Amidst the ongoing challenges presented by the COVID-19 pandemic, a team of researchers from the King Abdul-Aziz University, in collaboration with the Saudi Arabia Ministry of Health, has developed and validated a comprehensive questionnaire designed to assess the food safety knowledge, perceptions, and practices (KPPs) of hospital food service staff (FSS). Detailed in the latest issue of the Saudi Medical Journal (DOI: 10.15537/smj.2024.45.1.20230272), this pioneering study establishes a new standard for ensuring food safety in healthcare settings.

The importance of stringent food safety measures has been highlighted by the pandemic, as hospital food service workers play a crucial role in maintaining the health and safety of patients, visitors, and hospital staff. With the potential risk of coronavirus transmission through contaminated surfaces and poor hygiene practices, the need for an effective assessment tool has been more critical than ever.

A Rigorous Development Process

The process of developing the questionnaire involved an extensive literature review and engaging focus groups, which included members of the general public, FSS, and key food service experts. The team pursued a methodical approach to ensure the survey instrument adequately covered all essential aspects of food safety within the hospital context.

Pilot testing the questionnaire provided insights into its practical application and helped finalize the content validity ratio (CVR), with most items scoring an outstanding 0.96, demonstrating excellent content validity. The subsequent pilot study, which included 40 FSS, affirmed the reliability of the questionnaire with a Cronbach’s alpha value of 0.914, indicating strong internal consistency across the scales.

The final version of the instrument consists of 115 items and is available in both English and Arabic. It is not only an excellent tool for assessing the current state of food safety KPPs among FSS but will also serve as an invaluable resource for continuous improvement and training in foodborne disease prevention—a critical concern in healthcare facilities.

Validation and Accessibility

The team’s validation process followed best practices in questionnaire design, drawing upon guidelines for translating data collection instruments and supporting materials as outlined by Pan Y and de La Puente M (Survey Methodology, 2005). This ensured that the tool was culturally sensitive and accessible to all FSS in Saudi hospitals.

In discussing content validity, the research referenced Lawshe CH’s work, “A quantitative approach to content validity” (Personnel Psychology, 1975), confirming that the developed tool meets the stringent requirements for a valid assessment instrument.

Implications for Food Safety

This research arrives at a critical time when concerns about the spread of COVID-19 have galvanized attention on hygiene practices across all sectors, particularly in food service within healthcare environments. The Centers for Disease Control and Prevention (CDC) have emphasized the importance of cleanliness, proper food handling, and safety precautions to reduce the spread of the virus.

The World Health Organization (WHO) has also issued interim guidance on the use of masks and other protective measures, reinforcing the need for comprehensive safety protocols in high-risk settings like hospitals.

The development of such an evaluation tool can significantly influence how hospital kitchens implement and enforce food safety measures. By identifying areas of knowledge deficiency or incorrect practices, the questionnaire can guide targeted interventions to reduce the risk of foodborne illnesses.

Pathway for Future Research

Researchers Abdulssalam Nisreen M, Alnomani Hajar B, and their team have provided a framework that can be adapted to various hospital settings globally. The study’s implications go beyond the immediate need during the pandemic, offering a benchmark for future research and development in food safety assessment tools within healthcare institutions.

Through its rigorous development and validation process, this survey instrument sets a new precedent for assessing and maintaining food safety standards. It offers a pathway for healthcare facilities to actively mitigate risks associated with foodborne diseases, particularly during outbreaks and public health crises.


1. Hamed A, Mohammed N. “Food safety knowledge, attitudes and self-reported practices among food handlers in Sohag Governorate, Egypt.” East Mediterr Health J 2020; 26:374-381. DOI: 10.15537/smj.2024.45.1.20230272
2. Van Doremalen N, Bushmaker T, Morris DH, et al. “Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.” N Engl J Med 2020; 382:1564-1567. DOI: PMC7121658
3. Centers for Disease Control and Prevention. “How COVID-19 spreads.” Updated 2022.
4. World Health Organization. “Advice on the use of masks in the context of COVID-19: interim guidance, 5 June 2020.” Updated 2020.
5. Lawshe CH. “A quantitative approach to content validity.” Person Psychol 1975; 28:563-575.


1. Hospital Food Safety
2. COVID-19 Food Practices
3. Healthcare Food Service
4. Food Safety Assessment Tool
5. Foodborne Illness Prevention