Doctor of Philosophy (PhD)


Nutrition and Food Sciences

Document Type



Immunocompromised patients are often prescribed a neutropenic diet to reduce the intake of harmful microbial content. However research suggests it does not improve clinical outcomes when compared to a regular diet, is inconsistently defined and prescribed, and may even have adverse effects on a patient’s nutritional status and quality of life. To reflect evidenced-based practice, the Food and Drug Administration has suggested focusing on safe food handling practices rather than outdated dietary restrictions to reduce health risks. However, many healthcare institutions are reluctant to shift focus as it affects a high-risk patient population vulnerable to contracting a foodborne illness. In an effort to move towards a safe food handling approach, the knowledge, attitudes, and behaviors of healthcare foodservice workers as well as oncology providers regarding food safety must be explored. The first purpose of this study was to develop, validate, and test a self-assessment tool on food safety knowledge, attitudes, and behaviors in healthcare foodservice workers serving high-risk populations. The second purpose of this study was to identify opinions of the neutropenic diet and food safety protocols in oncology providers. A 46 item questionnaire was developed and underwent preliminary psychometric testing to establish content validity (mean score ≥ 70%) and test-retest reliability (alpha = 0.05). The survey was then revised and pilot tested over a 16-month period to healthcare foodservice workers (n=211) across six acute care hospitals to establish internal consistency (Cronbach’s alpha = 0.79) and construct validity based on a linear regression model to predict behavior of safe food practices (Behavior = 25.68 + 0.799*Attitude + To gain holistic insight, semi-structured interviews with oncology providers (n=9) revealed inconsistencies in diet ordering practices but offered suggestions, such as utilizing a multi-disciplinary care team, to assist institutions to move towards a safe food handling approach. Together, this study provided healthcare facilities a valid and reliable tool for foodservice workers assessment, as well as the insights from oncology providers regarding neutropenic diet and safe food handling for high-risk populations.

Committee Chair

Xu, Wenqing



Available for download on Saturday, June 28, 2025