Developing a food safety consumer experience scale: Qualitative insights from Bangladesh, Ethiopia, and Vietnam

Objectives: Unsafe food contributes to 600 million cases of foodborne illness and 420,000 deaths annually. Existing methods used to evaluate food safety risks overlook consumers’ perspectives coming from their everyday experiences that influence their food choices. Our objective was to develop a cross-culturally appropriate and user-friendly scale to assess consumers’ experiences related to food safety in low- and middle-income countries. This study identified the constructs that constitute the experiences of food safety that the scale should reflect. Methods: In-depth interviews were conducted with urban households in Bangladesh (n=51), Ethiopia (n=50), and Vietnam (n=41). Eligible households had children aged 2–5 years and members serving as primary food purchasers, preparers, and caregivers. Interviews explored attitudes, perceptions, and lived experiences related to food safety. Data were analyzed using a constant comparative method. Results: Respondents expressed awareness of biological and chemical contaminants in foods. Concerns about chemical additives and food adulteration were common, fueled by beliefs that these hazards cause chronic illnesses. Personal and familial experiences with foodborne illness reinforced caution when buying foods. Religious and cultural beliefs shaped how respondents explained and responded to food safety concerns, with some attributing illness symptoms to spiritual causes. Trust in food vendors was rooted in reputation, visible cleanliness, and willingness to rectify issues (e.g., exchange items). Respondents differentiated their extent of scrutinizing safety based on food type: staples such as rice and pulses were assessed more by vendor credibility, whereas perishables such as fish and meat underwent direct, detailed inspections. Low transparency in food sourcing and how vendors prepared foods were persistent concerns. Conclusions: Trust, perceived transparency, risk perceptions, and past incidents shaped consumers’ mental representations and behaviors related to food safety. Interviews underscored the centrality of context and sensory-based quality indicators, suggesting that scenario-based assessments are more appropriate than generic risk-reduction items.