Exploring factors influencing powdered infant formula preparation behaviours using COM-B Model: implications for food safety and public health.

Objectives: Approaches used to reconstitute powdered infant formula (PIF) have important implications for reducing the microbial risk of infant illness. This study aims to explore UK parents’ PIF preparation/storage and use the COM-B model to inform targeted food safety education strategies.
Design: Qualitative and quantitative data capture from UK-based parents who fed their infant with PIF at least once a day informed the basis of an exploratory study to identify/understand factors that influence PIF safety and identify behavioural change determinants.
Methods: Seven focus groups (n=50 parents) and 200 face-to-face Computer-Assisted-Personal-Interviews were carried out. Parent recruitment occurred according to predetermined criteria. Qualitative analysis used thematic approaches; quantitative analysis used descriptive/inferential statistics. Findings were mapped onto the ‘capability’, ‘opportunity’ and ‘motivation’ components of the COM-B Model.
Results: Key cognitive PIF behavioural influences in the home were identified as a lack of knowledge (87%) and negative attitudes (81%) concerning PIF microbiological hazards, thus potentially impeding psychological capability to minimise such risks during preparation; the majority of parents incorrectly believed that PIF “had to be” a sterile product. Motivation to implement recommended practices and “doing everything by the book” was to prevent infant illness. Challenges concerning the opportunity to implement recommended practices included difficulty in judgement of the temperature of boiled water >70oC before reconstitution.
Conclusions: The COM-B model provided a useful tool in identifying target PIF behavioural determinants. Findings will aid and inform development of targeted interventions to improve key PIF food safety practices and reduce infants’ risk of foodborne illness.