1. Introduction
Foodborne diseases remain a major public health concern in both developing and developed countries [
1,
2]. These illnesses are caused by various hazards, including viruses, bacteria, parasites, toxins, metals, and prions [
3]. They often arise from inadequate food safety knowledge and/or unsafe food-handling practices among both food handlers and consumers [
4]. In 2015, the World Health Organization reported that unsafe food caused approximately 600 million cases of foodborne illness and 420,000 deaths annually [
5]. In Saudi Arabia, the Ministry of Health reported 1632 foodborne outbreaks and 11,458 associated illnesses between 2014 and 2018, with nearly half of these outbreaks linked to public food service settings, such as restaurants, catering services, and banquet facilities [
6]. As consumers frequently obtain food from restaurants, bakeries, food trucks (FTs), and cafeterias, it is often difficult for them to judge whether proper food-handling practices are being followed. As dining out becomes increasingly common and expectations for hygiene and safety rise, consumers should be aware of the food safety risks associated with these establishments [
7]. Such awareness can help individuals make informed choices and may encourage food businesses to maintain high standards of food safety and hygiene.
This context underscores the importance of food safety, which refers to the proper handling, preparation, and storage of food to prevent foodborne diseases [
8]. Food safety involves multiple stages throughout the food chain, including the sourcing of raw materials, transportation, storage conditions, personal hygiene of food handlers, and adequate cooking temperatures. Failure at any of these stages can result in microbial, chemical, or physical contamination, potentially leading to serious health consequences and even death [
9]. As urban populations expand and food options become more diverse, food safety has emerged as a critical global public health issue affecting individuals across all ages, genders, and income levels. Understanding the risks associated with unsafe food handling therefore helps consumers make informed decisions about where to eat and encourages food establishments to maintain appropriate hygiene and safety standards [
7].
Recently, FTs have gained popularity, particularly among adults, because they offer high-quality food in casual and convenient settings [
10]. A study conducted in Vietnam reported that consumption of street foods has also been linked to food safety concerns [
11]. Consumers often prioritize taste and convenience over safety, thereby increasing their exposure to potential health risks. This growing trend has raised concerns about hygiene and safe food-handling practices, making the prevention of foodborne illness a priority for both consumers and food handlers. Previous reports from countries such as New Zealand, Australia, the United States, Denmark, and India have shown that foodborne disease outbreaks are more common in restaurants and street food settings than in households [
12]. Studies from several countries have examined food safety knowledge, attitudes, and awareness among FT or street food customers and have identified gaps in consumer understanding. A study from South Africa reported low food safety knowledge among street food consumers [
13]. A study conducted in Poland indicated that consumers perceive a higher risk when consuming food from street vendors compared to other food service establishments, reflecting concerns about potential contamination in informal food settings [
14]. Studies from Bangladesh and Portugal found moderate knowledge levels but limited awareness of specific foodborne pathogens among street food patrons [
2,
5]. In Saudi Arabia, moderate food safety knowledge and positive attitudes have been reported among customers of FTs [
15].
Despite previous research, gaps remain in our understanding of food safety knowledge, attitudes, awareness of foodborne pathogens, and consumption patterns among FT customers in Saudi Arabia. Thus, in the current study, we evaluated these aspects among adult FT customers in the Makkah region, Saudi Arabia. The associations between consumers’ sociodemographic characteristics, household income levels, food safety knowledge, attitudes, awareness, and consumption patterns from FTs were examined because these factors influence individuals’ access to health information and food safety practices, which may help to improve consumer food safety awareness and promote healthier dietary behaviors. This study’s results are intended to support the development of targeted food safety education and public health interventions to reduce foodborne disease risks associated with consumption from FTs and improve consumer health outcomes.
We hypothesized that sociodemographic factors of FT customers would be significantly associated with their knowledge and attitude about food safety as well as foodborne pathogen awareness. Additionally, the knowledge, attitude, and awareness of FT customers would be significantly associated with their food consumption. The main key findings are the effect of sociodemographic factors (gender, age, education, and income) on knowledge and attitude about food safety and foodborne pathogen awareness, and whether high knowledge, attitude, and awareness are associated with high consumption of healthy food groups and low from unhealthy ones. The findings provide evidence to inform targeted educational and policy interventions for improving food safety knowledge, awareness and attitude among food truck customers.
3. Results
Participant characteristics are presented in
Table 1. Most participants were women (75.8%), and 30.6% were >45 years. More than half held a bachelor’s degree (59.4%), whereas 21.8% had a postgraduate degree and 18.8% had a high school education or lower. Regarding monthly household income, 43.8% reported earning <5000 SR, 35.8% reported earning 5000–15,000 SR, and 20.4% reported earning >15,000 SR. Participants were almost evenly split by marital status, with 51.4% unmarried and 48.6% married. In terms of occupation, 31.2% were students, 31.0% were employed, 21.0% were unemployed, and 16.8% were retired. The mean awareness, knowledge, and attitude scores were 16.7 ± 3.8, 14.7 ± 3.3, and 30.8 ± 5.3, respectively.
Table 2 presents the associations of sociodemographic characteristics with food safety knowledge, attitude, and awareness scores among FT customers. Only the association between knowledge and awareness scores and gender remained significant (
p < 0.0001), after adjustment and Bonferroni correction. Attitude score was not significantly associated with any sociodemographic factors.
Table 3,
Table 4 and
Table 5 summarize the associations between sociodemographic characteristics and categorized levels of food safety knowledge, attitudes, and pathogen awareness among FT customers. As shown in
Table 3, knowledge level differed considerably by gender. Among men, 60.3% were classified as having low knowledge, whereas 52.2% of women were classified as having high knowledge. Educational level also showed an association with knowledge level: 56.0% of participants with high knowledge held a postgraduate degree, whereas 64.9% of those with low knowledge had a high school education or lower. No significant associations were found between knowledge level and sociodemographic factors.
Table 4 presents the distribution of negative, neutral, and positive attitude levels across sociodemographic categories. No significant differences in attitude level were found according to gender, age, educational level, income, marital status, or occupation (
p > 0.05).
Table 5 shows that gender was significantly associated with awareness level of foodborne pathogens. A higher proportion of men (62.8%) was in the low-awareness group, whereas 57.5% of women were classified in the high-awareness group. No other significant associations were observed with awareness level.
Table 6,
Table 7 and
Table 8 presents the associations between food safety knowledge, attitudes, awareness of foodborne pathogens, and FFQ responses among FT customers. Only fruit consumption showed an association with knowledge level, where participants with higher knowledge scores reported greater fruit consumption compared with those with lower knowledge scores (
p = 0.023;
Table 6). No significant differences were observed between most food groups and food safety attitudes (
Table 7). Concerning awareness of foodborne pathogens, fruit consumption was the only food group associated with awareness level, with participants who had higher awareness reporting greater fruit consumption than others (
p = 0.037;
Table 8).
Table 9 summarizes a strong positive association between food safety knowledge, attitudes, and awareness of foodborne pathogens scores among FT customers (
p < 0.001). However, the correlation between knowledge, attitudes, and awareness was moderate to weak.
4. Discussion
In the present study, we evaluated the food safety knowledge, attitudes, and awareness of foodborne pathogens of FT customers in the Makkah region of Saudia Arabia and assessed their association with sociodemographic characteristics and dietary consumption patterns. The findings showed that FT customers in the three largest cities in the Makkah region had good levels of food safety knowledge, attitudes, and awareness of foodborne pathogens. Gender was associated with knowledge and awareness, with women having higher levels. Knowledge, attitude, and awareness scores were significantly correlated. There was a trend toward high fruit intake among FT customers with a high level of knowledge, but no significant association was observed between knowledge, attitude, and awareness and food intake.
We found that FT customers’ food safety knowledge ranged from moderate to high, with most participants demonstrating a solid understanding of basic food safety concepts, including foodborne diseases, risks associated with raw and undercooked foods, hygiene, and prevention of cross-contamination. In addition, they showed high level of awareness regarding food allergens, expired foods, and chemical contaminants, such as insecticides, as potential food safety hazards. This finding is consistent those of previous studies conducted in Bangladesh [
5] and Portugal [
2], which reported moderate levels of knowledge alongside notable misconceptions regarding food safety, foodborne diseases, and microbial hazards. Similarly, an integrative review conducted in Gulf countries (Saudi Arabia, Qatar, UAE, Bahrain, Oman, and Kuwait) reported that consumers generally demonstrated acceptable knowledge regarding several food safety concepts, particularly those related to temperature control during food storage, safe food storage practices, prevention of cross-contamination, and the safe handling of raw or undercooked foods. However, the review also identified persistent gaps in some food safety practices among consumers [
23]. In contrast, a study from South Africa [
13] found that street food consumers reported low confidence in their food safety knowledge. These differences may reflect variations in socioeconomic conditions, general education levels, regulatory frameworks governing street food operations, and the intensity of national food safety campaigns.
In the present study, higher knowledge scores were strongly associated with women, which agrees with a previous study from Saudi Arabia [
24] but not with studies conducted in the UAE [
25], Egypt [
26], and Jordon [
27] where women had low food safety knowledge. The differences could be due to educational levels and low initiatives aimed toward women among these countries. The association between gender and knowledge is often explained by women’s greater involvement in food preparation and household food decisions [
28,
29]. Collectively, the overall level of knowledge among FT customers in the Makkah region is encouraging.
We found that food safety attitudes among FT customers were generally positive. This result agrees with a study conducted in Vietnam [
11], which reported that consumers demonstrated a positive attitude toward food hygiene and safety standards among food handlers. They particularly emphasized the importance of personal hygiene practices, including hand cleanliness, proper clothing, and the overall cleanliness of food preparation areas when evaluating food facilities. Similarly, a previous study conducted in the Asir region of Saudi Arabia among customers of FTs operated by productive families reported favorable food safety attitudes [
15].
Our findings revealed a limited awareness of foodborne pathogens among consumers, in contrast to their relatively stronger knowledge and attitudes. A considerable proportion of participants reported being unaware of major pathogens including,
Escherichia coli, Campylobacter jejuni, Listeria monocytogenes, and
Staphylococcus aureus. This level of awareness was lower than that reported in a study conducted in Ghana, where awareness of foodborne pathogens was relatively high [
30]. This discrepancy may be partly explained by differences in the study populations. The present study included a broad sample of consumers from the general community. Conversely, the Ghanaian study focused specifically on university students, who are more likely to encounter pathogen-specific information through academic coursework and campus-based awareness programs. Several misconceptions were identified in the present study: some participants believed that washing vegetables in salt solution or simply refrigerating food is sufficient to eliminate pathogens, and many incorrectly identified headache as a typical symptom of foodborne illness. Such misunderstandings may increase the risk of foodborne disease, particularly in the FT setting, where time–temperature control and prevention of cross-contamination are critical [
31]. These misconceptions further suggest that many consumers mainly associate foodborne illness with obvious gastrointestinal symptoms and may not recognize that nonspecific symptoms can also occur, potentially delaying recognition and appropriate response. Addressing these gaps requires focused educational messages that clearly explain both the limitations of common household practices and range of symptoms associated with foodborne illness.
We found that female FT customers had considerably higher awareness scores than men, which is consistent with previous studies from Saudi Arabia, Portugal, and Bangladesh [
2,
5,
21]. This could be explained by the traditional role of women as primary food preparers in many households, which may increase their exposure to food safety information and strengthen their motivation to protect family health. These findings underscore the importance of tailoring food safety interventions to specific demographic groups, particularly men, using communication channels and messages suited to each group.
We also found a trend toward high fruit intake among FT customers with high knowledge and awareness levels suggesting that better-informed individuals may be more likely to adopt certain healthier dietary choices. Although relatively few studies have explicitly combined food safety knowledge measures with FFQ-based dietary assessments, the present findings are consistent with previous research which showed that higher food safety-related knowledge was modestly associated with healthier dietary patterns, particularly higher intakes of fruits, vegetables, and other core food groups aligned with dietary guidelines [
32]. Thus, positive cognition may be related to health, and food safety can influence some aspects of dietary behavior, although the observed associations are generally modest. Nevertheless, the absence of consistent associations across all food groups and awareness levels indicates that improvements in knowledge and attitudes alone are unlikely to be sufficient to shift overall dietary patterns toward optimal health. Comprehensive strategies that combine education with environmental changes, such as healthier FT menus and clearer point-of-purchase information, together with economic incentives, are therefore likely needed to achieve meaningful and sustainable behavior change among FT customers [
33,
34,
35].
The correlation result indicated moderate to strong association between knowledge, attitude, and awareness. However, weak correlation was observed between attitude and awareness. Similarly, previous studies reported similar findings between knowledge and attitude among Malaysian FT handlers [
36], Ethiopian food handlers [
37], and Bangladeshi students [
38].
This study has several strengths. It focused on an understudied consumer group and provided context-specific insights from a setting wherein street food is becoming increasingly popular. The relatively large sample size and inclusion of participants from diverse sociodemographic backgrounds, including different age, education, income, and occupation groups, enabled meaningful subgroup analyses and identification of vulnerable groups with lower knowledge or awareness. The use of adapted questionnaires and appropriate statistical analyses, including adjusted models, further strengthens the internal validity of the findings.
Some limitations should be considered. First, the cross-sectional design does not allow causal relationships to be established between sociodemographic characteristics, knowledge, attitudes, awareness, and dietary behaviors; only associations can be inferred. Second, the data were based on self-reported questionnaires and are therefore subject to recall and social desirability bias, which may have led participants to overestimate their knowledge or report healthier behaviors than they actually practice. Furthermore, participant recruitment through online platforms may have introduced selection bias by favoring younger individuals, those who are more technologically engaged, or participants with greater interest in food safety and health-related issues, which may have influenced the overall level of reported knowledge and attitudes. The sample was also predominantly composed of women, which may limit the representativeness of the study population and reduce result generalizability to the broader population of FT customers, particularly male customers. The skewedness of the sample toward women may be because women tend to have the dominant decision about purchasing products.
Despite these limitations, the study provides valuable evidence that can inform targeted educational and policy interventions aimed at improving food safety among FT customers.