Bridging the Knowledge-Practice Gap: The Culturally Mediated Role of Attitude in Food Safety Behaviors During Pregnancy.

Foodborne diseases pose serious risks during pregnancy; however, cross-cultural studies on their cognitive and behavioral factors that influence safe practices are lacking. This study aimed to compare the food safety knowledge, attitudes, and practices (KAPs) of pregnant women in China and Syria and to develop a model that explores how food safety knowledge (FSK) and attitudes (FSAs) influence different practices. A cross-sectional study was conducted among 808 Chinese and 815 Syrian pregnant women using a validated questionnaire. Data were analyzed using descriptive statistics, Chi-square, and Partial Least Squares Structural Equation Modeling. Chinese women demonstrated higher FSK and more positive FSAs (59.0% vs. 48.5%, p = 0.001) than Syrian women, whereas Syrian women showed stronger personal hygiene practices (mean score: 4.06 ± 0.68 vs. 3.93 ± 0.67, p = 0.001). While FSK directly influenced FSAs in both cohorts (China: β = 0.379, p < 0.001; Syria: β = 0.405, p < 0.001), its translation into practices was culturally specific. For Chinese women, FSA fully mediated the relationship between FSK and temperature control (TC) practices (indirect effect: β = 0.121, p < 0.001) and partially mediated personal hygiene and cross-contamination (CC) prevention. In contrast, for Syrian women, FSA mediated the relationship with high-risk food (HRF) avoidance (indirect effect: β = 0.092, p < 0.05) and personal hygiene (indirect β = 0.076, p < 0.05). The findings conclude that the pathways from knowledge to practice are complex and culturally mediated, indicating that effective public health interventions must be tailored to specific socio-cultural contexts to improve food safety behaviors.