Listeria monocytogenes and Ready-to-Eat Meats: Tackling a Wicked Problem using Grounded Theory
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Background: Listeria monocytogenes and ready-to-eat meats have garnered considerable attention in Canada over the past decade as a result of foodborne outbreaks and product recalls that continue to transpire. A number of factors suggest that ready-to-eat meats and Listeria monocytogenes are a wicked problem. They include (among others) the number of stakeholders involved in the processing, distribution and inspection of ready-to-eat meats in Ontario, the ubiquitous and hardy nature of the organism and the challenges associated with eliminating it from ready-to-eat meat products and processing environments. Since Ontario public health units play an integral part in the inspection of ready-to-eat meats in the province, it is important to determine their current role in the wicked problem in order to identify possible solutions for change. Purpose: The purposes of the study were: (1) to determine how Ontario public health units address the wicked problem of Listeria monocytogenes and ready-to-eat meats in their food safety inspection programs using the provincial regulatory framework in addition to the use of research, knowledge translation and innovation; and (2) to develop a theory that identifies gaps (if any) in public health unit inspection practices, provincial legislation or food safety research that serves to generate recommendations to reduce incidence of listeriosis resulting from consumption of RTE meat products. Methodology: The research design used the principles of grounded theory to lead the interview and survey methodology and subsequent data analyses. The study was completed in three phases. Interviews were conducted in the first 2 phases of the study while a survey was conducted in the last phase. Interviews were conducted with public health unit ‘food safety leads’ that met pre-determined eligibility criteria. Following methods used in previous studies,interview data were analyzed in 4 stages of theory development using a grounded theory approach. Through substantive coding and constant comparative methods, core categories were identified in each of the study phases. As a result, theoretical saturation was reached leading to the process of theoretical coding and the emergence of the study theory. Results: In total, 27 public health units of 36 participated in the study. Eleven public health units participated in the first 2 phases of the interviews while 25 public health units (for a total of 45 participants) participated in the survey. The study core category, 'reactive and regulatory practice' evolved from the results of the interviews and survey. As a result, it was determined that: (1) the Ontario provincial regulatory framework including the Food Premises Regulation is almost exclusively responsible for directing food safety inspection practices in food premises; (2) food safety inspection and investigation activities associated with listeriosis outbreaks are the focus of Listeria monocytogenes and ready-to-eat meat research; and (3) innovation and knowledge translation are not currently influenced by inspection practice as a result of the food safety framework which does not require or encourage it. Using the processes of theoretical integration and theoretical coding, the following theory emerged from the data analyses; Ontario public health units manage ready-to-eat meats and Listeria monocytogenes through general population and reactive regulatory processes that focus on local-level, end-product, hazard reduction strategies for established risks in inspected food premises. Strengths and Limitations: The study had several strengths including being the first of its kind to associate ready-to-eat meats and Listeria monocytogenes as a part of a wicked problem. It was also the first study to use grounded theory to illuminate the function and role of Ontario public health units in managing Listeria monocytogenes and ready-to-eat meats. There are a number of limitations to the study including the study sample size, participant inclusion process through provincial public health unit senior management, the generalizability of study results, and method of interviews conducted with participants. Implications: The results of the study have implications for public health researchers and policy/regulatory makers in the province of Ontario. It stresses improved management of Listeria monocytogenes and ready-to-eat meats in food premises using a proactive approach. Conclusions: Using a grounded theory approach, this study demonstrated that Ontario public health units manage ready-to-eat meats and Listeria monocytogenes through reactive and regulatory food safety inspection practices. Survey and interview results indicate that study participants aspire for evidence-based regulatory and program amendments that will allow for proactive and targeted microbial risk-reduction activities at the local level that focus on vulnerable populations. The study substantiates that amendments to the Ontario Food Safety program and in particular, the Food Premises Regulation are necessary.