Food allergy knowledge, attitudes and their determinants among restaurant staff: A cross-sectional study

Background: There is wide international variation regarding food allergy knowledge among restaurant staff. Further, attitudes towards food allergy remain under-researched. Insights into the independent determinants of knowledge and attitudes are limited due to lacking mutual statistical adjustment for determinants/confounders in the vast majority of prior studies. In this study we aimed to contribute novel data on the food allergy knowledge and attitudes among restaurant staff in Germany whilst also examining potential determinants of both outcomes using multivariable approaches. Methods: We collected data face-to-face from 295 staff members in restaurants in Düsseldorf, Germany. Knowledge was assessed by asking participants to name three common food allergens and to answer five true/false-statements. Seven items assessed attitudes. A total of 16 potential determinants were examined using logistic regression models with backward selection. Results: Only 30% (n = 89) of the respondents correctly named three food allergens and 41% (n = 120) attained a perfect score on the true/false statements. The vast majority expressed positive attitudes toward the need for cooperation and shared responsibilities for food-allergic customers. However, the expressed attitudes towards serving customers with food allergies and validity of customer-reported food allergies were unfavorable. Determinants of food allergy knowledge (e.g. the type of restaurant, professional roles, or levels of school education) and of unfavorable attitudes (e.g. gender) were identified. Conclusions: Food allergy knowledge was suboptimal among restaurant staff and attitudes towards customers were rather poor. While we identified some determinants, additional studies are needed to systematically examine potential determinants for targetting educational interventions in the future.