey.
A
1.
4b
Has the scientific or academic merit of the research project been evaluated?
Review of the scientific or academic merit of the research project should be robust, formal and independent of the researcher team (e.g.
a peer review of the protocol/proposal/research plan may have occurred at confirmation of candidature, or the researcher may have
sought peer review from an independent scientist).
A peer review has been arranged. A copy will be forwarded to the ethics team once received.
A1.5 Why should this be considered a negligible OR low risk application?
Refer to Chapter 2.1 of the National Statement when preparing your response and note that:
 ‘Negligible risk research’ describes research in which there is no foreseeable risk of harm or discomfort; and any foreseeable risk
is no more than inconvenience (e.g. filling in a form, participating in a street survey, or giving up time to participate in research).
 ‘Low risk research’ describes research in which the only foreseeable risk is one of discomfort (e.g. minor side-effects of
medication, the discomforts related to measuring blood pressure, and anxiety induced by an interview).

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 Research in which the risk for participants is more serious than discomfort (e.g. where a person’s reactions include pain or
becoming distressed) the research cannot be considered low risk.
The research uses an anonymous online survey and does not target any potentially vulnerable groups,
i.e. no groups mentioned in the National Statement are targeted.
A2 Potential Risks and Benefits (refer to Chapter 2.1 of the National Statement when preparing your response)
A2.1 Describe ALL the identified potential risks and who may be affected by these risks e.g.
researchers, participants, participant community and / or the wider community. Ensure all
risks mentioned at A2.1 are addressed, and that the risks and their management are consistent
throughout the application and are addressed where applicable in the Participant Information
Sheet and Consent Form.
When gauging the level of risk ensure you take into account:
 The kinds of harm, discomfort or inconvenience that may occur.
 The likelihood of these occurring.
 The severity of any harm that may occur.
 The choices, experience, perceptions, values and vulnerabilities of different populations of participants will also be relevant.
The identified potential risk includes:
For participants:
- There are no risks beyond normal day-to-day living associated with your participation in this project
- Low risk associated with this project for the potential participants, as it uses an anonymous online
survey and does not target any potentially vulnerable groups, i.e. no groups mentioned in the National
Statement are targeted.
For researchers:
- Access to researcher’s personal mobile number by the potential participants can produce a safety risk
for the researcher.
The principal researcher does not have regular access to a landline phone number. The inclusion of a mobile
phone number may create a safety risk for the principal researcher. As the survey is online, participants are
likely to be confident communicating online. Consequently, only email addresses have been included in
resources which may be distributed to the general public.
A2.2 How are the risks to be minimised? And how will they be managed if they were to occur during the study or arise

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after the completion of the study?
NOTE: The greater the risk to participants in any research for which ethical approval is given, the more certain it must be both that the
risks will be managed as well as possible, and that the participants clearly understand the risks they are taking on. Ensure all risks
mentioned at A2.1 are addressed here, that the risks and their management are consistent throughout the application and relevant
information is included in the Participant Information Sheets and Consent Forms.
The identified risk will be minimized by:
For participants:
- Maintaining privacy and confidentiality as detailed in this application.
- All the collected information will be anonymous, not highlighting any potential names of the
participants with highlighted information.
- It is an online based anonymous survey reducing the risk of transmitting any personal
information of the participant.
- Names of the participants for the lucky draw will be collected in a separate second survey
only if the participant wish to participate in the lucky draw, and will be erased from the
system after random allotment of the prize to the one lucky winner.
- Only the research team will have access to the collection information maintain the
confidentiality of the collected information.
- All the information will be saved in QUT server in a password protected files
For researchers:
- Mobile number of the principal researcher has not been included in the contact information to
minimize the potential safety risk of the researcher.
A2.3 What are the potential benefits of the research and who would benefit from these?
 Benefits of research may include, e.g. gains in knowledge, insight and understanding, improved social welfare and individual
wellbeing, and gains in skill or expertise for individual researchers, teams or institutions.
 Some research may offer direct benefits to the research participants, their families, or particular group/s with whom they identify.
Where this is the case, participants may be ready to assume a higher risk than otherwise.
General benefits of the research include:

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- Identify gaps in the current fresh produce knowledge of the consumers’. This will initially benefit the
research project, and then the food safety authorities, and ultimately if food safety authorities target
messages it will help the consumers.
- Setting a baseline knowledge of the current fresh produce handling practices, and knowledge of
Australian consumers.
- Highlighting consumers’ current fresh produce handling practices, knowledge, and their associated
risks.
- Provide useful information for the future researchers to create better strategies and awareness
programs for consumers’ future risks of foodborne illness associated with fresh produce.
- Information collected by the survey can help create future awareness programs for consumers to
provide them with suitable information on specific illnesses caused by fresh fruits and vegetables.
Expected benefits for Researcher include:
- Improving research skills, and gaining further experience with quantitative research, and the
establishment of a questionnaire.
- Increasing the employability for the researcher with good knowledge of research design, and carrying
out a research.
Expected benefits for Participants include:
- Providing an opportunity for the consumers to take part in the survey to further review, and analyze
their current knowledge and fresh produce handling practices.
- All potential participants will be offered links to consumer-focused food safety resources regarding
safe fresh produce handling so they can gain additional knowledge if interested.
- Participants will have a chance to win the Lucky draw of a $50 Coles voucher that will be randomly
allocated to the one lucky winner.

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A2.4 How do the benefits justify the risks?
 Research is ethically acceptable only when its potential benefits justify any risks involved in the research.
The benefits of the research outweigh the residual risk.
A3 Other General Information
A3.1 Where will the data be collected? (e.g. on site at QUT or other location)
NOTE: If you would like to conduct your study at the premises of an external organisation/association please ensure you provide a
copy of your intended approach letter which requests their support/permission for this, or provide evidence of this if already gained.
X QUT X Other –
details:
An online survey will be developed using Key Survey and
published on the university websites. The link to the survey will be
distributed via QUT social media pages (e.g. Facebook) and via a
recruitment email. The recruitment email and Facebook
advertisement for participants have been attached. Participants
may also be recruited via existing consumer networks (e.g. a Coles
consumer advisory group). Whilst preliminary discussions with a
Coles representative has indicated this may be possible, no formal
request to distribute the survey to this group can occur until ethics
approval has been received. Consumer outreach email is attached.
A3.2 Is the QUT Human Research Ethics Committee (UHREC) the primary or only ethics committee reviewing this
proposal?
If NO, provide details of any other institutional HREC involved and the role of each institution (including QUT) in the project. If the
project involves more than one institution that also has a HREC, please provide details on the role of QUT UHREC; whether
arrangements can be put in place for to minimise multiple review; arrangements for communication of the roles/responsibilities between
the institutions HRECs, e.g. who will monitor etc.
Yes
A3.3 What are the estimated timeframes for the project? (mmm / yyyy)
NOTE: Data collection cannot commence until you have received formal written UHREC approval.
Start of project 3/03/17 Start of data collection
25/04/17 (Subject to the
ethics approval)
End of project 20/6/17 End of data collection 25/05/17 (4-weeks)
A3.4 Describe the qualifications and relevant experience of the researcher team
NOTE: Include the training and experience student researchers have in the relevant research methodologies.

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The applicant (Masters student) has completed research units including HLN707 Research methods
in health at QUT, and a health statistics unit at Edith Cowan University. Applicant has successfully
taken the 3-day key survey development training workshops from QUT. Furthermore, the principal
researcher has previous experience in quantitative research projects and research on Musculoskeletal
pain in dentists in 2015. The research was completed during his clinical training as a house officer in
Baqai Dental University.
The principal supervisor, Belinda Davies, has recent experience leading qualitative research projects
and has previously led quantitative research. She has been involved in supervising PhD students
undertaking qualitative and quantitative research. She is currently a PhD student (completed
confirmation) and has completed QUT human research ethics training. She also has significant food
safety expertise and teaches food safety at QUT.
SECTION B: PARTICIPANT OVERVIEW (refer to Chapter 2.2 of the National Statement when preparing your response)
B1.1 Who will be approached to participate? Clearly outline each participant group.
Provide details of the potential participant pool. If you are accessing secondary data please provide full details, including whether
permission has been sought. If you are accessing confidential health information e.g. Queensland Health data, the Public Health Act
specifies the approvals required (see http://www.health.qld.gov.au/ohmr/html/regu/aces_conf_hth_info.asp) and QUT requires a
Hospital Access Agreement. Contact the Division of Research & Commercialisation for assistance.
The eligibility criteria are that participants must be 18 years of age or older and currently residing in
Australia.
B1.2 How many participants do you need for your study and approximately how many will you need to approach?
As it is an anonymous survey with a wide distribution potential, an approximation of a decent
number of 200-300 participations required to highlight the current practices.
Moreover, the aim of the research will be to get maximum participation with a wide distribution
among all age groups to get a tentative idea of the current knowledge, and food handling practices
among consumers’ linked with fresh produce.
B1.3 How will potential participants be identified and approached?
NOTE: If you would like to recruit participants via an external organisation/association please ensure you provide a copy of your
intended approach letter which requests their support/permission, or provide evidence of this if already gained.

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-The online survey will be published on the Australian university web sites, to target the university
students and staff members.
-The link to the survey will be distributed via QUT, social media pages (e.g. Facebook) and via a
recruitment email. The recruitment emails and Facebook advertisement for participants have been
attached.
-Participants may also be recruited via existing consumer networks (e.g. a Coles consumer advisory
group). Whilst preliminary discussions with a Coles representative has indicated this may be
possible, no formal request to distribute the survey to this group can occur until ethics approval has
been received. Consumer reach email has been attached.
B1.4 How will the participants provide their consent to participate?
Outline the consent process you will use, what type of consent will be requested (i.e. specific, extended or unspecified – see NS2.2.14),
what material will be provided to participants, how long participants will have to consider their decision to participate and what
discussion will occur with participants.
NOTE:
 A person’s decision to participate in research must be voluntary and informed i.e. not forced, coerced or obtained by improper
inducements AND based on sufficient information and adequate understanding of both the proposed research and the implications
of participation in it (the purpose, methods, demands, risks and potential benefits of the research).
 The process of communicating information to participants and seeking their consent should not be merely a matter of satisfying a
formal requirement. The aim is mutual understanding between researchers and participants. This aim requires an opportunity for
participants to ask questions and to discuss the information and their decision with others if they wish.
Questions are asked at the start of the survey to determine if participants meet the eligibility criteria
(being 18 years or above and currently residing in Australia), and to record consent to participate.
B1.5 Will the project involve participants who are unable to give voluntary or informed consent?
If YES, what special arrangements will be put in place to protect your participants’ interests/welfare?
These questions refer to research involving:
 Children and young people whose particular level of maturity has implications for whether their consent is necessary and/or
sufficient to authorise participation (see Chapter 4.2 of the National Statement).
 Persons with a cognitive impairment, and intellectual disability, or a mental illness (permanent or temporary) which impacts upon
their ability to supply voluntary and informed consent (see Chapter 4.5 of the National Statement).
 Persons who are highly dependent on medical care, e.g. unconscious or unable to communicate their wishes ( see Chapter 4.4 of
the National Statement).

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 Covert observation of behaviour, particularly if this relates to sensitive, contentious or illegal activity consent (see Chapter 2.3 and
Chapter 4.6 of the National Statement).
NOTE: Where participants are unable to make their own decisions or have diminished capacity to do so, respect for them involves
empowering them where possible and providing for their protection as necessary.
No.
B1.6 Do you propose to screen or assess the suitability of the participants for the project?
If YES, clearly state and explain the criteria (inclusion and exclusion, as applicable) for selecting potential participants.
Yes, the participant must be 18 years of age or above and currently residing in Australia.
B1.7 Will participants be offered reimbursements, payments or incentives?
If YES, also provide the specific details (type and value), how and when it will be provided and whether its offer could compromise the
voluntary nature of the consent obtained from participants. See Guidance on prize draws.
NOTE: Details of these should be provided on the Participant Information Sheet.
 It is generally appropriate to reimburse the costs to participants of taking part in research, including costs such as travel,
accommodation and parking. Sometimes participants may also be paid for time involved. However, payment that is
disproportionate to the time involved, or any other inducement that is likely to encourage participants to take risks, is ethically
unacceptable (NS2.2.10)
 Decisions about payment or reimbursement in kind, whether to participants or their community, should take into account the
customs and practices of the community in which the research is to be conducted (NS2.2.11)
Yes, there is one $50 Coles voucher that will be anonymously drawn and sent to the winner after the
survey has closed.
B1.8 Do you, or others involved in facilitating or implementing the research, have a pre-existing relationship with the
proposed participants? Could this result in the proposed participants feeling obliged or coerced into participation?
Refer to Chapter 4.3 of the National Statement and the QUT Research Data Collection in Classrooms or Lecture Theatres guidance
when considering/preparing your response.
If YES, describe this relationship and how you will address the special ethical issues this raises (e.g. potential coercion in recruitment).
Also outline what special arrangements will be put in place to protect the interests / welfare of potential participants.
NOTE:
 Pre-existing relationships may compromise the voluntary nature of participants’ decisions, as they typically involve unequal
status, where one party has or has had a position of influence or authority over the other.
 Examples may include relationships between employers or supervisors and their employees; teachers and their students; carers
and people with chronic conditions or disabilities or people in residential care or supported accommodation; etc (see Chapter 4.3
of the National Statement for more examples).
 While this influence does not necessarily invalidate the decision, it does mean that particular attention should be given to the
process through which consent is negotiated.
The survey is anonymous and recruitment will occur via various groups. Consequently, some
participants could have pre-existing relationships with the researchers. The answers of participants
are not individually identifiable, so if by chance a participant does have a pre-existing relationship

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with a researcher, it will not influence their answers.
B1.9 Will you conduct a debriefing session at the end of the research or at the end of each participant’s involvement?
If YES, please provide the details of this session. NOTE: Such a session is required for research involving deception (see Chapter 2.3
of the National Statement), and may be appropriate if the research is likely to cause discomfort to participants.
No - due to the anonymous and online nature of the survey, a debriefing session is not possible.
However, links to consumer-focused food safety resources regarding safe fresh produce handling will
be provided so consumers can gain additional knowledge regarding the topic.
B1.10 Consider providing feedback to participants as this is encouraged by the National Statement.
Will feedback and/or the research results be reported to participants?
 If YES, explain how this will be done and in what form this reporting will occur.
 If NO, explain why the participants are not to be provided with such a report.
Due to the anonymous nature of the survey, it will not be possible to provide all participants with
feedback.
A question has been included in the survey for the prize draw (which includes contact details) so
participants can indicate if they want to receive a summary of the research findings. A one-page
summary will be sent to the participants who indicate that they would like this information.
All participants will be offered links to consumer-focused food safety resources regarding safe fresh
produce handling so they can gain additional knowledge if they are interested.
Furthermore, a second survey will be utilized for participation in the prize draw that will include the
names and contact details of the participants. All the collected information will be kept confidential
and will be deleted after random allotment of the prize to the one lucky winner.
SECTION C: DATA MANAGEMENT
C1 Future Use of Data
C1.1 Is it likely / possible that any of the data collected will be used by you, or others, for any
research other than that outlined in this application? See Chapter 2.2 and Chapter 3.2 when preparing your
response.
If YES, describe below and ensure this is outlined in all your participant information sheets and consent forms.
 Participants should be fully informed of the possibility of any future use of data collected and their ‘extended’ or ‘unspecified’
consent gained. Failure to do this may restrict the future use of the data.
 Any restrictions on the use of participants’ data should be recorded and the record kept with the collected data so that it is always
accessible to researchers who want to access those data for research.

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 Please note that data sharing is increasingly being encouraged to gain maximum benefit from research, so a YES response is
encouraged in most cases. If YES, describe below and ensure this is outlined in all your Participant Information Sheets and
Consent Forms.
Non-identifiable data collected in this project may be used as comparative data in future projects or
stored on an open access database for secondary analysis (as noted in the participant consent form).
C2 Procedures & Protection
C2.1 What data collection procedures will be utilised?
Place an ‘X’ in the relevant boxes below AND provide a copy (draft or finalised, labelled as such) of the relevant instrument, protocol
or other written form used to guide (e.g. interview questions/guide) or collect data (e.g. survey) or include an explanation of the
method by which the data will be collected. Clinical experimental measures / tools or creative works are considered “Other
Instrument”.
X Questionnaires/Surveys Archival records
Interviews Focus groups
Other instrument – provide
details: (If there is insufficient space below, provide details in an additional separate document)
C2.2 Have the data collection procedures been previously approved by QUT or are they an academic
standard instrument? If YES, provide brief details on prior approval or where instruments have been used previously, e.g.
under a similar research context
Online based questionnaires are a standard data collection method.
C2.3 In what form will the human data be collected, stored and used/reported?
In each row, indicate which form of data (eg. interviews, questionnaires etc) applies for your study.
At least one column must be completed in each row but if different data are in different forms, you will need to complete more
than one box in each column or row.
Individually Identifiable Re-Identifiable or
Potentially Re-
Identifiable
Non-Identifiable
i.e. Data that have never been
labelled with individual identifiers
OR from which identifiers have

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i.e. Data from which the identity of
a specific individual can be
reasonably ascertained eg. name,
image, date of birth, and/or address.
i.e. Data from which identifiers
have been removed and replaced by
codes, but it remains possible to re-
identify individuals, eg. by using
the code or linking different data
sets.
been permanently removed such
that no specific individual can be
identified by the researchers.
Collected
Name and contact details
in the second
questionnaire for
participants to go into the
draw for the $50 Coles
voucher.
Completed online
questionnaire regarding
food safety knowledge and
handling practices
associated with fresh
produce.
Stored
Name and contact details
in the second
questionnaire for
participants to go into the
draw for the $50 Coles
voucher will be stored
until the winner has been
randomly allocated.
Data from completed
questionnaires.
Used/Reported
Only non-identifiable data
from the first
questionnaire (regarding
food safety knowledge and
handling practices of fresh
produce) will be reported.
C2.4 How is this project funded?
Outline what rights the funder of the study will have to data obtained from the study, and in what format e.g. aggregate reports only,
access to raw data or other. NOTE: Any access by the funder should be made clear to participants.
Self-funded. A fifty dollar Coles voucher will be purchased that will be randomly allocated to one
lucky participant.

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Secondly, Facebook advertisements will be purchased. The associated cost is approximately five
dollars per day. As different groups will be active on social media at different times, every Monday,
Tuesday, Friday, and Saturday, while the survey is open will be targeted, with a high focus on
Queensland and New south Wales. Consequently, approximately eighty dollars will be spent over
the 4-week period the survey is open, but it is likely to increase the number and diversity of
participants.
C2.5 How will confidentiality of the study records be protected during the study and in the
publication of results?
NOTE: If you intend to identify participants or organisations, this needs to be made clear on the Participant Information Sheet.
- By the anonymous nature of the survey.
- Names will be included only in the second survey for people who wish to participate in the
lucky draw and will be erased from the electronic database after random allotment of the
prize to one of the lucky winner.
- All the collected information will be assessable only by the research team.
C2.6 Is this a collaborative project?
If YES, also provide brief detail on data-sharing arrangements e.g. open – all parties have access to each other’s data; partial – data
held by collaborator completing particular component.
No.
C2.7 Who will own the resulting research data and the created intellectual property?
Place an ‘X’ in the relevant box/es below – at least one box must be checked. If relevant you can check more than one box, ie QUT
and an external organisation. Please refer to the D/3.1 Intellectual property (IP) policy for further information.
QUT – QUT is the owner of IP created by staff members in the course of their employment.
STUDENT/S –The IP generated is personally owned by the student if not assigned to QUT or other organisation.
X BOTH QUT & STUDENT/S – If the IP for a student project has been assigned to QUT, ownership of data and IP is
shared
(see Student IP protocol).
EXTERNAL ORGANISATION –
Give details:

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NOTE: QUT requires an IP agreement to be in place if IP ownership is to deviate from that described in D/3.1 Intellectual property
(IP) policy. Please contact the relevant section of the Division of Research & Commercialisation if you require any further
assistance.
C3 Storage & Security
Ensure you have completed your QUT Data Management Plan BEFORE completing this section.
 Data should be stored in a locked filing cabinet at QUT and/or electronically on a QUT mainframe drive.
 Data must not be stored solely at home.
C3.1 X YES Confirm that your research data and other records will be stored for the
required period.
Refer to the Management research data.
C3.2 HARD/PAPER COPIES... (e.g. signed consent forms, are required to be kept for 15 years as per the Qld State Archives
Schedule)
Qld State Archives: http://www.archives.qld.gov.au/Recordkeeping/Governance/Pages/Default.aspx
University Sector: http://www.archives.qld.gov.au/Recordkeeping/GRKDownloads/Documents/Universities.pdf
C3.2. What is the location/s of storage?
(i.e. QUT room/building location and/or offsite storage location)
Only electronic data will be collected as it is an
online based questionnaire.
C3.2. How will access to the stored data be
controlled?
C3.2. Who will have access to the stored data?
C3.3 ELECTRONIC DATA...
C3.3. What is the location/s of storage and back-up?
(i.e. a secure computer/server and/or offsite storage location)
QUT server in a password protected files.
C3.3. How will access to the stored data be
controlled? Password protected.
C3.3.
3
Who will have access to the stored data? QUT research team.

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Appendix 6 - Invitation email for consumer’s participation.
Consumers Reach Email:
Subject Title:
Invitation to participate in research regarding food safety and fresh produce.
Thanks for your time. My name is Murtaza Makhdoom and I am undertaking food safety
research as part of my Master of Public Health (Health, Safety and Environment) course at
Queensland University of Technology (QUT). My research project aims to identify consumers’
food safety knowledge and food handling practices associated with fresh produce, including pre-
packaged fruits and vegetables. If the research identifies any gaps in consumer knowledge, food
safety agencies can use this information to target food safety education.
To gather relevant information, we’re asking people over 18 who currently live in Australia to
complete a 10-minute anonymous online survey.
People who complete the survey can enter the draw to win a $50 Coles voucher. A one-page
summary of the research findings will also be sent to participants who indicate that they would
like this information.
Further details on the study and how to participate can be found by clicking on the following
link:
http://survey.qut.edu.au/f/189300/6c1f/
If you have any questions about this research, please contact our research team via email.
Please note that this study has been approved by the QUT Human Research Ethics Committee
(approval number 1700000400).
Many thanks for your consideration of this request. We would also really appreciate it if you
could pass the survey link on to your family and friends to encourage more people to complete
the survey.

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Murtaza Ahmed Makhdoom
Master student (Principal researcher)
[e-mail]
Belinda Davies
Supervisor
07 3138 5790
[e-mail]
School of Public Health and Social Work, Faculty of Health
Queensland University of Technology
Appendix 7 – Sample approach email
Subject Title:
Participate in a research study regarding food safety and fresh produce.
Dear colleagues,
My name is Murtaza Makhdoom from the School of Public Health and Social Work, Queensland
University of Technology (QUT) and I am doing a research project as part of my Master degree.
If you are over 18 and currently live in Australia, I would appreciate it if you would complete a
10-minute anonymous online survey. The survey focuses on consumers’ food safety knowledge
and practices in relation to fresh produce, including pre-packaged fruits and vegetables.
You can enter the draw to win a $50 Coles voucher. A one-page summary of the research
findings will also be sent to if you indicate you would like this information.
Further details on the study and how to participate can be found by clicking on the following
link:
http://survey.qut.edu.au/f/189300/6c1f/

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If you have any questions about this research, please contact our research team via email.
Please note that this study has been approved by the QUT Human Research Ethics Committee
(approval number 1700000400).
Many thanks for your consideration of this request. We would also appreciate it if you could pass
the survey link on to your family and friends to encourage broader participation.
Murtaza Ahmed Makhdoom
Master student (Principal researcher)
[e-mail]
Belinda Davies
Supervisor
07 3138 5790
[e-mail]
School of Public Health and Social Work, Faculty of Health
Queensland University of Technology
Appendix 8 –Facebook Advertisement.
Draft Facebook Advertisement

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Are you over 18 and currently live in Australia? Complete a 10-minute research survey about
food safety and fresh produce for a chance to win a $50 Coles voucher.
Please note the opening date for entries is 30 May 2017 and the closing date for entries is 28 June 2017.
The prize will be drawn on 30 June 2017. The Terms and Conditions of the prize draw are available at:
https://survey.qut.edu.au/survey-data/68/68338/media/62/6249.pdf
Click on the link to participate in the research
http://survey.qut.edu.au/f/189300/6c1f/
Link will take people to survey information which includes details about the QUT research,
ethics number, etc.
Note: the image used is from https://pixabay.com/en/market-stand-vegetables-variety-601580/
and is free for commercial use and no attribution is required.

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Appendix 9 – Participants Information sheet
PARTICIPANT INFORMATION FOR QUT RESEARCH PROJECT
Consumers’ awareness, knowledge and practices in relation to fresh produce (including pre-
packed fruits and vegetables).
QUT Ethics Approval Number 1700000400
RESEARCH TEAM
Principal Researcher: Murtaza Makhdoom Masters student
Associate Researcher: Belinda Davies Principal Supervisor
School of Public Health and Social Work, Faculty of Health
Queensland University of Technology (QUT)
DESCRIPTION.
This project is being undertaken as part of a Master degree by Murtaza Ahmed Makhdoom.
The purpose of this research is to identify consumers’ current level of food safety knowledge and
food handling practices associated with fresh produce, including pre-packaged fruits and
vegetables.
PARTICIPATION
Participation will involve completing an anonymous online survey that will take approximately
10 minutes of your time.

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Questions will include:
 Who is the primary grocery shopper in your house?
 Where do you get your fresh fruits and vegetables?
 Do you clean fresh produce before consuming it?
 How do you store pre-packaged fruits and vegetables?
 How do you determine when to dispose of fresh produce?
 Where did you learn how to store and handle fresh produce, including pre-packaged fruits
and vegetables?
 Have you or any member of your household previously had food poisoning / food-borne
illness?
Your participation in this research project is entirely voluntary. If you agree to participate you do
not have to complete any question(s) you are uncomfortable answering. Your decision to
participate or not participate will in no way impact upon your current or future relationship with
QUT or any associated external organisation. If you do agree to participate you can withdraw
from the research project during your participation without comment or penalty. However, as the
survey is anonymous once it has been submitted it will not be possible to withdraw.
EXPECTED BENEFITS
It is expected that this research project will not directly benefit you, however you will be
provided a link to information about the safe handling of fresh produce if you’re interested in
learning more about this topic.
Establishing information about consumers’ knowledge and practices in relation to fresh produce
which may also assist future research, environmental health professionals and food safety
agencies. For example, the identification of any gaps in consumers’ food safety knowledge could
be used by food safety authorities to target food safety messages, improve food safety strategies,
etc. This may result in fewer people becoming ill from consuming contaminated fresh produce.

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To recognize your contribution, the research team is offering you the opportunity to go into the
draw to win a $50 Coles voucher. Entries for the prize draw open on 30 May 2017 and close on
28 June 2017. The prize will be drawn on 30 June 2017 at QUT. The Terms and Conditions of
the prize draw can be found at:
https://survey.qut.edu.au/survey-data/68/68338/media/62/6249.pdf
RISKS
There are no risks beyond normal day-to-day living associated with your participation in this
research project.
PRIVACY AND CONFIDENTIALITY
All comments and responses are anonymous and will be treated confidentially unless required by
law. The names of individual persons are not required in any of the responses in the fresh
produce survey, however individualised information will be collected in a second survey which
is not be connected to any responses and only completed if you wish to go into the draw for a
$50 Coles voucher. Names and contact details will be deleted after the prize draw and
distribution of a summary of the research findings.
Any data collected as part of this research project will be stored securely as per QUT’s
Management of research data policy. Please note that non-identifiable data from this research
project may be used as comparative data in future research projects or stored on an open access
database for secondary analysis.
CONSENT TO PARTICIPATE
Submitting the completed online survey is accepted as an indication of your consent to
participate in this research project.
QUESTIONS / FURTHER INFORMATION ABOUT THE RESEARCH PROJECT
If you have any questions or require further information, please contact one of the listed
researchers:

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Murtaza Makhdoom [e-mail]
Belinda Davies [e-mail] 07 3138 5790
CONCERNS / COMPLAINTS REGARDING THE CONDUCT OF THE RESEARCH
PROJECT
QUT is committed to research integrity and the ethical conduct of research projects. However, if
you do have any concerns or complaints about the ethical conduct of the research project you
may contact the QUT Research Ethics Advisory Team on 07 3138 5123 or email
[e-mail]. The QUT Research Ethics Advisory Team is not connected with the
research project and can facilitate a resolution to your concern in an impartial manner.
THANK YOU FOR HELPING WITH THIS RESEARCH PROJECT.
PLEASE PRINT THIS SHEET FOR YOUR INFORMATION.

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Appendix 10: Terms and conditions of entry in the prize draw.
TERMS AND CONDITIONS OF ENTRY INTO A PRIZE DRAW
1. The Promoter is Queensland University of Technology (QUT) ABN 83 791 724 622
having its principal place of business at 2 George Street, Brisbane, Queensland 4000.
2. By entering the competition connected to the research project title ‘Consumers' awareness,
knowledge and practices in relation to fresh produce (including pre-packaged fruits and
vegetables), participants agree to be bound by these Terms and Conditions.
3. Submitting a survey fulfils the conditions of entry into the competition.
4. The opening and closing dates of the competition are listed in the survey. The prize winner
will be selected by random draw which will take place at QUT on the prize draw date as
listed in the survey.
5. The first entry drawn randomly will receive the prize listed on the attached survey. The
prize is not transferable, refundable, exchangeable, and cannot be taken as cash.
6. The Promoter will use reasonable efforts to notify the prize winner by no later than two
weeks post the prize draw date. If a winner cannot be contacted or refuses the prize it will
be offered to the next randomly drawn entry. The promoter’s decision is final as to the
winner of the prize and binding and no correspondence will be entered into in relation to
the conduct of the competition or otherwise.
7. The prize will be available for collection by the winner at a time organised as suitable for
the winner.
8. If this competition is interfered with in any way or is not capable of being conducted as
anticipated due to any reason beyond reasonable control of the Promoter, the Promoter
reserves the right, in its sole discretion, to the fullest extent permitted by the law to (a)

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disqualify any participant; or (b) subject to any written directions from a regulatory
authority, to modify, suspend, terminate or cancel the competition, as appropriate.
9. All entries become the property of the Promoter and will not be returned to participants.
10. Except for any liability that cannot be excluded by law, the Promoter (including its
officers, employees and agents) excludes all liability (including negligence), for any
personal injury or any loss or damage (including loss of opportunity), whether direct,
indirect, special or consequential, arising in any way out of the competition, including but
not limited to, where arising out of the following: (a) any technical difficulties or
equipment malfunction (whether or not under the Promoter's control); (b) any theft,
unauthorised access or third party interference; (c) any entry or prize claim that is late, lost,
altered, damaged or misdirected (whether or not after their receipt by the Promoter) due to
any reason beyond the reasonable control of the Promoter; (d) any variation in prize value
to that stated in these Terms and Conditions; (e) any tax liability incurred by a winner or
entrant; or (f) use of the prize.
11. Each participant indemnifies and keeps indemnified the Promoter against all claims, losses,
damages and expenses suffered by the Promoter or any third parties arising out of the
breach of these Terms and Conditions by the participant, the conduct of the participant in
the competition, the use of information supplied by the participant or the use of the prize.
12. Under the applicable Privacy Laws, the Promoter must tell participants when it collects
personal information about them and how it plans to use it. lf a participant chooses to enter
or take part in the competition, the participant will be required to provide the Promoter
with personal information such as the participant's name and email address. The Promoter
collects participants' personal information in order to conduct the competition and
associated research study. QUT’s Privacy Policy is available at:
https://www.qut.edu.au/additional/privacy

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Appendix 11 – Online Survey.
Survey 1:
Consent:
Thank you for your interest in this survey which focuses on food safety knowledge and food
handling practices associated with fresh produce, including pre-packaged fruits and vegetables.
Your participation in this project is entirely voluntary. If you agree to participate you do not have
to complete any question(s) you are uncomfortable answering. Your decision to participate or not
participate will in no way impact upon your current or future relationship with QUT or any
associated external organisation. If you do agree to participate, but change your mind, you can
withdraw any time during the survey by closing the incomplete survey. However, as the survey
is anonymous once it has been submitted it will not be possible to withdraw.
Submitting the completed online survey is accepted as an indication of your consent to
participate in this project.
Eligibility Criteria:
1. Are you currently living in Australia?
- Yes
- No
2. Are you over 18 years of age?
- Yes
- No
If no to either question, terminate with the survey 3:

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Thank you for your interest in this survey. Only people who are 18 years or older and currently
residing in Australia can participate.
If you’re particularly interested in how to handle fresh produce safely, you may like to visit the
following link: http://www.foodauthority.nsw.gov.au/foodsafetyandyou/special-care-foods/fresh-
fruit-and-vegetables
Demographics:
3. What is your age?
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65-74
- 75 or older
- Prefer not to say
4. What is your gender?
- Male
- Female
- Other
- Prefer not to say
5. What is the highest level of education you have completed?
- Primary school
- High school
- Certificate or trade qualification (e.g. Tafe, diploma)
- Undergraduate university (e.g. Bachelor degree)
- Postgraduate university (e.g. Masters, PhD)
- Prefer not to say

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6. What is your average gross household income per week?
- Less than $500
- $500-$999
- $1,000-$1,499
- $1,500-$1,999
- $2,000-$2,499
- $2,500 or more
- Prefer not to say
7. Which state or territory do you currently live in?
- Australian Capital Territory
- New South Wales
- Northern Territory
- Queensland
- South Australia
- Tasmania
- Victoria
- Western Australia
- Prefer not to say
The next set of questions focuses on identifying if groups at higher risk of food-borne illness are
in the households surveyed.
8. Do you or any of member of your household have an ongoing systemic health condition (i.e.
an underlying medical condition which can affect the immune system)? (select all that apply)
- No
- Yes, a child under 5 years of age
- Yes, a child 5-17 years of age
- Yes, an adult 18-65 years of age
- Yes, an adult over 65 years of age

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9. Are any members of your household under 5 years of age?
- No
- Yes, 1-2 children are under 5 years of age
- Yes, 2-4 children are under 5 years of age
- Yes, there are 5 or more children under 5 years of age
10. Are any members of your household 65 years of age or older?
- No
- Yes, 1-2 adults are 65 or older
- Yes, 3-4 adults are 65 or older
- Yes, 5 or more adults are 65 or older
The following questions focus on the purchasing habits associated with fresh produce.
11. Who is the primary grocery shopper in your house?
- Self
- Shared equally among adults in the house
- Another adult (e.g. partner, parent, housemate)
- Other (please specify) ……………….
12. Who is responsible for most food preparation and cooking in your house?
- Self
- Shared equally among adults in the house
- Another adult (e.g. partner, parent, housemate)
- Other (please specify) ……………….
13. Where do you get your fresh fruits and vegetables? (select all that apply)
- Supermarket (i.e. Coles, Woolworths, IGA, Aldi, etc.)
- Local independent shop or small business
- Farmers market or other market

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- Grow them yourself
- Other (please specify) ……………….
The next questions assess consumers’ current food handling practices.
14. Do you clean and dry your hands before consuming fresh produce? (select all that apply)
- No
- I wash my hands with water
- I wash my hands with soap and warm water
- I use hand sanitiser
- I use a towel or t-towel to dry my hands
- I wipe my hands on my clothing to dry them
- I use paper towel to dry my hands
- Other (please specify) ……………….
15. Do you clean food preparation surfaces (e.g. cutting boards) before preparing fresh produce?
- No
- I use cutting boards / plates and utensils which have already been cleaned
- I clean cutting boards / plates and utensils immediately before use
- I clean cuttings boards / plates and utensils with water
- I clean cuttings boards / plates and utensils with warm water and detergent
- I clean cutting boards / plates and utensils in the dishwasher
- Other (please specify) ……………….
16. Do you clean kitchen benches before preparing fresh produce?
- No
- I use benches which have already been cleaned
- I clean the bench immediately before use
- I clean the bench with a damp cloth
- I clean the bench with an anti-bacterial wipe
- I clean the bench with an anti-bacterial spray

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- Other (please specify) ……………….
17. Do you clean fresh produce before consuming it?
- Never
- Only if it looks dirty
- Most of the time
- Always
- Other (please specify) ……………….
If ‘never’ go to Q19.
18. How do clean fresh produce before consumption? (select all that apply)
- Rinse under running water
- Wash under running water while rubbing the surface
- Rinse in a container of cold water
- Soak the produce in water which contains a product designed to kill bacteria
- Use a damp cloth to wipe the outer surface
- Use paper towel to wipe the outer surface
- Use a brush to scrub the skin of hard vegetables (e.g. potatoes)
- Use a brush to scrub the skin of fruit with rough surfaces (e.g. cantaloupe)
- Wipe the dry product (e.g. rubbing an apple against clothing)
- Other (please specify) ……………….
19. Do you wash pre-packaged fruits and vegetables before consumption?
- No, it is already prewashed
- I quickly rinse it under tap water
- I wash it the same way I wash unpackaged fruits and vegetables
- I don’t buy pre-packaged fruits or vegetables
- Other (please specify) ……………….
If ‘I don’t buy pre-packaged fruits and vegetables’ is selected, go to Q22.
20. Once open, how long do you keep pre-packaged fruits or vegetables?

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- I use it gradually until it has all been used
- I use it gradually, but don’t use it after the best before date
- I use it all in one meal
- Other (please specify) ……………….
21. How do you store pre-packaged fruits and vegetables?
- On the bench / room temperature
- In the refrigerator
- Other (please specify) ……………….
22. Which of the following products do you refrigerate? (select all that apply)
- Berries
- Stone fruits (e.g. peaches, apricots)
- Apples, pears
- Bananas
- Tomatoes
- Spinach
- Lettuce
- Potatoes
- Onions
- Cut vegetables
- Cut fruit
- Other (please specify) ……………….
23. How do you determine when to dispose of fresh produce? (select all that apply)
- By its appearance (e.g. colour change, wilting)
- By its smell
- Starts going mouldy or decaying
- After one week
- After a month
- Other (please specify) ……………….

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The next questions focus on consumers’ perception of food safety risks associated with fresh
produce.
24. Do you believe organic fresh produce is safer?
- Yes
- No
What factors (e.g. chemicals used, how the food is grown) did you consider when making this
decision?
……………….
25. At what stages do believe contamination of fresh produce can occur? (select all that apply)
- While growing in fields, orchards, etc.
- During harvesting
- During processing/packaging
- During distribution (e.g. transporting to retailers)
- In markets
- In food businesses (e.g. supermarkets, restaurants, cafes)
- In homes
- None of the above
- Other (please specify) ……………….
26. How do you believe fresh produce can be contaminated? (select all that apply)
- Soil
- Irrigation systems
- Contaminated / unclean surfaces
- People (e.g. food handlers, customers)
- Other (please specify) ……………….
The next set of questions focus on consumers’ food safety knowledge.

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27. Identify which terms you have heard of. (select all that apply)
- Food-borne illness
- Food poisoning
- Food contamination
- Food spoilage
- None of these
- Other (please specify) ……………….
28. Where did you learn how to store and handle fresh produce, including pre-packaged fruits
and vegetables? (select all that apply)
- Family
- Friends
- School
- TV
- Social media
- Websites
- In-store advice (e.g. information near products)
- Packaging (for pre-packaged fruits and vegetables)
- Other (please specify) ……………….
29. Have you ever heard of anyone getting sick from eating fresh produce including pre-
packaged fruits and vegetables?
- No
- Cannot remember
- Yes
- Other (please specify) ……………….
30. Have you or any member of your household previously had food poisoning / food-borne
illness?
- No
- Cannot remember

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- Yes, within the last year
- Yes, 1-5 years ago
- Yes, 6-10 years ago
- Yes, more than 10 years ago
- Other (please specify) ……………….
31. Which of the following microorganisms (e.g. bacteria, virus) do you believe can contaminate
fresh produce and cause food-borne illness? (select all that apply)
- Clostridium perfringens
- Escherichia coli (e. coli)
- Hepatitis A
- Listeria monocytogenes
- Salmonella
- Staphylococcus aureus
- None
- Don’t know
32. How do you rate your knowledge of e. coli?
- I know everything
- I know a lot
- I know a little
- I have heard of e. coli
- I have never heard of e. coli
33. How do you rate your knowledge of Hepatitis A?
- I know everything
- I know a lot
- I know a little
- I have heard of Hepatitis A
- I have never heard of Hepatitis A

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34. How do you rate your knowledge of Listeria monocytogenes/listeriosis?
- I know everything
- I know a lot
- I know a little
- I have heard of Listeria monocytogenes or listeriosis
- I have never heard of Listeria monocytogenes or listeriosis
35. How do you rate your knowledge of Salmonella?
- I know everything
- I know a lot
- I know a little
- I have heard of salmonella
- I have never heard of salmonella
If answered ‘male’ in Q4, end survey.
The next set of questions focus on advice given to pregnant women to reduce the likelihood of
Listeriosis (i.e. a food-borne illness which can cause miscarriage or birth defects).
36. Are you currently or have you ever been pregnant?
- Yes, currently pregnant
- Yes, have previously been pregnant
- No
- Prefer not to say
If no, end survey.
37. Have you received any information about food safety (e.g. Listeria) during pregnancy?
(select all that apply)
- Yes, from health professionals (e.g. doctor / midwife / nurse)
- Yes, from family
- Yes, from government website/s
- Yes, from other websites

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- No
- Other (please specify) ……………….
38. During pregnancy, which of the following foods do believe are high-risk foods (i.e. have a
higher risk of causing significant illness)? (select all that apply)
- Whole fresh fruit
- Freshly sliced fresh fruit
- Pre-prepared sliced fruit/fruit salad
- Canned fruit
- Frozen fruit used raw
- Frozen fruit used cooked
- Fresh vegetables and herbs
- Cooked vegetables and herbs
- Pre-packaged or pre-prepared salads
- Sprouts (e.g. alfalfa sprouts)
- Canned vegetables
- Frozen vegetables used raw
- Frozen vegetables used cooked
- Other (please specify) ……………….
Thank you for completing the survey.
After submitting the first survey, a link will be provided for the participant to complete a second
survey which allows them to enter the draw for a $50 Coles voucher and request a one-page
summary of the research findings.
Please click on the following link to go into the draw for a $50 Coles voucher or if you would
like a one-page summary of the findings of this research.
- [link to second survey] (Please note: clicking on this link will take you to a separate
survey where you can register your name and contact details for the prize draw of the

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Coles voucher. Using a separate survey for the prize draw ensures the survey you have
just completed remains anonymous.
- No thanks, I don’t want to go into the draw for the Coles voucher or receive a summary
of the research findings.
-
If ‘No thanks, I don’t want to go into the draw for the Coles voucher or receive a summary of the
research findings’, end with message:
Thank you for completing the survey. If you’re interested in how to handle fresh produce safely,
you may like to visit the following link:
http://www.foodauthority.nsw.gov.au/foodsafetyandyou/special-care-foods/fresh-fruit-and-
vegetables
Survey 2:
Consent:
To enter the draw for a $50 Coles voucher, please complete the following information.
Submission of this survey is accepted as an indication of your consent to participate in the draw
for a $50 Coles voucher.
The terms and conditions of the prize draw are available via: [link to terms and conditions]
The competition opens on 15 May 2017 and closes on 11 of June 2017. The prize draw will
occur on 13 of June.
All identifiable information including your name and contact details will be deleted after the
winner has accepted the prize and a summary of the research findings have been emailed to
people who have requested it.

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1. Name: ……………….
2. Postal address: ……………….
3. Phone number: ……………….
4. Email address: ……………….
5. Would you like a one-page summary of the research findings emailed to you?
- Yes
- No
By clicking submit you agree to participate in the prize draw and be bound by the Terms and
Conditions [‘Terms and conditions’ text will be a link to the terms and conditions]
[Submit button]
Thank you for completing the survey. If you’re interested in how to handle fresh produce safely,
you may like to visit the following link:
http://www.foodauthority.nsw.gov.au/foodsafetyandyou/special-care-foods/fresh-fruit-and-
vegetables

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Survey 3:
A third survey has been added, which is only used to provide a termination message to
participants who do not meet the eligibility criteria. The third survey has been added based on
advice from Donald, the HPC Survey Inquiries and Key Survey Daily Event Coordinator, as a
means of preventing system issues in survey 1 (i.e. the main survey).
Thank you for your interest in this survey. However, we are only surveying people who are 18
years or above and currently live in Australia.
If you’re particularly interested in how to handle fresh produce safely, you may like to visit the
following link: http://www.foodauthority.nsw.gov.au/foodsafetyandyou/special-care-foods/fresh-
fruit-and-vegetables

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