Abstract

Foodborne diseases (FBD) pose a major public health concern in South America, where home-based food preparation is a significant risk factor. This study investigated whether risk perception and all constructs of the Theory of Planned Behavior (TPB) - attitude, subjective norm, and perceived behavioral control (PBC) - serve as potential mediating variables in the relationship between knowledge and the intention to engage in food safety behavior. A cross-sectional survey was conducted across seven South American countries (Argentina, Brazil, Chile, Colombia, Ecuador, Peru, and Venezuela) with 2255 consumers. Data were collected using a validated questionnaire in Portuguese and Spanish, based on the World Health Organization's Five Keys to Safer Food and the TPB constructs. The questionnaire's content was validated with experts (n = 5) and the target population (n = 30) of each country using a content validity coefficient (CVC) with a cut-off point of CVC >= 0.70. A parallel mediation model using Hayes PROCESS was performed to examine direct and indirect effects. Bootstrapping with 5000 resamples was used to estimate direct and indirect effects. All participants provided informed consent according to Brazilian ethics committee. Knowledge drove food safety intentions indirectly through PBC (H5d - accepted, f(2) = 0.089 - small; beta = 0.137; p < 0.001) and risk perception (H5e - accepted, beta = 0.113; p < 0.001). PBC (H3 - accepted, f(2) = 0.175 - medium; beta = 0.481; p < 0.001) was the strongest predictor of intention and behavior, followed by subjective norms (H2 - accepted, f(2) = 0.018 - small; beta = 0.071; p < 0.001), while attitude (H1 - rejected, f(2) = 0.019 - small; beta = 0.007; p = 0.620) had a limited effect. Risk perception significantly drove behavior through PBC (H6c - accepted, f(2) = 0.048 - small; beta = 0.134; p < 0.001), reinforcing the importance of perceived control in safe food handling. The findings underscore the role of social influence in collectivist societies, where social norms shape food safety practices. This study provides practical guidance for designing interventions that promote food safety by strengthening individuals' perceived control and harnessing positive social norms. The findings offer actionable insights to support the development of public policies and educational programs aimed at reducing the risk of FBD in South America.