Introduction

Sub-Saharan Africa’s traditional informal markets are a key source of fresh, affordable, and easily accessible food [1]. However, because of limited regulations and infrastructure, poor environmental conditions, and unhygienic food handling practices by vendors, foods sold at these markets significantly contribute to foodborne diseases, thereby hampering food and nutrition security and exacerbating socio-economic inequalities [2,3]. Ready-to-eat animal-source food sold at local eateries, are a particular high-risk food category [4]. In Burkina Faso, flamed, braised, and grilled chicken are popular dishes among urban consumers [5]. Three-quarters of chicken meat is consumed at, or taken away from local eateries [6]. Compared to beef, dairy, and vegetables, the levels of microbial contamination in poultry meat and the resulting disease burden are high [7]. In Burkina Faso alone, the estimated annual economic losses attributed to foodborne disease were US$3 billion in 2018 [8] accounting for 3% of the gross national income per capita (GNI) [9]. Escherichia coli and Salmonella spp. prevalence in poultry meat ranged between 29 to 45%, and 57% respectively [8]. Approximately one out of 50 consumers fell sick, while one out of 30,000 persons in the total population died from consuming contaminated poultry meat in 2017 [7].

At the point of sale, unhygienic handling and preparation practices by vendors during slaughtering, scalding, plucking, washing, and grilling, contribute to high contamination levels in ready-to-eat chicken [6]. Contamination has been linked to poor personal and environmental hygiene, improper transporting and storage, unclean materials, and contaminated water [5]. Hence, vendors are key to preventing foodborne disease [4]. Evidence, however, points towards low food safety knowledge and awareness deficits resulting in high-risk practices among food handlers in the informal sector [1,10] For instance, a survey among poultry vendors in Ouagadougou, Burkina Faso, revealed poor food handling and preparation practices, despite awareness of food safety requirements [11]. Despite efforts to promote food safety in low and middle-income countries (LMICs), informal food value chains are still largely ignored by governments, with minimal on-ground efforts and initiatives that often overlook vendors [3]. Generally, interventions targeting vendors heavily rely on education to improve safe food handling [12], assuming that increased knowledge will change attitudes and behavior [13]. Several studies reported on the potential effectiveness of food safety training in enhancing knowledge and awareness of risky food practices [14,15], and overall effectiveness of training in improving vendor food safety behaviors in LMICs [13,15]. Other studies, however, observed that despite initial behavioral improvements, hygiene at outlets not always improved, and behavior change did not necessarily sustain over time due to physical barriers [16]. The challenge of on-off training programs without ongoing support systems could be attributed to reliance on traditional knowledge-sharing models, and discrepancies with knowledge-application contexts [17]. For behavior change, knowledge should be combined with attitudinal and motivational change, increased skills, and opportunities to implement the required behavior [18]. Thus far, research evaluating food safety interventions has generally focused on knowledge and behavior changes, with limited attention to vendors’ capabilities, opportunities, and motivations that drive behavior change [19,20]. For example, evidence on motivational change after participating in interventions remains mostly anecdotal, with only a few studies aiming to understand motivations using qualitative techniques, while these are better suitable for understanding the underlying, hidden drivers or barriers behind actions [12,19].

This study therefore aimed to provide a comprehensive understanding of ready-to-eat chicken street vendors’ capabilities, opportunities, and motivation for behavior change, after participating in a food safety training intervention at informal markets in Ouagadougou, Burkina Faso through qualitative research. The training intervention, implemented in October and November 2022, aimed to improve vendors’ food safety knowledge, attitudes, and practices, through participatory training and the distribution of enabling equipment. A quantitative baseline assessment, conducted as part of a Randomized Controlled Trial (RCT), which assessed the impact of this intervention through outlet observations and vendor surveys reported elsewhere [21], showed relatively poor food safety knowledge and practices prior to the training. For example, on a ten-point knowledge score, mean knowledge score was six, pre-training. In terms of chicken carcass management and chicken preparation, less than half of the vendors regularly renewed water when washing raw chicken carcasses or handled prepared chicken while wearing gloves or using a fork and knife. Less than a quarter of outlets had an adequate handwashing facility for employees and customers, and more than half of the outlets were observed to have poor waste management practices [22]. Additionally, a previous Knowledge-Attitudes-Practices survey—part of the same research project conducted among 100 vendors in Ouagadougou—showed that only one out of five food handlers had implemented strategies to improve food safety at their outlet, while four out of five food handlers believed that cleanliness and hygiene were not important to their customers [23].

To gain a deeper understanding of the impact of the training on the by vendors’ perceived capabilities, opportunities, and motivations related to food safety behaviors following their participation, and to further inform the sustainable scale-up of effective food safety vendor training interventions in Sub-Saharan Africa, we conducted a qualitative study in parallel with the RCT (reported elsewhere [22], with the vendors who were part of RCT’s treatment arm.

Methods

We conducted a total of 24 qualitative in-depth interviews complemented with the Most Significant Change technique, with 24 vendors from the RCT’s treatment arm. The study was guided by the Capability-Opportunity-Motivation-Behavior (COM-B) model, which identifies three interacting components influencing one’s behavior: capability, opportunity, and motivation [24]. Capability involves psychological capabilities including cognitive skills and knowledge, and physical skills and competencies, that enable vendors to safely handle food. Vendors must understand safe food practices and correctly use equipment to handle chicken meat safely, whilst risk perceptions, shaped by knowledge and experience, may influence adoption [25]. Opportunity encompasses external factors that facilitate or hinder behavior, including the sociocultural and physical environment [24]. Social opportunities involve support or norms, while economic opportunities include financial resources and access to basic needs like potable water, sanitation, and waste management, which street vendors often lack [26]. Motivation can be reflective and automatic [24]. Reflective motivation involves conscious decision-making, encompassing deliberative goal-setting and intentions based on beliefs and values, while automatic motivation refers to impulsive influences such as emotions, habits, and immediate responses without conscious awareness [27]. Optimal behavior change is achieved when all three components are effectively aligned and supportive of the desired behavior, see Fig 1 [24].

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Fig 1. COM-B model (adapted from [24]).

https://doi.org/10.1371/journal.pone.0313635.g001

Results

Participant characteristics

An overview of socio-demographic characteristics of the 12 outlet owners and 12 employees is presented in Table 1. Except for one, all participants were men. The average age of 24 interviewees was 34.5 years. Outlet size, the number of employees working at the time of the training, averaged four, with a minimum of one and maximum of 15 employees. Most vendors had not obtained any (formal) education, four vendors completed primary school, and three vendors attained secondary or higher education.

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Table 1. Socio-economic characteristics of participants.

https://doi.org/10.1371/journal.pone.0313635.t001

Fig 2 below summarizes the main results mapped onto the COM-B model, outlining prerequisites for food safety behavior changes.

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Fig 2. Food safety capabilities, opportunities, and motivation.

https://doi.org/10.1371/journal.pone.0313635.g002

Discussion

This study provided a comprehensive overview of the impact of a food safety intervention aimed at improving food safety practices of vendors selling ready-to-eat chicken in informal markets in Ouagadougou, Burkina Faso. While previous RCT’s findings showed that training combined with equipment significantly enhanced vendor food safety knowledge and behavior [30], this qualitative study sheds light on how the intervention specifically influenced vendors’ food safety capabilities, opportunities, and motivations, using the COM-B model. Findings highlighted increased perceived capabilities and motivations related to food safety behavior post-training as reported by the vendors, but moreover this study identifies significant opportunities and persistent barriers to implementing behavior changes, despite vendor willingness and intentions to change.

First of all, vendors reported a major boost in their capabilities specifically regarding knowledge gains and awareness, as well as an improvement in their skills to perform food safety behaviors, post-training [30]. In line with RCT findings, knowledge increases were perceived in relation to live chicken management, slaughtering, serving, and seasoning practices. Behavior-based training combining knowledge and behavior modification techniques including how to handle equipment strengthened a sense of responsibility to change behavior and affected vendors’ risk perceptions [37]. Vendors’ motivation to adopt safe food practices was strongly driven by a sense of moral responsibility for consumer and employee health and the ability to prevent foodborne illness. This intrinsic motivation is crucial for sustainable behavior change, as it stems from the belief in the effectiveness of the behavior to reduce risks (response-efficacy) and confidence in one’s ability to perform the behavior (self-efficacy) [38]. Moreover, perceived improvements in both awareness and self-efficacy resulted in a renewed sense of food safety ownership.

Secondly, vendors’ motivation to change was driven by increased perceived benefits related to client satisfaction, attracting and retaining clientele, as well as the perceived obligation to adhere to hygiene regulations. Outlet owners seemed especially motivated by the perceived increased profits associated with improved hygiene, through higher sales and attracting new consumers, and the prospect of financial stability in the longer term. These findings are in line with the RCTs findings that showed reported mean increases in daily profits and clients [21]. However, despite increased motivations, fear of change, and vendors’ inability to break habits hindered implementation of changes, whereas passion and perceived importance of continuous learning was seen as motivator to break these habits.

Interviews uncovered additional opportunities and barriers beyond what the RCT findings revealed. For instance, customer criticism towards new practices, and time pressure during peak hours compromised food safety behavior. Henson and colleagues illustrate how vendor motivation is influenced by incentives to adopt food safety practices. Such incentives “reflect the benefits and costs for the enterprise”[10]. The economic and social costs and benefits include the market’s regulatory system, social pressure from vendors, and rewards for better food safety measures driven by consumer demand [38]. With consumers becoming more aware about food safety issues in LMICs [39], they may act as agents of change through demanding safer food as an additional motivator [3]. Thus, empowering consumers to shift norms may be an effective tool for driving the food safety agenda in informal markets. For example, a study assessing the impact of a consumer targeted communication behavior change campaign to improve consumer demand for safer food, campaign in Ouagadougou, showed promising effects: campaign recall was associated with improved consumer knowledge, awareness, and perceived benefits related to buying from outlets that safely handle poultry meat In East-Ethiopia, recall of a similar mass-media campaign targeting consumers was associated with the purchase of safer tomatoes in informal markets [40].

Vendors reported poorer food safety practices during peak hours, aligning with evidence that non-compliance rates are highest during busy times for both motivated and poorly motivated food vendors [41]. This pressure forces vendors to balance client satisfaction with safety measures. Consumer concerns can both reinforce and hinder safe practices. Training that enhances capacity and self-efficacy can ultimately help vendors discern between demands that promote unsafe or safe outcomes [38]. Additionally, outlet culture and social support was seen as essential to improve food safety behavior. However, resistance from untrained employees, high turnover and associated financial risks, and the need for constant supervision perpetuated unsafe practices, according to outlet owners. Training untrained colleagues is therefore essential to avoid employee resistance and the need for constant supervision, an approach that was successful in improving food safety knowledge and practices among meat producers in Nigeria [42].

Distributed equipment was believed to be the most significant driver (and opportunity) for behavior change, which is in line with findings showing significant behavioral improvements in domains where equipment was provided [21]. For instance, handwashing increased with the distribution of handwashing devices, and waste management improved with the introduction of bins. Equipment thus facilitated behavior change by directly enabling or reminding of the implementation of practices, increasing capabilities, and boosting motivation.

After training, owners remained concerned about structural barriers to implementing food safety behaviors: limited financial resources, poor market infrastructure, and regulatory challenges. These measures necessitated investments in equipment and outlet layout, explaining limited changes in behavioral domains requiring financial outlays. Financial constraints were exacerbated by rising living costs, inflation, and higher live chicken prices, prompting owners to deprioritize food safety measures. Limited operating space, dust, heat, and inadequate water and waste disposal systems pose significant challenges. Such market infrastructure deficiencies are recognized in literature as fostering contamination and impeding safe food practices in informal markets [3,10,43]. In Burkina Faso’s urban informal markets, low income and poor state of market infrastructure and amenities such as potable water, clean environment, and pest control have been linked to poor hygienic practices among chicken vendors [11]. In Phnom Penh, Cambodia, vegetable vendors had higher perceived motivation and capability to implement food safety practices than perceived opportunities to do so [44]. Similarly, other studies on food vendors’ food safety practices in Bangladesh, Vietnam, Ghana, and South-Africa show that infrastructural deficits to street food vending including a lack of operational space and basic facilities are a major shortfall to the application of knowledge and foster attitudinal change [45–48].

Despite recognizing the importance of regulations, many vendors doubted their usefulness due to complexity and distrust in regulators. Barriers included complex health card acquisition processes and lack of support from regulators. These shortcomings in food control oversight in LMICs stem from weaknesses in regulatory frameworks and control systems. In Tanzania, informal dairy vendors criticized high taxation, bribery, and harassment from officials, despite lacking government support [49]. Studies from Sub-Saharan Africa and South Asia showed that informal market governance involves bribery, fines, harassment, confiscation, violence, forced closures, and threats [1,50]. These counterproductive strategies reduce vendors’ incentives to invest in safe food practices and infrastructure [51–54]. The regulatory gaps are underpinned by insufficient human, financial, and technical resources, ultimately hindering effective implementation and highlighting the need for regulatory reforms and increased resources to secure safer food supply chains in LMICs [10,55].

Conclusion and implications

This study showed the importance of increased capabilities and motivations when seeking to improve food safety behaviors. Behavior change goes beyond knowledge acquisition and depends on risk perceptions. Findings show how contextual opportunities and barriers related to financial resources, market infrastructure and regulations, influence implementation of food safety behaviors promoted in trainings in informal settings. Investing in infrastructure and engaging vendors in navigating these challenges are therefore crucial for sustainable effects. Collaborative alliances between vendors and regulators, rather than punitive measures, may offer a pathway to addressing regulatory challenges. In the short term, training sessions should explicitly address and engage vendors in finding solutions to navigate the structural, economic, and social barriers they face. Client satisfaction and increased profits, as well as continuous learning, could strategically incentivize behavior change. Additionally, tapping into spillover effects among neighboring vendors, e.g. through peer-to-peer learning and role models, may provide pathways to improve food safety within a retail sector community.

Supporting information

Acknowledgments

We would like to express our gratitude to the research team, in particular Ms. Yameogo and Mr. Diarra, as well as all vendors who were willing to share their stories with us.