Food Safety Practices Among Small-Scale Produce Growers Exempt from Federal Regulations: A Systematic Literature Review.

Small-scale produce growers exempt from the Food Safety Modernization Act (FSMA) Produce Safety Rule (PSR) are not required to follow federal food safety standards, yet their practices have direct implications for public health. The extent to which knowledge, attitudes, and behaviors (KAB) influence voluntary adoption of PSR-aligned practices in this group remains unclear. This systematic literature review aimed to examine self-reported food safety behaviors and willingness to adopt practices among FSMA-exempt small-scale growers. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, six databases (ScienceDirect, Web of Science, Scopus, AGRIS, AGRICOLA, and ProQuest) were searched for studies published from 2013 to 2025. Eligible studies included cross-sectional surveys reporting on food safety behaviors and KAB across three high-risk domains: agricultural water (AW), cleaning and sanitation (CS), and storage and transport (ST). Out of 133 records screened, seven studies met the inclusion criteria. Six reported findings on AW, five on CS, and five on ST. Use of tested well water ranged from 28.9% to 39.4%; 71-74% of respondents reported managing sanitation or packing produce in designated facilities; and 64% reported managing transport sanitation. Despite widespread awareness of food safety importance, the adoption of specific practices was inconsistent. Findings underscore a gap between intention and implementation, reinforcing the need for targeted outreach and affordable infrastructure solutions to support voluntary compliance among FSMA-exempt growers.