الفهرس 
Introduction and Aim of the StudyOnly 14 pages are availabe for public view
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Abstract
Safe food is a basic human right and in modern society prevention of disease and improvement of human health is of paramount importance, not only for governments and industries but also for consumers themselves.
Given that chemotherapy used for cancer treatment interrupts the growth cycle of the rapidly dividing cancer cells, as well as the patients’ immune cells. Cancer patients become more susceptible for immunodeficiency which reduces their defense against opportunistic pathogens. Listeria monocytogenes is one of the pathogens which result in high mortality among patients with various malignancies.
Consequently, this work aimed to evaluate the effect of food safety intervention program on knowledge, attitudes and practices of cancer patients undergoing chemotherapy.
To fulfill this objective, a total of 90 patients diagnosed with cancer and currently receiving chemotherapy were selected. Sampled patients were divided and allocated in the control group (45 patients) and the experimental group (45 patients), based on patient’s willingness to receive food safety information during their treatment.
Data was collected through interview questionnaire. Patients in both the control group and the experimental group were assessed for knowledge, attitude and practices pre-intervention and post-intervention. Only patients of the experimental group were subjected to the intervention program. Experimental group patients were divided into small sub-groups which don’t exceed 5 patients per sub-group and received the intervention program sessions during their chemotherapy session. Patients in the experimental group received two sessions of the intervention program, each session was about 60-90 min long. Sessions included group discussion, lectures, talks, videos and brochures. The same interview questionnaire used in the first assessment phase had been used twice for the experimental group (immediately after the intervention and one month later) to evaluate knowledge, attitudes and practices after implementation of the program.
The results of the present study revealed that:
77.8% of patients in the control group and 82.2% of the experimental group were from Alexandria.
42.2% of patients in the control group were illiterate or read and write and 37.8% of the experimental group had secondary or technical education.
97.8% of patients in the control group and 86.7% of the experimental group never received food safety information from healthcare staff during cancer therapy.
11.1% of patients in the control group and 28.9% of patients in the experimental group reported to eat out-home meals once per month.
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All patients in the two groups reported family and friends as one of their food safety information sources, followed by T.V and internet. Then only few of experimental group patients reported doctors and study/reading as a source of their information.
1- Food safety knowledge:
For the control group before intervention, no patient showed good level of overall knowledge, food contamination, food handling, and safe food knowledge, as well as 17.8% and 13.3% of patients showed good level of cross-contamination and personal hygiene knowledge.
For the control group immediately after the intervention period, no patient showed good level of overall knowledge, food contamination, food handling, and safe food knowledge, as well as 11.1% and 13.3% of patients showed good level of cross-contamination and personal hygiene knowledge.
There was no statistically significant difference between the patient’s knowledge in the control group before intervention and immediately after the intervention period.
For the experimental group before intervention, 4.4%, 8.9%, 4.4%, 15.6%, 4.4% and 2.2% of patients showed good level of knowledge for food contamination, cross-contamination, food handling, personal hygiene, safe food and overall knowledge, respectively.
For the experimental group immediately after intervention, 80.0%, 95.6%, 84.4%, 80.0%, 95.6% and 91.1% of patients showed good level of knowledge for food contamination, cross-contamination, food handling, personal hygiene, safe food and overall knowledge, respectively.
There was highly statistically significant increase in patient’s knowledge in the experimental group due to the intervention.
For the experimental group one month after intervention, 73.33%, 100.0%, 86.67%, 86.67%, 91.1% and 97.78% of patients showed good level of knowledge for food contamination, cross-contamination, food handling, personal hygiene, safe food and overall knowledge, respectively.
There was a statistically significant increase in patient’s knowledge for only cross-contamination, and food handling one month after intervention.
Most of the studied factors had no statistically significant effect on most of food safety knowledge parameters in the experimental group of patients before intervention, immediately after intervention and one month later.
Before intervention, only the source of food safety information showed statistically significant effect on patient’s overall knowledge.
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2- Food safety attitude:
For the control group before intervention, only 22.2% patients showed positive overall attitude, as well as 31.1%, 33.3%, 6.7%, 31.1% of patients showed positive attitudes towards cross-contamination, food preparation, food storage and safe food parameter, respectively.
For the control group immediately after the intervention period, only 15.6% of patients showed positive overall attitude, as well as 20%, 28.9%, 8.9%, 24.4% of patients showed positive attitudes towards cross-contamination, food preparation, food storage and safe food parameter, respectively.
There was no statistically significant difference between the patient’s attitude in the control group before intervention and immediately after the intervention period.
For the experimental group before intervention, only 31.1% of patients showed positive overall attitude, as well as 26.7%, 46.7%, 8.9% and 31.1% of patients showed positive attitudes towards cross-contamination, food preparation, food storage and safe food parameter, respectively.
For the experimental group immediately after intervention, all patients showed positive overall attitude, as well as 73.3%, 95.6%, 84.4% and 93.3% of patients showed positive attitudes towards cross-contamination, food preparation, food storage and safe food parameter, respectively.
There was highly statistically significant increase in patient’s attitude in the experimental group due to the intervention.
For the experimental group one month after intervention, all patients showed positive attitudes in overall attitude and safe food parameter, as well as 80%, 95.6% and 82.2% of patients showed positive attitudes towards cross-contamination, food preparation and food storage, respectively.
There was only a statistically significant increase in patient’s attitude for safe food parameter one month after intervention.
Most of the studied factors had no statistically significant effect on most food safety attitude parameters in the experimental group of patients before intervention, immediately after intervention and one month later.
The source of food safety information showed statistically significant effect on patient’s overall attitude immediately after intervention. While receiving food safety advice from healthcare staff, showed statistically significant negative effect on patient’s overall attitude immediately after intervention and one month later.
3- Food safety practice:
For the control group before intervention, no patient showed good level in overall practice and safe food parameter, as well as 13.3%, 6.7% and 13.3% of patients showed
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good level of practice in cross-contamination, handling and preparation, and food storage parameters, respectively.
For the control group immediately after the intervention period, no patient showed good level of overall practice, as well as 6.7%, 4.4%, 11.1% and 2.2% of patients showed good level of practice in cross-contamination, handling and preparation, food storage and safe food parameters, respectively.
For the control group, there was no statistically significant effect after the intervention period on studied parameters except for safe food parameter.
For the experimental group before intervention, no patient showed good level in overall practice, cross-contamination, handling and preparation and safe food parameter. While only 6.7% of patients showed good level of practice in food storage parameter.
For the experimental group immediately after intervention, 75.6% of patients showed good level of overall practice, as well as 82.2%, 86.7%, 66.7% and 40% of patients showed good level of practice in cross-contamination, handling and preparation, food storage and safe food parameter, respectively.
There was highly statistically significant increase in patient’s practice in the experimental group due to intervention.
For the experimental group one month later after intervention, 91.1% of patients showed good level of overall practice, as well as 91.1%, 86.67%, 82.2% and 68.89% of patients showed good level of practice in cross-contamination, handling and preparation, food storage and safe food parameter, respectively.
There was a statistically significant increase in patient’s overall practice, food storage parameter and safe food parameter one month after intervention.
Most of the studied factors had no statistically significant effect on most of food safety practice parameters in the experimental group of patients before intervention, immediately after intervention and one month later.
6.2. Conclusion
It could be concluded from the study that:
Before intervention, no patient showed good level of food safety practice, and only 2.2% showed good level of food safety knowledge. In the meantime, most of patients showed indifferent attitude towards food safety.
There was high significant improvement in the level of food safety knowledge, attitude, and practice of patients due to intervention and one month later.
Improving patient’s food safety knowledge induces their attitudes towards food safety, which in return support patient’s capability to adopt good practices after intervention and even for a month later.
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6.3. Recommendations
According to the present study, the following recommendations should be into consideration regarding:
A. Healthcare providers-oriented recommendations:
1- Regular developing of highly focused and targeted food safety programs for cancer patients by adequately trained healthcare providers to introduce science-based solutions for the specific difficulties and barriers faces cancer patients in implementing safe food practices and to target gaps between what was being done and what should be done.
2- Involving cancer patients in food safety programs early after diagnosis and don’t confine it only for patients who suffer from neutropenia.
3- Provide waiting area in hospitals, oncology clinics and rooms gathering patients for chemotherapy sessions with educational videos on display screens, banners, posters and brochures to create discussions and facilitate speech about food safety issues between patients and healthcare providers such as nurses.
4- Provide regular psychological support sessions for cancer patients by adequately trained cancer coaches, as patient’s psychological status during cancer therapy was reported as one of the main factors enhance their decision making skills to adopt safe practices throughout their treatment journey.
B. Governments and health administrations-oriented recommendations:
1- Establish fixed food safety units in hospitals provided with adequately trained healthcare providers in food safety.
2- Provide healthcare professionals with scientific-based educational materials, in addition to a documented food safety guidance which specifically targets cancer patient’s problems in order to avoid inconsistency in food safety advice given for patients.
3- Highlight the responsibility of ministry of education to provide food safety education starting from the elementary school.
4- Activate the role of ministry of information and broadcasting in providing food safety speech through different tools of social media in order to raise public awareness towards food safety topics.
5- Encourage the collaboration between ministry of social solidarity and ministry of health to provide low-income cancer patients with monthly vouchers that could help them to maintain a minimum level of food security during their treatment.
C. Future researches recommendations:
1- More interventions are needed among cancer patients in Egypt to investigate the barriers and the motivators which affect patient’s adherence to food safety advice in order to design effective food safety programs based on patient’s needs.
2- More studies are needed to investigate healthcare professional’s barriers and motivators to provide food safety advice for their patients.
3- More studies are needed to measure the effectiveness of food safety education among cancer patients with different medical cases and its realistic impact on their health status.