The International Food Safety Authorities Network (INFOSAN) is a global network of national food safety authorities from 190 countries, managed jointly by the Food and Agriculture Organization of the United Nations and the World Health Organization, which facilitates the rapid exchange of information during food safety incidents. Until now, INFOSAN has not been characterized or examined as a functional community of practice, and its value, as understood from the perspective of its members, has not been determined in a systematic or rigorous way. The purpose of this study was to explore and describe the experiences and opinions of INFOSAN members to better understand the role of the network in improving food safety and mitigating the burden of foodborne illness globally. There were four main research questions: (i) How is the INFOSAN Community Website being used to support network activities? (ii) What are the barriers to active participation in INFOSAN? (iii) Do INFOSAN members believe that participation in the network prevents foodborne illness and saves lives? and (iv) Does participation in INFOSAN create value for members, and if so, through what mechanisms does this occur? To answer these questions, an online questionnaire was developed and adapted from English into French and Spanish before being disseminated to INFOSAN members. Responses were received from 239 INFOSAN members in 137 countries over a 10-week period between August and October 2019. This study represents the first to explore and describe the experiences of INFOSAN members with respect to their participation in network activities to improve global food safety and prevent foodborne diseases and to describe the characteristics of INFOSAN as a community of practice. The results suggest that INFOSAN is a valued tool, used globally to reduce the burden of foodborne illness and save lives. The INFOSAN Secretariat could use the results to prioritize future activities to further strengthen the network and support participation of members.
The INFOSAN Community Website is an important and supportive tool for the network.
Numerous barriers to participation in INFOSAN reduce engagement of some members.
The majority of members believe that INFOSAN prevents illnesses and saves lives.
Participation in INFOSAN has been a valuable experience for nearly all members.
The International Food Safety Authorities Network (INFOSAN) is a global network that aims to halt the international spread of contaminated food, prevent foodborne disease outbreaks, and strengthen food safety systems globally to reduce the burden of foodborne illness. Established in 2004, INFOSAN has since grown to include more than 600 people from 190 countries in 2020 and is jointly managed by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO), with most operational functions led by the Secretariat at WHO. INFOSAN members are officially designated to represent national authorities that have responsibilities for some aspects of food safety management. The network includes members from various government sectors including health, agriculture, veterinary services, trade, standards, education, and others. One of the most important functions of the network is to promote the rapid exchange of information during food safety–related incidents, including multicountry outbreaks of foodborne illness linked to a common food and international recalls of food due to an identified human health risk (11). Since 2012, most communication among network members occurs through an online platform called the INFOSAN Community Website (ICW), named as such in recognition of the network as a community of practice (5). A community of practice is a group of people sharing a particular concern, problem, or passion for an area and who deepen their knowledge and expertise by learning from one another and interacting on a regular basis (28).
Over the past 15 years, INFOSAN has marked many notable achievements, most of which are documented in biannual activity reports published by FAO and WHO (4–6, 8, 10). These achievements include large-scale responses to serious international food safety emergencies, delivery of training and capacity-building workshops, and facilitation of emergency preparedness simulation exercises, to name a few. However, the same reports have also highlighted that a lack of active participation among members creates delays in information sharing during food safety emergencies, which could translate into delayed implementation of risk management measures and thus more cases of foodborne illness that could have otherwise been prevented.
A review of INFOSAN published by Savelli et al. (20) in 2019 concluded that the network would benefit from further exploration into the experiences of members with respect to their participation in network activities. In doing so, barriers to active participation could be identified and addressed by the INFOSAN Secretariat.
A three-phase study of INFOSAN was subsequently launched in 2019 with the overall aim of exploring and describing the experiences of INFOSAN members with respect to their participation in network activities to improve global food safety and prevent foodborne illness. The first phase of this research involved the descriptive analysis of the ICW (22), the second phase involved a global survey of INFOSAN members, and the third phase will involve interviews with a small group of INFOSAN members. The research protocol for the full study, including details on all three phases, has been published by Savelli and Mateus (21). This current article presents the results of the global survey of INFOSAN members, representing the second phase of the study. The main research questions addressed by this phase include the following: (i) How is the ICW being used to support the network activities? (ii) What are the barriers to active participation in INFOSAN? (iii) Do members of INFOSAN believe that participation in the network prevents foodborne illness and saves lives? and (iv) Does participation in INFOSAN create value for members, and if so, through what mechanisms does this occur? Responses to the global survey are intended to provide systematic insights into the characteristics, performance, and opinions of INFOSAN members and contribute to a broader understanding of their experiences with network activities.
MATERIALS AND METHODS
Recruitment and consent
In August 2019, all members of INFOSAN received an informational e-mail that provided indicative results from phase 1 of this study and an invitation to attend an online seminar (i.e., webinar), delivered by the researcher, to learn more about the results from phase 1 and to provide further details about phase 2. Following the webinar, all INFOSAN members received another informational e-mail that included an invitation to participate in phase 2 of the study and a link to the online questionnaire. Only those who expressed consent were recruited as participants for phase 2. No consent form was collected because that would compromise anonymity; however, the information e-mail explained that by clicking on the questionnaire link, the participants confirmed having read the introductory information and understood what would be expected of them as participants in phase 2 of the study.
Questionnaire development, including adaptation from English into French and Spanish
The questionnaire consists of questions from the Community Assessment Toolkit (CAT) (26) as well as a supplemental set of questions, tailored specifically to INFOSAN members. Using CAT in this study enables future comparative research between communities of practice that have been assessed with the same tool.
However, given the unique nature of INFOSAN and the specific objectives of this study, it was also necessary to develop a set of supplemental questions to examine the experiences of INFOSAN members that are unique to this particular community of practice (20, 22). A preliminary set of supplemental questions was therefore inserted to the appropriate sections of the CAT questionnaire. These supplemental questions were reviewed for content validity by a panel of six experts consisting of members of the INFOSAN Secretariat and INFOSAN Advisory Group because they are familiar with the constructs that the supplemental questions are designed to measure. The expert panel judged whether the supplemental questions adequately measure the construct they are intended to assess, and whether these supplemental questions are indeed sufficient to measure the domain of interest. A content validity index was computed for each supplementary item, and items with a content validity index of 0.78 or higher were considered evidence of good content validity and therefore retained (19). Supplementary items that did not receive a content validity index of 0.78 or higher were removed, and the first draft of the English questionnaire was finalized and referred to as CAT+.
Results from phase 1 of this study indicate that 98% of INFOSAN members speak English, French, or Spanish (22). As such, it was important to ensure that the questionnaire was adapted into these languages to encourage a higher response rate from the global membership. The aim of the adaptation process was to achieve different language versions of the English instrument that are conceptually equivalent in both French and Spanish. The instrument needed to be equally natural and acceptable and practically perform in the same way, with a focus on cross-cultural and conceptual equivalence, rather than on linguistic or literal equivalence. A well-established method to achieve this goal is to use forward translations and back translations (31). This method has been refined over the course of several WHO studies and was used to adapt the questionnaires into French and Spanish. The detailed process of expanding and adapting the questionnaire into French and Spanish is summarized in Supplemental File S1, which also contains the final English version of the questionnaire.
Anonymized, one-time-use links to the questionnaire were generated for each INFOSAN member in Qualtrics, and individual e-mails were sent out by the main researcher to 479 INFOSAN members in 181 countries. Results were collected for a 10-week period between August and October 2019. Members were sent reminders three times during this period to indicate how many members had completed the questionnaire so far and to encourage others to do so. Only those questionnaires that were submitted were analyzed (i.e., questionnaires that were started, partially completed, and subsequently abandoned are not included in the analysis).
Overall, 239 (50%) of 479 members responded to the questionnaire and 123 (51%) of 239 respondents are female. The response rate was highest among members from the Americas (60%), followed by Africa (57%), the Eastern Mediterranean (44%), Europe (41%), the Pacific (38%), and finally Asia (37%). Regional divisions of Member States in Africa, the Americas, the Eastern Mediterranean, and Europe are based on coverage provided by WHO regional offices. Asia includes the Member States from the WHO South-East Asia region plus 11 Asian countries from the WHO Western Pacific region, including Brunei Darussalam, Cambodia, China, Japan, Lao People's Democratic Republic, Malaysia, Mongolia, Philippines, Republic of Korea, Singapore, and Viet Nam. The Pacific group includes the remaining pacific island countries from WHO Western Pacific region. These regional divisions were recommended by the INFOSAN Advisory Group because of differences in the ways that INFOSAN activities have been historically organized and current practices in regional food safety management. Respondents include members from 137 (76%) of 181 countries where INFOSAN members are registered (Table 1). Response rates between Emergency Contact Points (82 of 168, 49%) and Focal Points (148 of 311, 48%) are approximately the same. The average length of membership of respondents is 4.3 years (minimum, 2 weeks; maximum, 15 years).
Membership to other “communities of practice.”
More than half of respondents (131 of 239, 55%) report being members of more than one food safety–related community or practice, including those at the national, regional, and global levels. At the national level, one example provided from Brazil is the Food Risk Alert and Communication Network (Rede de Alerta e Comunicação de Riscos de Alimentos), which promotes the exchange of information on risks associated with food in routine and emergency situations, aiming to provide reactions and quick decision making regarding the interventions necessary for their minimization and prevention (18). At the regional level, an example from Africa is the African Food Safety Network, which promotes networking among food safety institutions, laboratories, and related stakeholders to strengthen food safety control systems (1). As an example of a global community of practice, one respondent indicated membership to the International Society of Infectious Diseases, which aims to support health professionals, nongovernment organizations, and governments worldwide in their work to prevent, investigate, and manage infectious disease outbreaks when they occur, particularly in countries that have limited resources and that disproportionately bear the burden of infectious diseases (14).
INFOSAN aims and objectives
INFOSAN aims to prevent the international spread of contaminated food and foodborne disease and strengthen food safety systems globally. The main objectives are to (i) promote the rapid exchange of information during food safety incidents and emergencies, (ii) share information on important food safety issues of global interest, (iii) promote partnership and collaboration between countries, and (iv) help countries strengthen their capacity to manage food safety emergencies. Respondent perceptions on the aims and objectives of INFOSAN are shown in Figure 1. Notably, 230 (97%) of 237 respondents agree or strongly agree that the objectives of INFOSAN are still valid. More than two-thirds of respondents agree or strongly agree that because of INFOSAN, illnesses have been prevented (161 of 236, 68%) and lives have been saved (158 of 236, 67%). One hundred forty-six (62%) of 235 respondents agree that INFOSAN has improved the safety of the global food supply, and 138 (59%) of 233 respondents agree or strongly agree that INFOSAN has reduced the burden of foodborne illness globally.
Barriers to active participation in INFOSAN activities
When indicating factors that create barriers to active participation in INFOSAN, those that were reported by more than half of all respondents include (i) the need for a simpler and more standardized way to share information between national authorities within my country (60%); (ii) challenges in conducting food safety risk assessments within my country (59%); (iii) insufficient funds dedicated to monitoring and/or responding to food safety events within my country (55%); and (iv) limited capacity and/or infrastructure dedicated to addressing food safety events within my country (54%). Respondents' perceptions on potential barriers are shown in Figure 2. Perceptions of barriers vary across regions, with members from Africa perceiving the most barriers followed by those from the Americas and then Asia, the Eastern Mediterranean, the Pacific, and finally Europe. Details on the barriers reported by region are presented in File S2.
Information and communication technology support
The ICW was launched in 2012 and is an online portal through which all members can communicate with each other and with the INFOSAN Secretariat. Two hundred sixteen (94%) of 229 respondents agree or strongly agree that the ICW is an important and supportive tool for the network, and 185 (79%) of 233 respondents agree or strongly agree that it facilitates information sharing and provides collaborative features that help to foster the community of practice among INFOSAN members. Figure 3 presents INFOSAN members' perceptions of the utility of the ICW.
Only 14 (6%) of 236 respondents reportedly access the ICW daily, 40 (21%) of 236 access the ICW weekly, 61 (26%) of 236 access the ICW monthly, 68 (29%) of 236 access the ICW every few months, 19 (8%) of 236 never access the ICW, 10 (4%) of 236 do not know how often they access the ICW, and 14 (6%) of 236 preferred not to answer this question.
Among 219 respondents who do reportedly access the ICW, a range of reasons for doing so have been indicated and are displayed in Figure 4. Nearly all users of the ICW access it to read about alerts issued by the INFOSAN Secretariat (212 of 219, 97%). The majority of ICW users also access the site to read INFOSAN documents (152 of 219, 69%) and to read publications and newsletters from FAO and WHO (142 of 219, 65%). Additional reasons for accessing the ICW reported by respondents include to find information provided in discussion posts, to read about INFOSAN activities, to ask for help managing food safety incidents, and to seek partnerships and international cooperation.
Respondents have indicated that the most important goals they are trying to achieve by participating in INFOSAN include preventing foodborne diseases and improving the safety of the food supply, which were rated as extremely important factors for participation by 163 (68%) of 238 and 139 (59%) of 236 members, respectively. Table 2 presents a range of reasons for participating in INFOSAN ranked by their relative importance. Ranking was calculated by assigning numeric values to each possible response and then calculating the sum (score) for each reason according to responses, where 4 = extremely important, 3 = very important, 2 = moderately important, 1 = slightly important, and 0 = not important at all.
Only 35 (15%) of 234 respondents rated the way that INFOSAN members interact as very good, 66 (28%) of 234 as good, 74 (32%) of 234 as acceptable, 28 (12%) of 234 as poor, and 1 (0.4%) of 234 as very poor. The majority of respondents rate their own participation as occasionally active (130 of 230, 57%). Only 8 (3%) of 230 respondents rate their participation as extremely active and 33 (14%) of 230 respondents as very active. Thirty-six (16%) of 230 members report being almost never active, and 7 (3%) of 230 members reported never being active. Seven (3%) of 230 respondents do not know how active their participation is, and 9 (4%) of 230 respondents preferred not to say. Ninety-one (39%) of 235 respondents have participated in face-to-face meetings, and 138 (59%) of 235 have not, 2 (1%) of 235 do not know, and 2 (1%) of 235 preferred not to answer. Slightly more respondents (99 of 232, 43%) have participated in virtual meetings (e.g., video conferences, telephone conferences, via the Internet) and 122 (53%) of 232 respondents have not. Seven (3%) of 232 respondents do not know whether they have participated in virtual meetings, and 4 (2%) of 232 respondents preferred not to answer. Respondents report a variety of ways of communicating with other INFOSAN members, including mainly by e-mail. Table 3 presents the frequency of various types of contact that respondents have with other INFOSAN members.
INFOSAN is a joint program, managed by FAO and WHO, with most operational functions coordinated by the Secretariat at WHO. Half of respondents are satisfied with the coordination of INFOSAN (116 of 234, 50%) and 50 (21%) of 234 respondents are very satisfied. Forty-nine (21%) of 234 respondents feel neutral about the coordination of INFOSAN, whereas 6 (3%) of 234 are dissatisfied and 2 (1%) of 234 are very dissatisfied. Five (2%) of 234 do not know whether they are satisfied with the coordination of INFOSAN, and 6 (3%) of 234 preferred not to answer. The INFOSAN Secretariat coordinates several activities meant to strengthen the community of practice, such as connecting INFOSAN members with each other, stimulating members to participate in INFOSAN activities, and promoting INFOSAN publicly. The perceived frequency of these activities by respondents is presented in Table 4.
A large majority of respondents (165 of 236, 70%) indicate that their own organization allocates time for their participation in INFOSAN. Forty-seven (20%) of 237 respondents are not allocated time for participation in INFOSAN, 7 (3%) of 236 do not know whether they are allocated time, and 17 (7%) of 236 preferred not to answer. Many respondents feel encouraged (102 of 236, 43%) or strongly encouraged (39 of 236, 17%) by their organization to participate actively in INFOSAN, whereas 65 (28%) of 236 feel neither encouraged or discouraged, 10 (4%) of 236 feel discouraged, and 1% feel strongly discouraged. Three percent of respondents do not know how encouraged they feel by their organization to participate actively in INFOSAN, and 12 (5%) of 236 respondents preferred not to answer. Most respondents (183 of 237, 77%) would like to have more time available for activities concerning INFOSAN; of the remainder, 25 (11%) of 237 respondents would not like to have more time available for activities concerning INFOSAN, 13 (5%) of 237 do not know whether they would like to have more time, and 16 (7%) of 237 preferred not to answer.
Impact of INFOSAN as a community of practice
Many respondents agree (114 of 232, 49%) or strongly agree (41 of 232, 18%) that INFOSAN members feel a sense of belonging to INFOSAN, whereas 25 (11%) of 232 respondents neither agree nor disagree, 6 (3%) of 232 disagree, 42 (18%) of 232 do not know, and 4 (2%) of 232 preferred not to answer. Many respondents also agree (103 of 230, 45%) or strongly agree (39 of 230, 17%) that INFOSAN members feel a sense of loyalty to INFOSAN, whereas 30 (13%) of 230 neither agree nor disagree, 3 (1%) of 230 disagree, 1 (0.4%) of 230 strongly disagree, 47 (20%) of 230 do not know, and 7 (3%) of 230 prefer not to answer. In addition, the majority of members (118 of 231, 51%) strongly agree or agree that INFOSAN members trust each other (37 [16%] of 231 neither agree nor disagree, 4 [2%] of 231 disagree, 1 [0.4%] of 231 strongly disagree, 69 [30%] of 231 do not know, and 2 [1%] of 231 preferred not to answer). In terms of using INFOSAN to find new information to solve problems, advancing projects, or keeping updated on new developments related to food safety, 76 (33%) of 230 respondents indicate that using INFOSAN is essential. Seventy-five (32%) of 230 respondents report that using INFOSAN for such purposes is very important, 53 (23%) of 230 report that it is important, and 18 (8%) of 230 report that it is slightly important, whereas 4 (2%) of 230 report that it is not important at all and 4 (2%) of 230 preferred not to answer. Other important ways of finding new information related to food safety include asking individual colleagues, using the Internet, or reading publications or reports, as displayed in Table 5. In addition, respondents identified meetings and conferences, scientific articles and books, and podcasts as other important resources for finding information on food safety. Knowledge transfer and exchange is an important characteristic of any community of practice, and such activities are commonly occurring among INFOSAN members. Figure 5 shows the perceptions of members on various aspects of knowledge transfer and exchange among INFOSAN members. Participation in INFOSAN has been shown to have numerous positive impacts on members' organizations. For example, approximately one-third of respondents strongly agree (16 of 230, 7%) or agree (58 of 230, 25%) that INFOSAN has contributed to cost savings for their organization. In addition, nearly half of respondents agree (91 of 230, 40%) or strongly agree (18 of 230, 8%) that INFOSAN has made a real contribution to the effectiveness of their organization. Furthermore, more than half of respondents agree (104 of 230, 45%) or strongly agree (22 of 230, 10%) that participation has contributed new ideas to their organization. Additional impacts of INFOSAN on members' organizations are shown in Figure 6. Finally, through membership to INFOSAN, many members report making new contacts, working more efficiently, and being kept up to date in the field of food safety. The extent of these and other personal achievements due to membership in INFOSAN are displayed in Table 6. Overall, 226 (97%) of 234 members responded that they like being a part of INFOSAN (4 [10%] of 234 do not know and 4 [2%] of 234 preferred not to answer).
Overall, results from the global survey of members has provided insights into INFOSAN as a community of practice. According to the structuring qualities of communities of practice proposed by Dube et al. (3), INFOSAN can be characterized in the following ways, pertaining to demographics, organization context, membership characteristics, and technological environment.
The orientation of INFOSAN is operational in nature, focusing on helping members answer questions and find information to solve problems on a daily basis. The lifespan is indeterminant, but it has been created as a permanent community and will continue to provide an ongoing mechanism for information sharing. INFOSAN is a mature community of practice that has moved from a coalescing stage when it was originally launched in 2004, through a maturing stage when INFOSAN developed a stronger sense of itself, into a stewardship phase. Maturation is evidenced by the large number of members feeling a strong sense of loyalty and belonging to the community. The majority of respondents have also indicated that network members trust each other and have reported that a lack of trust is not a barrier to participation in INFOSAN activities for more than a few members. Building trust among any group of collaborators is an important social process that has been widely accepted as a prerequisite to effective cooperation (27) and specifically as an antecedent to knowledge sharing in virtual communities of practice (25). Following the global meeting of INFOSAN members in 2019 (the first such meeting in nearly a decade and only the second ever), as well as the publication of the INFOSAN strategic plan for 2020 to 2025 (the first-ever strategic plan for INFOSAN), INFOSAN as a community of practice is sitting firmly in the stewardship phase and will require stalwart leadership from the Secretariat to sustain momentum.
The creation of INFOSAN was intentional, as opposed to spontaneous, following requests by Member States at the World Health Assembly (20), but sharing and learning within a community cannot be legislated into existence. Because many INFOSAN members report being only occasionally active in network activities, it emphasizes the need for greater facilitation efforts of intentionally created communities compared with those that form spontaneously (23). INFOSAN, like other communities of practice, has a function of promoting collaboration among members. INFOSAN membership clearly crosses boundaries across sectors and countries, so boundary crossing can be described has high. Despite this, INFOSAN has managed to maintain a high degree of trust and knowledge sharing that can both be challenging in communities with a high level of boundary crossing (28). The environment that INFOSAN operates in can be described as facilitating rather than obstructive. Although different members face various barriers to participation that can be obstructive, the Secretariat plays a facilitating role, acknowledging individual member contexts, and aims to support each one according to specific needs and requirements. Organizational slack can be considered high, meaning that the INFOSAN Secretariat has the general availability of tangible and intangible resources, including human and financial resources. High organizational slack can enable experimentation and exploration of new ideas within communities of practice (3), and INFOSAN members are encouraged to drive new initiatives they feel would be of benefit to the broader membership. INFOSAN has a high degree of institutionalized formalism and the Codex Alimentarius Commission (CAC) revised the Principles and Guidelines for the Exchange of Information in Food Safety Emergency Situations (CAC/GL 19-1995) in 2016 to make appropriate references to INFOSAN (9). This important revision, endorsed by all CAC members, has further formalized the global mandate of INFOSAN and the important and internationally recognized role that INFOSAN should play in the rapid exchange of information between countries during food safety emergencies. In addition, since the International Health Regulations came into force in 2007, INFOSAN has been recognized as a fundamental tool to assist countries in developing the core capacities required for food safety emergency preparedness and response (20). Improved institutionalism provides INFOSAN with legitimacy and may help to explain why INFOSAN has a good reputation in the majority of members' organizations. Leadership within INFOSAN is clearly structured with most operational functions being coordinated by the INFOSAN Secretariat at WHO (10). In addition, member roles and responsibilities are defined (7) and made clear upon formal designation by representative government agencies. Because INFOSAN is meant to be a member-driven network, new leadership roles may emerge among members over time that may help to spur engagement and accountability (2). This may also help to justify the time spent working on INFOSAN activities that may be especially important for the large group of members who indicate a desire to have more time to spend on INFOSAN-related activities.
With more than 600 members registered in 2020, the size of INFOSAN as a community of practice can be considered large (28). Large communities of practices often consist of a core group of very active users who regularly contribute new information and ideas and others whose engagement is more passive (29). In virtual communities of practice such as INFOSAN, the passive participants are known as “lurkers” and often comprise of the largest group of community members (24). This is indeed the case with INFOSAN as demonstrated by ICW access data described by Savelli and Mateus (22), which show only a limited number of active members, as well as results from this survey whereby the majority of members report being only occasionally active. However, the fact that nearly all respondents indicate that participation in INFOSAN has been a valuable experience (despite many being passive participants) is consistent with other research to suggest that such peripheral members get great value from their lurking activity (15). As the size of the network grows, the INFOSAN Secretariat should consider the diverse interests of members and consider forming subgroups (e.g., by topic or region) to encourage active participation (28). The geographic dispersion of INFOSAN is necessarily high, and as such the majority of members have not participated in face-to-face meetings. In this case, the reliance on the ICW is of utmost importance to facilitate asynchronous communications given membership across different time zones. High geographic dispersion also indicates a high degree of cultural diversity that should be taken into consideration when engaging INFOSAN members in network activities. Membership at the individual level is closed and reserved for those officially designated on behalf of national authorities; however, it is open to all 194 Member States. Although membership enrollment is voluntary, it is strongly encouraged given the formalization of INFOSAN with CAC and International Health Regulations, and members are expected to fulfill their roles and responsibilities once designated. Because membership is voluntary, it is perhaps not surprising that nearly all respondents have indicated that they like being a member of INFOSAN. Previous research has shown that in communities of practice, members who volunteer are generally more motivated to participate compared with conscripted members (3). Membership to INFOSAN has been steadily growing each year (by an average of 52 new members per year from 2013 to 2019 (22)). At the time of this study, the average INFOSAN member has been registered on the ICW for 3 years 10 months. For Emergency Contact Points, the average is 4 years 5 months, and for Focal Points the average is 3 years 6 months. INFOSAN members registered on the ICW in 2012, between 6 and 7 years ago, represent the largest group (22). A growing membership has implications for the INFOSAN Secretariat in terms of the considerable energy that must be devoted to helping new members understand their role in the network. Existing members also play an important role here and results from the survey indicate that most INFOSAN members assign at least some degree of importance to helping out new members as a reason for participating in INFOSAN activities. Members' information and communication technology literacy appears quite high, considering that the majority of respondents are using the Internet to find information and report that e-mail is a more frequent mode of communication between members compared with the telephone or in-person meetings and many members report participation in virtual meetings (i.e., webinars) organized by the INFOSAN Secretariat. In terms of cultural diversity, the membership is quite heterogenous, coming from hundreds of different agencies in 190 countries; in total, the members speak dozens of different languages and come from various professional backgrounds. Although unified around a common goal of preventing foodborne illness and improving food safety, the heterogenous nature of the membership may help to explain the relatively low levels of engagement reported among a large group of members. Cultural heterogeneity can be considered an asset by bringing rich and varied perspectives and experiences, but past research has also revealed that it can make information sharing difficult (17). The INFOSAN Secretariat must carefully consider such cultural differences when delivering key messages through the network to ensure that misinterpretations or distortions are limited. Finally, the topic's relevance to members can be considered high because nearly all members report learning about their subject area to some extent and the majority agree that one of the most important things that happens in INFOSAN is that members find solutions to problems in their work. Past research has shown that fostering engagement, developing commitment, and creating and sustaining motivation in communities of practice are all done more readily when members focus on problems that are related to their work (29). The most important reasons for participating in INFOSAN are reportedly to improve the safety of the food supply and to prevent foodborne diseases that align well with the overall mission of INFOSAN, which is to halt the international spread of contaminated food, prevent foodborne disease outbreaks, and strengthen food safety systems globally to reduce the burden of foodborne diseases (11).
The degree of reliance on information and communication technology is high. Nearly all information being shared with INFOSAN members is done so through e-mail or on the ICW; face-to-face meetings of INFOSAN members are rare. When discussing the survey results at the INFOSAN global meeting, members have recommended to increase the frequency of face-to-face meetings and to do so in all regions (12). Previous research has shown that virtual communities of practice benefit from face-to-face interactions to be the most effective, and such meetings can result in the formation of stronger personal relationships among members, which may be essential to maintaining productivity during extended periods of virtual communication (13). Information and communication technology availability within INFOSAN is high, with multiple avenues for collaboration on the ICW, including document sharing, asynchronous discussion forums, and synchronous chat functionality. Use of web conferencing tools is also common in INFOSAN, with online seminars (i.e., webinars) being organized regularly by the Secretariat, including most recently during the World Food Safety Day 2020 celebrations in June 2020, which attracted hundreds of participants during webinars in English, French, and Spanish (32). Given the high reliance on information and communication technology, and specifically the ICW, a new version of the ICW is currently under development, taking into account the results from this survey as well as recommendations from Savelli and Mateus (22) following the analysis of the ICW in phase 1 of this study.
In addition to providing a better understanding of the structuring qualities of INFOSAN as a community of practice, the results of this survey provide a broad understanding of members' perceptions of the use of INFOSAN as a global communication tool for knowledge transfer and exchange and the prevention of foodborne illness in their respective country and beyond. Results have also illuminated the ways in which the ICW is used to support network activities and highlighted certain barriers as most important to overcome to improve active participation. The results have also revealed the ways in which participation in INFOSAN creates value for members and the mechanisms through which this may occur.
ICW is an important and supportive tool for the network
The results indicate that the ICW is clearly perceived by the majority of members as an important and supportive tool for the network, with most members accessing the ICW to read about food safety alerts issued by the INFOSAN Secretariat. However, it is also clear from the results that many members would like to see more information posted from the Secretariat and from members themselves. The results concerning the use of the ICW (i.e., many members report infrequent access) are consistent with the results from phase 1 of this study, which also indicate that only a small subset of the membership regularly access and share information on the ICW (22).
Numerous barriers to participation in INFOSAN reduce engagement of some members
Potential barriers to active participation in INFOSAN have been ranked according to respondents' perspectives and regional differences noted. Between regions, the only barrier that is consistently reported in the top five is the limited capacity and/or infrastructure dedicated to addressing food safety events. This suggests a widespread and systemic problem regarding the underdevelopment of certain fundamental aspects of national food control systems. At the second global meeting of INFOSAN members, held in December 2019 in Abu Dhabi, United Arab Emirates, more than 285 INFOSAN members from 135 countries were divided into groups according to geographic region. Each group was provided with the list of potential barriers to participation in INFOSAN, ranked according to regional responses to the survey. Participants were asked to consider the list of barriers as a starting point for their group discussion. The goal of the group discussions was to identify solutions to overcome some of these barriers and increase active participation in INFOSAN activities. In terms of what members can do to overcome the barriers to active participation in INFOSAN, the following suggestions were made: (i) familiarize themselves with the existing tools and use resources available, including templates, webinars, the ICW, etc.; (ii) advocate for INFOSAN in different settings to raise awareness and understanding (within and outside of their own organization, at national and international levels, etc.); (iii) organize national INFOSAN workshops to improve communication and cross-sectoral collaboration including for emergency response with support from the INFOSAN Secretariat; (iv) develop, test, and use national food safety emergency response plans; and (v) participate in a buddy system or twinning initiative that would pair more active INFOSAN members with less active INFOSAN members to develop capacities and improve participation. In terms of what the INFOSAN Secretariat can do to overcome the barriers to active participation in INFOSAN, the following suggestions were made: (i) engage regional authorities for collaboration (e.g., training, communication, member identification); (ii) align contact points in other regional networks with INFOSAN to prevent parallel tracks of communication during emergencies; (iii) clarify processes and protocols for exchange of information between regional networks and INFOSAN; (iv) expand the availability of technical and training material to include all United Nations official languages (i.e., English, French, Spanish, Arabic, Russian, and Chinese); (v) continue organizing global meetings at an increased frequency (instead of every 10 years) and regional meetings for all regions (and not only Asia and the Americas); (vi) continue to organize webinars on a range of technical topics; (vii) support simulation exercises to test national food safety emergency response plans; (viii) facilitate buddy system or twinning initiative to pair more active INFOSAN members with less active INFOSAN members to develop capacities and improve participation; and (ix) ensure new ICW is more user friendly to encourage increased engagement. Additional details are captured in the INFOSAN global meeting report (12).
According to members, INFOSAN prevents illnesses and saves lives
The results from this survey also clearly demonstrate that the majority of members believe that because of INFOSAN, illnesses have been prevented and lives have been saved. Moreover, many respondents believe that participating in INFOSAN has prevented foodborne illnesses in their own country and that INFOSAN has improved the safety of the global food supply. However, the fact that there are still many members who do not know whether INFOSAN has reduced foodborne illnesses globally or improved the safety of the food supply highlights the need for better indicators to monitor global food safety and foodborne diseases more broadly. This could include the development of a global foodborne disease surveillance system to monitor trends in foodborne illness over time. Such a system should complement and work closely with other ongoing international efforts to track foodborne diseases including PulseNet International (16) and the Global Microbial Identifier initiative (30).
Participation in INFOSAN has been a valuable experience for nearly all members
Finally, the results clearly indicate that participation in INFOSAN creates value for members with nearly all respondents, indicating that participating in INFOSAN has been a valuable experience. Value has been created in many different ways, including by contributing to cost savings and new ideas for many members' organizations. It has also made a real contribution to the effectiveness of many respondents' organizations. In addition, many members have indicated that using INFOSAN is absolutely essential for finding new information that helps solve problems, complete projects, and keep up to date in the field of food safety. Respondents have indicated that the most important reasons for participating in INFOSAN are to improve the safety of the food supply and to prevent foodborne disease. They have also indicated that learning is an important factor for participation in INFOSAN, with nearly everyone reporting some degree of learning about food safety through INFOSAN and learning from each other despite coming from different professional backgrounds.
One limitation of this study is that the data represent the perceptions of INFOSAN members at a single point in time and do not allow for trend analysis over any period. The questionnaire was available in English, French, and Spanish, and although nearly all (98%) of members have reported speaking one of these three languages (22), making it available in Russian, Arabic, and Portuguese may have encouraged additional responses from members who speak Russian, Arabic, and Portuguese as their first language.
In conclusion, results from this questionnaire have enabled the assessment of the functioning of INFOSAN as a community of practice by providing systematic insights into the characteristics, performance, and opinions of members. It has also provided a broad understanding of members' perceptions of the use of INFOSAN as a global communication tool for the prevention of foodborne illness. Finally, results clearly demonstrate that INFOSAN members value participation in INFOSAN, for a range of personal and professional reasons. Further research is needed to explore the experiences of members and understand some of the results in more depth with a subset of members. This work will be undertaken in phase 3 of this study of INFOSAN.
C. J. Savelli conceived the original idea, designed the study, drafted the manuscript, and approved the final document. C. Mateus drafted the manuscript and approved the final document. C. J. Savelli is a staff member of WHO. We alone are responsible for the views expressed in this publication and do not necessarily represent the views, decisions or policies of WHO. We thank several individuals for their support in developing the questionnaire used in this research including Mr. Adam Bradshaw (New Zealand), Prof. Alan Reilly (Ireland), Mr. Jan Baele (Belgium), Ms. Jenny Bishop (New Zealand), Dr. Raul Garcia (Mexico), and Dr. Zainab Jallow (Gambia) for help to conduct the content validity check of an earlier version of the questionnaire; Ms. Ngouille Yabsa Ndiaye (Senegal/Canada), Ms. Rim Mouhaffel (Algeria), Ms. Noemie Andriamiseza (Switzerland), Dr. Emilie Youda (Cameroon), Dr. Romy Conzade (France/Switzerland), and Ms. Roxane Delagrave (France) for help with the adaptation of the questionnaire into French; and Ms. Laila Sofia Mouawad (Brazil), Dr. Raul Garcia (Mexico), Ms. Alyssa Palmquist (United States), Mr. Federico Paoletti (Argentina/Italy), and Ms. Kareena Hundal (United States) for help with the adaptation of the questionnaire into Spanish. We also thank Prof. Alan Reilly (Ireland), Dr. Jorgen Schludnt (Singapore), and Dr. Robert Verburg (The Netherlands) for technical input to the study protocol that has guided this research. Finally, we thank staff from the INFOSAN Secretariat for review of an earlier draft of this article, including Drs. Ceyhun Gungor, Raul Garcia, Rachelle El Khoury, and Peter Ben Embarek from WHO and Dr. Kosuke Shiraishi from FAO.