Food Safety Knowledge and Domestic Food-Handling Practices: The Mediating Role of Attitude and the Moderating Role of Risk Perception in Urban Pakistani Households

Abstract

Background: Foodborne disease remains a substantial public health burden worldwide, and unsafe food handling within the home is a recognised contributor to this burden, particularly in low- and middle-income countries where domestic kitchens receive comparatively little regulatory or educational attention. Evidence on how food safety knowledge translates into safer practices in South Asian household settings, and on the psychological mechanisms that strengthen or weaken this translation, remains limited.

Objective: This study examined the relationship between food safety knowledge and food safety practices among domestic food handlers in Pakistan, testing food safety attitude as a mediator and risk perception as a moderator of this relationship. Methods: A cross-sectional, correlational design was used. A convenience sample of 320 domestic food handlers residing in Rawalpindi and Islamabad completed a structured, previously validated online questionnaire measuring food safety knowledge (10 items), food safety attitude (6 items), food safety practices (11 items) and risk perception (9 items) on five-point Likert scales. Data were analysed in SPSS (version 22) using descriptive statistics, correlation, one-way analysis of variance, and hierarchical multiple regression; mediation and moderation were tested with the Hayes PROCESS macro (model 4 and model 1, respectively) using 5,000 bootstrap resamples. Results: Food safety knowledge was positively associated with food safety practices (β = 0.734, p < .001), as was food safety attitude (β = 0.137, p < .001); together these variables explained 72.6% of the variance in practices. Food safety attitude partially mediated the knowledge-practice relationship (indirect effect = 0.125, boot SE = 0.036, 95% CI [0.054, 0.195]). Risk perception significantly moderated the attitude-practice relationship (β = -0.087, p = .005): the association between attitude and practice was stronger among respondents reporting lower risk perception. Conclusion: Food safety knowledge shapes domestic food safety practices both directly and through its influence on attitude, while high risk perception paradoxically attenuates the benefit of a positive attitude on practice. Interventions that pair knowledge transmission with attitude change, while addressing complacency associated with low perceived risk, may be more effective than knowledge-only food safety education for household food handlers.

Keywords: Food safety knowledge; food safety attitude; food safety practices; risk perception; mediation; moderation; domestic food handling; Pakistan