# Knowledge, attitude, and practice towards food safety amongst school children, food handlers and consumers: protocol for a pre-post longitudinal study in North East India

## TL;DR

This study aims to improve food safety knowledge and practices among school children, food handlers, and consumers in North East India through an educational intervention and a mobile app.

## Contribution

The study introduces a mobile app for scalable data collection and a framework adaptable to diverse regions for food safety awareness.

## Key findings

- The study will assess changes in knowledge, attitudes, and practices before and after an educational intervention.
- A mobile app will be used to streamline data collection and improve consistency in field surveys.
- Findings will support the development of a Social and Behavior Change Communication model for food safety.

## Abstract

The North Eastern states of India exhibit a rich diversity of cultural, geographical, and traditional food practices, which, while unique and valuable, contribute to an increased susceptibility to foodborne and waterborne diseases. While these practices contribute to the region’s identity, inadequate food safety measures increase the risk of foodborne diseases, constituting a pressing public health issue.

This study aims to assess the knowledge, attitudes, and practices (KAP) related to food safety among school children, food handlers, and consumers in eight North Eastern (NE) states of India. It also evaluates the changes in KAP scores across all three study groups following an educational intervention program.

A pre-post quasi experimental longitudinal study design involving 11 NE centres under the ICMR FoodNet program and comprising three waves:

Wave 1: Baseline cross-sectional KAP assessment among school-going children (studying in 9th and 10th standard), food handlers, and consumers by using structured questionnaires adapted from WHO and CDC guidelines.

Wave 2: Implementation of an educational intervention in all three study groups only, guided by a checklist. No intervention for control groups.

Wave 3: Post-intervention quasi-experimental assessment of both the study and control groups to evaluate changes in KAP at one-month post-intervention, and 6 months post-intervention.

The study is expected to enhance knowledge and promote sustainable hygiene practices among participants, reduce high-risk behaviors, and foster community-level dissemination of food safety knowledge. Findings will contribute to evidence-based policymaking and support the development of a Social and Behavior Change Communication (SBCC) model for food safety. Insights from this pilot study will provide an adaptable framework to generate food safety awareness data in other regions with diverse cultural and geographical contexts. The mobile app developed for this KAP study will act as a ‘scalable tool’ by enabling field workers to efficiently collect and submit standardized KAP data across diverse settings, thereby improving consistency and moderating the logistical burden often associated with such large-scale field surveys. If effective, the app can support data collection nationwide, extending its utility beyond North East India.

Diagram illustrating the e-KAP study. The target population includes school children, food handlers, and consumers. Two groups, control and study, are shown. Pre-intervention involves no intervention at day zero for control. The study group receives an intervention within three weeks. Post-intervention assessments occur at one and six months. Outcome measurement involves comparing study and control groups using a checklist and bar chart.