Knowledge, attitudes and practices of food handlers in restaurants that serve undercooked burgers in Hong Kong: A mixed methods study

Abstract

“Gourmet-style” burger restaurants have become increasingly popular in Hong Kong in recent years. These restaurants' practice of undercooking beef patties for desired juiciness may result in foodborne illness. This study examined food handlers' knowledge, attitudes, and practices regarding beef burger preparation at food premises using a two-phase mixed methods approach. The Health Belief Model (HBM) was applied to examine food handlers' perceptions of risk, severity, barriers, and benefits associated with cooking burgers thoroughly. The telephone survey (n = 1025) showed that higher-priced beef burger restaurants were more likely to serve undercooked burgers (p < 0.00001). Face-to-face interviews and observations of restaurants that served undercooked burgers (n = 24) found that most food handlers were unfamiliar with the safe internal temperature-time combinations and did not use a thermometer to verify doneness. Around 17% of the reportedly well done burgers were undercooked, posing an uninformed risk to consumers who ate undercooked burgers without being told beforehand. The HBM analysis revealed that food handlers were not keen on cooking burger thoroughly. Despite the lack of knowledge (e.g., not knowing the risk of eating undercooked minced meat) and high-risk practices (e.g., thawing frozen meat at room temperature) found among some food handlers, they were confident in their ability to properly prepare food. This study suggests that efforts should be made to promote safe food handling practices and stress the importance of using thermometers for food handlers.