Progressive Changes in Household Food Safety Handling Knowledge and Behaviors Associated with a Continuous Tracing Intervention Among Rural Residents in China

Household food safety refers to consumer practices that reduce microbial contamination, cross-contamination, temperature abuse, and foodborne disease risks during food storage, preparation, cooking, and leftover handling. Rural households may be particularly vulnerable because of limited access to standardized food safety education and the persistence of experience-based practices. This study examined progressive changes in household food safety handling knowledge and behaviors associated with cumulative exposure to a continuous tracing intervention among rural residents in China. A two-month quasi-experimental repeated-measures study without a non-intervention control group was conducted in rural households in Liaoning, Jilin, and Heilongjiang provinces. A total of 139 households completed all intervention activities and four assessment waves, yielding 556 valid questionnaires. The intervention consisted of 10 rounds of paper-based and video-based materials targeting food safety knowledge, risk awareness, and self-efficacy. Outcomes were measured at baseline, after four intervention rounds, after eight rounds, and after ten rounds. Food safety behavior scores increased from 9.76 at baseline to 11.66, 13.33, and 14.72 after successive intervention stages. Knowledge scores increased from 13.71 to 17.35, 19.34, and 21.43, respectively. Pairwise comparisons showed significant differences between all assessment waves for both outcomes. Analyses accounting for the repeated-measures structure showed a positive association between food safety knowledge and self-reported handling behavior. Both online and offline delivery channels were associated with improvements in knowledge and behavior, while between-channel differences did not appear to be the primary driver of the observed changes. However, causal interpretation should be cautious because the study lacked a non-intervention control group, and testing effects, maturation, seasonal influences, and social desirability cannot be ruled out.