Structural Equation Modeling of Food Safety Knowledge, Attitude, and Practice among Vendors and Customers in an...

Food safety in low- and middle-income countries (LMIC) is often compromised by informal fruit and vegetable markets due to poor infrastructure, weak oversight, and unsafe handling. While the Knowledge-Attitude-Practice (KAP) framework is widely applied, links between knowledge and practice in these settings remain unclear. This study assessed KAP profiles of 111 vendors and 384 customers in an informal market in Kermanshah, Iran. The market mainly sells fresh vegetables (80-85%) and cut fruits (15-20%), typically displayed without refrigeration. Validated questionnaires revealed that only 23.4% of vendors met acceptable food safety standards, and 60% stored cut fruits improperly. Vendors, despite greater awareness, showed poorer hygiene than customers (p < 0.001), who practiced safer behaviors such as hand hygiene and reusable bag use. Structural Equation Modeling indicated that knowledge influenced practice directly (β = 0.35) and indirectly via attitude (β = 0.42), with attitude being the strongest predictor (β = 0.50, p < 0.001). Prior municipal training increased vendors' odds of high KAP scores 4.35-fold (95% CI: 1.20-16.7). Findings highlight the need for tailored interventions in LMICs' informal markets, combining vendor training, practical support, and infrastructure improvements to close the knowledge-practice gap.