Community readiness to improve food safety practices among informal food handlers: A qualitative analysis in the three major cities in Ecuador

Background and objective: Food safety is a critical issue in low- and middle-income countries and is a barrier to healthy eating in Ecuador. This study aimed to explore community readiness to implement strategies to improve food safety among informal food handlers in urban Ecuador. Methods: Using the Community Readiness Model (CRM), 40 in-depth interviews were conducted with key informants in the urban area of the three major cities in Ecuador (Quito, Guayaquil and Cuenca). Data collection was conducted from September to December 2020. The informants included governmental officials involved in regulatory actions regarding food safety among informal food handlers and non-governmental community members related to the preparation, transportation, and consumption of informally produced foods. The governmental informants belonged to the Ministry of Health, Food Safety Regulatory Agencies and the City council; the non-governmental informants comprised informal food handlers, consumers' advocacy groups, health professionals, food deliverers, and cleric representatives. The CRM determines the communities' willingness to implement preventive strategies for a specific problem (i.e., unsafe foods sold by informal food handlers) by exploring five critical dimensions (community knowledge of efforts, leadership, community climate, knowledge of the issue and resources). A score was assigned for each dimension (from 1 = no awareness to 9 = high level of community ownership), which was then used to generate an overall readiness score for each city. A thematic analysis was undertaken to understand the scores and identify critical factors (i.e., barriers or facilitators) for preventive strategies. Results: The three cities were in a "denial/resistance" stage (Cuenca: 2.9 ± 0.4; Quito 2.9 ± 0.4; Guayaquil 2.8 ± 0.5), regarding the need to implement strategies to improve food safety among informal food handlers. In Cuenca and Quito, the scores ranged from denial to vague awareness for all the dimensions, with community knowledge about the efforts receiving the lowest score (Cuenca: 2.4 ± 0.8; Quito: 2.3 ± 1.4). In Guayaquil, the community knowledge about the efforts was in a "no awareness" stage (1.8 ± 0.8), while the other dimensions ranged from denial to vague awareness. Straightforward strategies to promote food safety among informal food handlers were not identified. Training sessions were mentioned as the primary strategy but seemed to be improvised. The governmental enti