Beyond Knowledge and Behavior: Exploring the Modifying Factors Influencing Older Adults' Domestic Food Safety

Older adults are at increased risk of foodborne illness due to age-related changes in immune function. Previous research has identified discrepancies between food safety knowledge, attitudes, self-reported practices, and observed behaviors among older adults; however, why potentially unsafe food safety practices occur is unknown. The Health Belief Model identifies modifying factors as influences on health behaviors, yet these factors are seldom considered in consumer food safety research. This study aimed to explore the modifying factors influencing domestic food safety beliefs and behaviors among older adults. A retrospective qualitative analysis was undertaken using interview transcripts from a completed doctoral study involving adults aged ≥60 years living in Wales (n = 100). The original study identified discrepancies between food safety cognition and behavior, but the factors contributing to these differences were not explored. Interview transcripts were analyzed using the Dimensions of Wellness (physical, intellectual, emotional, social, spiritual, vocational, financial, and environmental) as an analytical framework to examine the modifying factors of the Health Belief Model. Factors influencing food safety beliefs and behaviors included health changes, sensory decline, household transitions, social circumstances, access to food, financial resources, and changing food environments. Findings indicate that food safety behaviors are shaped by wider life circumstances rather than knowledge and perceptions alone. Although the eight dimensions provided a useful exploratory framework, considerable overlap indicated the need for refinement into five broader determinants: biological, physical, psychological, economic, and social. This revised framework provides a more structured approach for understanding the modifying factors of food safety behaviors among older adults. It may also support future research and the development of targeted food safety interventions.