Hygiene and Food Safety Habits among Slovenian Mountaineers

Abstract

The study provides a deeper insight into Slovenian mountaineers’ and excursionists’ habits regarding food safety knowledge, food handling practices, and hygiene on expeditions. The objective of the study is to identify gaps in food safety knowledge and food handling practice at home and during mountaineers’ activities. Data were collected using an anonymous online questionnaire (n = 330) and eight semi-structured interviews. The research participants take most of their food with them when they set off, mountaineers more often than excursionists (p < 0.05, p = 0,000). Few interviewees indicated that it is important to them that food is safe while consuming it. Almost 90% of mountaineers and excursionists believe they can identify food safety by smell and taste. Significantly more mountaineers prioritise food enjoyment over hygiene compared to excursionists (p < 0.05, p = 0.001). Mountaineers also feel that they are more resistant to foodborne diseases and are much less concerned about foodborne disease than excursionists (p < 0.05, p = 0.011). The respondents highlighted the need for the Alpine Association of Slovenia to organise food safety education for its members. The greatest emphasis has to be put on food safety education material that has to be put in general training programme for mountaineers. Informing mountaineers and excursionists about food safety requirements needs to be improved with target strategy.

1. Introduction

The burdens of foodborne diseases (FBD) on public health, welfare, and the economy have often been underestimated due to underreporting because they cause short-term diseases or asymptomatic infections. Outbreaks of FBD occurring in private homes are less likely to be reported than those in commercial and public premises, and it is believed that infections attributed to private homes are three times more frequent than those attributed to canteens [1]. However, studies in recent years have highlighted gaps in food safety knowledge and critical safety violations regarding food handling at home [2,3,4].

According to Al-Sakkaf [5], the main factors influencing consumers’ food handling are personal. They can be divided into psychological, demographical, and socio-economical. The psychological factors include the so-called optimism control and habit bias. The optimism bias is defined as follows: an individual exposed to risk is aware that a certain factor may pose a risk but believes that the probability of this happening to them is lower than the probability of it happening to someone else [5].

The perceived impact of FBD on individuals can depend on perceptions of risk, experiences, trade-offs, and heuristics [6]. According to Zanetta et al. [7], the risk perceptions were not associated with the risk assessment of the restaurants. Performance, time, and health were the consequences with higher risk perceptions. Consumers underestimate the risk of FBD in their home kitchen [8] and when they eat away from home [7]. They believe it is less likely that they perform inadequate food handling practices than others do. Most investigations of food FBD outbreaks state that the consumers have more positive memories of food consumed away from their homes and blame food prepared by their friends or a restaurant as the main cause of FBD. The consumers identify the food industry and food processing plants as the most high-risk places for food contamination. Consequently, they are less motivated to change their own poor food handling practices [9,10]. The consumer is the last link in the food supply chain, which the European Food Safety Authority believes is inadequately addressed, as the largest proportion of foodborne outbreaks is related to consumers’ domestic environment [11]. Lack of knowledge and misconduct in food preparation is more prevalent among consumer groups such as young adults (18 to 29 years), men, and individuals over 60 years of age [8,12,13].

Automatic behaviour patterns regularly occurring without special thought are called ‘habits’, and individuals do not pay special attention to them [5]. They get used to the behaviour; consequently, the cognitive effort needed for certain behaviours is reduced. For many individuals, food preparation can be described as usual behaviour as it is a frequently repeated act. If the behaviour is repeated regularly, individuals react to it without deep thought. As a result, their practice follows its goal without further ado. The practise becomes a habit, and as the behaviour had been performed often in the past, it becomes increasingly automated [5,9]. Age and gender demographic factors significantly impact people’s behaviour when preparing food at home and on trips. Some studies have shown that older consumers follow safe food preparation processes more consistently than younger consumers do and that young consumers have less knowledge about food safety [10]. Gender is important for the perception of risk. Women place greater importance on health risk prevention than men. Because women are mothers and educators, they give more importance to health. Women also have more knowledge about safe food preparation than men do [5,14,15].

Among different groups of athletes, actual nutrition [16] and food safety knowledge [9,17] does not always comply with the official recommendations because of a lack of general nutrition and food safety knowledge, mistaken beliefs, lack of interest or motivation, practical problems, or perhaps intuition [18]. Food safety knowledge and beliefs can influence food safety behaviour [9,19], even if the relationship is not necessarily obvious. Improved food safety and nutritional knowledge and practices during sport activities play an important role in changing already established habits among mountaineers and climbers’ [19]. Better insight into food safety and nutrition knowledge and behaviour is of importance for adapting guidelines in view of improving compliance [2,16,17].

Mountaineers perform their sports activity in demanding conditions that increase the risk of FBD and are an interesting target group for researching food safety knowledge and practice [17]. They are organised within the Alpine Association of Slovenia, which is the largest sports organization in Slovenia. A member of the alpine association can take part in a variety of mountaineering activities: hiking, sport climbing, mountaineering, ski touring, mountain biking [20]. Due to the lack of satisfactory data in Slovenia and worldwide, a pilot study among mountaineers in Slovenia was carried out to investigate food safety knowledge and practices and their experience with FBD during mountaineering activities.

The objective of the study was to identify gaps in food safety knowledge and critical safety violations regarding food handling at home and during mountaineering activities.

2. Materials and Methods

2.1. Research Protocol

We used a combination of qualitative and quantitative data collection methodologies. Data were collected using an anonymous online questionnaire and semi-structured interviews. Informed consent was obtained for semi-structured interviews. In addition, the privacy rights of participants were observed.

2.2. Data Collection and Statistical Analysis of the Questionnaire

A link to the online questionnaire (see Appendix B) was sent to Slovenian mountaineers of various profiles. Alpinists, mountaineers, sport climbers, and mountain guides were combined into a group named ‘mountaineers’. A second group (control group) was ‘excursionists’ which are people who are not mountaineers but spend time in nature and do not take part in mountaineering activities (e.g., campers, mushroom pickers, nature visitors). The link was sent via e-mail to alpine, climbing, hiking, and mountaineering clubs and was posted on various websites and social media sites whose potential users are people who go on nature trips. The purpose of the questionnaire was explained. The questionnaire was designed based on the authors’ pre-existing empirical research [2,17] dealing with various aspects of food safety. The pre-tested questionnaire included 21 closed-ended questions divided into sections: demographic data, dietary information, knowledge and concern about food safety, the attitude towards it, and experience with FBD. The survey was administered online from 25 March to 25 May 2020, via the web platform 1 ka™. In total, 898 participants responded to the invitation (clicked on the questionaries’ link), whereby 345 completed the questionnaire, and 15 were excluded (because they selected the answers ‘other’ and were not part of a target group, e.g., cyclists). Finally, 330 participants were included in data analyses. According to their answers about activity, we divided the sample into two groups: 64.2% were mountaineers, and 35.8% were excursionists.

The IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA) was used for statistical analysis. The demographic data were shown using descriptive statistics. We performed preliminary analyses for normality. Given that the distribution was not normal, we used Mann–Whitney U test to investigate statistically significant differences between the groups. Nevertheless, we presented results with averages and standard deviations for a more straightforward interpretation and comprehensibility of results. A p-value of less than 0.05 was considered significant for all analyses. The statistically significant differences between the different groups of categories were determined with the χ2 square test. Finally, the level of statistical significance was adjusted (p < 0.05).

2.3. Data Collection and Analysis of the Semi-Structured Interviews

This qualitative study used semi-structured interviews to explore gaps in food safety knowledge and critical safety violations regarding food handling at home and during mountaineers’ activities. We followed the 32-item consolidated criteria checklist for reporting qualitative research [21]. Through purposeful sampling, participants were recruited from the population of Slovenian mountaineers. The following sampling criteria were applied: participants from different age groups and the various mountaineering activities in which they engage. We introduced the researchers to them and explained the purpose of the research. The purposeful sample size was determined by theoretical saturation, which is the point in the data collection process at which new data no longer offer additional insights for the research question [22]. The final number of interviews conducted was 8 (

Table A1. Demographic characteristics of respondents and interviewees.

RESPONDENTS
	Data Sample
Characteristics	Mountaineers (n = 212)		Excursionists (n = 118)
	n	%	n	%
SEX
Male	95	44.8	35	29.7
Female	117	55.2	83	70.3
AGE GROUPS
<31	93	43.9	38	32.2
31–50	85	40.1	50	42.4
>50	34	16.0	30	25.4
EDUCATION
Primary school	4	1.9	5	1.5
High school	49	23.1	92	27.9
college, university, university program	124	58.5	188	57.0
specialisation, master’s degree, doctorate of science	35	16.5	45	13.6
DIET
Omnivorous	185	87.2	108	91.5
Vegetarian	15	7.1	8	6.8
Vegan	12	5.6	2	1.7
YEARS ENGAGING WITH MOUNTAINEERING
1 to 5	40	19
5 to 10	54	25.6
10 to 15	29	13.7
>15	88	41.7
FREQUENCY OF ENGAGING WITH MOUNTAINEERING
very often, at least twice a month	163	77.3
often, once a month	34	16.1
occasionally, less than once a month	14	6.6
INTERVIEWEES
Characteristics (n = 8)
Label of the interviewee	Sex	Age (years)	Time of engaging with (years)	Kind of diet
M1	M	70	36	omnivorous
M2	Ž	61	16	vegetarian
M3	Ž	31	31	omnivorous
M4	M	48	21	vegetarian
M5	M	26	15	omnivorous
M6	Ž	35	10	omnivorous
M7	M	28	8	omnivorous
M8	M	56	35	omnivorous

in Appendix A).

In line with the research goals, we decided to conduct interviews to explore mountaineers’ attitude towards food safety and their experiences with FBD during their activities. A semi-structured questionnaire (see Appendix C) was prepared and developed through a literature review. It was additionally redesigned after pilot interviews. The interviews were conducted by a doctoral student of Public Health at the Faculty of Medicine of the University of Ljubljana and an assistant professor at the Sanitary Engineering Department, Faculty of Health Sciences. The interviews were held face to face between September and November 2020. They took place at the interviewees’ homes. They were recorded digitally (audio), transcribed verbatim, and anonymised. Some field notes were made during and after interviews and included in the final analysis. Transcripts were not returned to participants. No repeat interviews were made.

The authors of the study conducted a qualitative content analysis. The interview transcripts were read, qualitatively coded, reviewed, and labelled, using inductive content analysis. Each interview was analysed by the authors independently. After that, the authors reached a consensus on categories and themes. Themes and categories were defined in an inductive process after establishing codes to condense observations from the data. To provide anonymity, interviewees’ names were changed, but they did not provide feedback on the findings. Because of the amount of data obtained through interviews, this part of the results introduces only excerpts from interview transcripts, with the sharpest and most interesting quotes reflecting each interviewee’s positions/opinions/experience.

2.4. Demographic Data

A total of 330 respondents participated in the study (64.2% mountaineers and 35.8% excursionists). Approximately 40% of the respondents were under the age of 30, and the same percentile was between 30 and 50 years of age. A good half (57%) of the respondents were university graduates. Meat eaters represented 88.8% of all respondents. The largest share (41.7%) of the surveyed mountaineers had been physically active for over 15 years. Slightly over three-fourths of the mountaineers were often physically active.

We conducted 8 interviews. Each of them lasted about 30 min on average (Table A1 in Appendix A).

3. Results and Discussion

In the following, we present the results obtained from the analysis of survey questionnaires (hereafter respondents) and the qualitative analysis of interviews (hereafter interviewees).

3.1. Eating Habits

The surveyed mountaineers and excursionists most often eat food that they bring with them from home. Typically, mountaineers eat food that they bring from home more often than excursionists do (p < 0.05, p = 0.000), or they combine that food with eating meals in mountain huts (p < 0.05, p = 0.016). Mountaineers and excursionists most often bring the beverages they consume from home, however, mountaineers do it more often (p < 0.05; p = 0.030) than excursionists, who tend to (p < 0.05; p = 0.001) purchase (additional) beverages from a restaurant, shop (

Table 1. Eating habits and water supply on nature trips.

	Mountaineers x-, (σ)	Excursionists x-, (σ)	p-Value
Eating habits
Only with the food I took from home. *	3.05 (0.7)	2.8 (0.7)	0.000
By combining my food and eating in a mountain hut. *	2.6 (0.8)	2.3 (0.8)	0.016
In a mountain hut.	2.3 (0.6)	2.2 (0.6)	0.208
In bars where they serve food (inn, farm tourism, etc.). *	1.9 (0.6)	2.1 (0.5)	0.006
By self-cooking on a portable stove.	1.5 (0.6)	1.4 (0.7)	0.010
Water supply
I bring all the necessary drinks with me from home. *	3.4 (0.6)	3.3 (0.7)	0.030
If I run into a water source, I pour myself a drink.	2.8 (0.9)	2.7 (1)	0.010
I buy a drink (up to) in a restaurant, shop. *	1.8 (0.6)	2.1 (0.7)	0.001
If I pour water from a source in nature, I filter it or add disinfectant tablets.	1.1 (0.4)	1.1 (0.3)	0.494

Legend: Average grades for both groups of the respondents are expressed as means (and standard deviations); a score means: 1 = never; 2 = sometimes; 3 = often; 4 = always; *—statistically significantly (p < 0.05) different when compared groups; x^-—average; σ—standard deviation.

).

From the interviews, we defined three key themes related to the mountaineers’ and excursionists’ eating habits during their activities in nature T: T1 eating habits, T2 experience with FBD, T3 ensuring health compliance of foodstuffs (

Table 2. Theme and categories of qualitative analysis.

THEMAS	Eating Habits	Experience with Foodborne Diseases	Ensuring Health Compliance of Foodstuffs
CATEGORIES	(1) dietary concept, (2) foodstuffs, (3) what is important in a diet	(1) location, (2) cause, (3) consequence (4) what helped	(1) types of foods, (2) no risk/risk for health, (3) food processing, (4) better resilience of mountaineers, (5) hygiene of hands, (6) hygiene of food, and (7) role of alpine society

).

Under Theme T1, ‘eating habits’, we identified three categories with associated subcategories: (1) dietary concept, (2) foodstuffs, and (3) what is important in a diet. In the interviews, the mountaineers highlighted that during their activities, they adapt their diet to the season, length of their tour (half-day, day, several-day long expedition), risk in the country they are travelling to (domestic tours, Europe, other countries), location of accommodations (mountain lodge, camping, bivouac), as well as the available personnel (a hired cook, cooking for themselves). They eat according to how they feel in the moment (1.1.13.5.M3 ‘intuitively’), modestly (1.1.3.1.M1 ‘spartan’), and whether they are meat-eaters or vegetarian.

The results of the quantitative analysis show that a total of 74% of the surveyed mountaineers and 78% of excursionists often or regularly take fresh fruit and vegetables; 70.8% of mountaineers and 66.1% of excursionists take dried fruit and nuts. They often or always take beverages or tea prepared at home (69.4% of mountaineers and 55.9% of excursionists). About half of mountaineers and excursionists take cured meats (salami, prosciutto etc.); 47.1% of mountaineers take chocolate bars, energy bars and similar products, with 37.9% of excursionists doing the same. A little less than a third consume different tinned food on their trips (30.7% of mountaineers and 29.7% of excursionists); 28.3% of mountaineers and 24.5% of excursionists consume dairy products (cheese, spreads). Often, mountaineers (21.2%) and excursionists (28%) bring homemade pastries on the trip. Mountaineers never or rarely (99.8%) take fresh milk with them, and it is much the same for excursionists (98.3% do not bring fresh milk). Less than 5% of mountaineers and excursionists take soft-boiled eggs or store-bought pastries with them.

During interviewees’ activities in the mountains, we established that they consume very diverse foodstuffs: grains, fresh vegetables, fresh or dried fruit, nuts, dairy products, cured meat, spreads, deserts, eggs, and even mushrooms. Liquids are very important to them: water, water with lemon, tea, homemade tea, or tea with honey. They take water from the springs, streams, or snowmelt to obtain fluids. Schnapps was also mentioned (1.2.11.11 M5 ‘My flask accompanies me everywhere, with homemade schnapps inside’.). Interviewee (1.2.11.11 M1) stressed that liquids are more important to them than food: ‘If I run out of liquids, I will overheat, but I can do without food, providing I have enough to drink’. Interviewee PB (1.3.8.2.M6) highlighted the great role of food during activities: ‘It is almost better to forget socks than food’. Several interviewees mentioned that it is important to them that the meal fills them (1.3.2.1.M6: ‘It takes up little space, but is still nourishing’), that it is light and with the smallest possible volume, yet has sufficient energy value so that they consume enough carbohydrates, which give them enough strength and energy, and also that the food makes them feel full and that they are sufficiently hydrated at the same time. They also said it is important they enjoy the food (tasty food, that they like it, that it is good: 1.3.4.2.M7 ‘I like the food to be tasty’), and that the food is homemade (1.3.7.1.M5: ‘I swear by homemade food’). Very few individuals highlighted that it is important to them that food is safe (shelf life, reliable food, non-perishable, safe so they do not get sick, and food they have tested), easy to digest, or that they consume a warm meal. For some, it was important they consume food without meat. Others pointed out the psychological (reward, motivation, pleasure) or social (ritual, learning about the culture, sharing, socialising) aspects of eating. The latter was emphasised by 1.3.5.1.M3: ‘For me, it is the pleasure on the top of the hill when you eat that sandwich and share some sweets with others’.

3.2. Safety of Food

Almost 90% of respondents (mountaineers and excursionists) believe they can judge food safety by taste and smell. Compared to excursionists, a six-times larger share of mountaineers prioritise food enjoyment over hygiene, which is also statistically significantly (χ2 = 14.348; p < 0.05) higher. Mountaineers also consider themselves more resistant to FBD (χ2 = 8.978; p < 0.05) and worry about possible FBD in a significantly lower proportion (χ2 = 6.008) than excursionists do (

Table 3. Beliefs about food safety.

	Mountaineers		Excursionists
Statements	% of Agreement	I Do Not Know	% of Agreement	I Do Not Know	p-Value
I can tell by the smell and taste that the food is safe to eat.	88.7	4.7	89.8	2.5	0.596
The most important thing is that the food suits me, and only then is hygiene important. *	26.4	5.2	9.3	4.2	0.001
Mountaineers are more resistant to possible foodborne poisonings. *	13.7	21.2	5.1	32.2	0.011
I am often worried that I would be poisoned with spoiled food during activity in nature. *	9.4	3.3	15.3	7.6	0.048
The food in the mountain huts is safe. *	83.0	15.1	66.1	28.8	0.002
I have good experience in ensuring food safety with food providers when I go to nature, the mountains.	82.5	14.6	73.7	21.2	0.155
Employees in mountain huts do not pay enough attention to clean hands.	10.8	62.3	10.2	66.1	0.778

Legend: The percentage of agreement with the statement according to the number of all respondents in each group are shown; *—statistically significantly (p < 0.05) different when compared groups.

).

The respondent group of mountaineers ranked their knowledge about the safety of food on a scale of 1 to 5 (1-insufficient knowledge, 5-excellent knowledge) with an average grade of 3.58 and excursionists with 3.71; there were no significant differences between the groups in the average self-assessment of their knowledge (p > 0.05; p = 0.136). The mountaineers acquired the most knowledge through their education (average 2; 1 means no knowledge, 2 medium and 3 a lot of knowledge), the least in mountaineering school (average 1.6) or in newspapers (average 1.6). The majority of the respondent group of excursionists also acquired most of this knowledge through education or online (both average 2.2; where 1 means no knowledge, 2 medium, and 3 a lot of knowledge). Most of the food is prepared by consumers at home [23], so knowledge about food preparation in their home kitchens is definitely more important, as it reduces the likelihood of FBD [24].

With qualitative analysis, we identified seven categories and associated subcategories: (1) types of foods, (2) no risk/risk for health, (3) food processing, (4) better resilience of mountaineers, (5) hygiene of hands, (6) hygiene of food, and (7) role of alpine society. Some interviewees highlighted the importance of consuming properly conserved food or sufficiently thermally processed food. Although mountaineers take a wide variety of food with them in the mountains (see theme 1, category 2), they said that it is important for them that food is non-perishable (3.1.2.2.M8: ‘non-perishable’; 3.1.2.3 ‘perhaps food that does not spoil easily’). In contrast, M7 (3.1.3.4.M7) states: ‘Even if food is past the best-before date, it is not that bad’. Some are aware of health risks due to FBD during mountaineering activities. They believe that contaminated water and food can present health risks. They explained that FBD has an undesired effect on a mountaineer’s body, which is especially problematic since they are active in demanding conditions (heat/cold), and they cannot cope with the effort required when sick.

Foodborne diseases make the body more vulnerable, leading to hypothermia and dehydration, as well as the inability to think rationally, which can result in improper actions. This can pose an additional danger of slipping or falling.

3.2.3.1.M3 had the following thoughts on the subject: ‘When I get sick, I am done for. I can no longer think well or rationally. I can no longer withstand such strain and deal with nature, such as it is in the mountains. I cannot imagine being up there on 5K and get seriously ill?! How will I get down? There is a greater likelihood I will slip or fall’. In addition, the opinion of 3.2.3.2M3 was that a person can die of an FBD.

There are, however, those among the interviewees who feel that food does not pose a health risk due to FBD. For example, 3.2.4.1.M7 said: ‘Well, it is not great, no, but I would not say it is a serious threat’. Others prioritise other things before food safety (3.2.4.1.M5): ‘I do not complicate things with food; there are other more important things when mountain climbing. There are a lot more dangerous things in the mountains than food—there are rocks and slips and cliffs, avalanches, rock walls’.

The surveyed mountaineers doubt that they are more resilient to FBD than people in general. They link this ‘hardiness’ of their bodies is due to the fact that they are often exposed to risks and poor conditions. 3.4.2.1.M7: ‘Because mountaineers spend a lot of time in a wild environment, they consume more bacteria and bad things. In the mountains, it very often happens that we drink water from whatever stream is there. I feel that the more things pass through your stomach, the more you strengthen your immunity, flexibility to be creative’.

However, interviewee 3.4.1.12.M3 warned about the trap of such a ‘brave’ posture: ‘A couple of times it happened that I thought, it is okay, nothing will happen, or some food was questionable, and I ate it, but I was later sorry, when my stomach hurt, when I felt ill or when I vomited. Every time I said to myself, how stupid you are when you know you should not have!’

3.3. Ensuring Food Safety When Processing Food at Home

When buying food in a shop and preparing food at home, the respondent group of mountaineers takes measures for ensuring food safety less often than excursionists (p < 0.05;

Table 4. Measures for purchasing food and preparing food at home.

	Mountaineers x-, (σ)	Excursionists x-, (σ)	p-Value
WHEN SHOPPING IN A STORE
Shelf life of the food. *	2.8 (1.9)	3.1 (1)	0.017
(Non) damage to the packaging. *	2.9 (1.1)	3.2 (1)	0.036
Temperature in the refrigerators in the store when buying dairy or meat products and desserts. *	1.2 (0.6)	1.4 (0.8)	0.030
WHEN PREPARING FOOD AT HOME
Washing hands before preparing food.	3.4 (0.9)	3.6 (0.7)	0.082
Checking the shelf life of food before preparation.	2.9 (1)	3 (1)	0.065
Checking the cleanliness of the packaging in which you store food (thermos, container, …). *	3.7 (0.6)	3.8 (0.4)	0.027
Additional cooling of perishable food with freezers. *	1.8 (1)	2.6 (1.1)	0.000

Legend: Average grades for both groups of the respondents are expressed as means (and standard deviations); a score means: 1 = neve; 2 = sometimes; 3 = often; 4 = always; *—statistically significantly (p < 0.05) different when compared groups; x^-—average; σ—standard deviation.

). In addition to the knowledge of food hygiene, proper consumer behaviour in food preparation is a key element in ensuring consumer safety [8,25,26]. The lack of knowledge and mishandling of food during preparation is more common in consumer groups of young adults (18 to 29 years), men, and people older than 60 years [2,12]. Irregularities in food handling at home are related to improper handwashing, improper separation of equipment and utensils, inadequate cold food storage, cross-contamination, and insufficient heat treatment of food [2,13,27,28,29].

3.4. Ensuring Food Safety during Activities in Nature

The surveyed mountaineers observe food safety measures more infrequently than excursionists while eating during activities in nature (p < 0.05) (

Table 5. Measures regarding hand hygiene in nature.

	Mountaineers x-, (σ)	Excursionists x-, (σ)	p-Value
I rub my hands against my pants or T-shirt. *	2.3 (1)	1.9 (0.9)	0.001
I wash my hands with running drinking water. *	2.1 (0.8)	2.7 (0.9)	0.000
I wipe my hands with wet (factory-prepared) wipes. *	1.9 (0.8)	2.4 (0.9)	0.000
I wipe my hands with a paper towel. *	1.5 (0.7)	1.9 (0.8)	0.000
I wash my hands with running drinking water and soap. *	1.4 (0.6)	1.8 (1)	0.000
I clean my hands with disinfectant (spray, etc.). *	1.4 (0.7)	1.7 (0.9)	0.001

Legend: Average grades for both groups of the respondents are expressed as means (and standard deviations); a score means: 1 = never; 2 = sometimes; 3 = often; 4 = always; *—statistically significantly (p < 0.05) different when compared groups; x^-—average; σ—standard deviation.

).

Proper handwashing before and during food preparation is important to prevent cross-contamination. In our survey, only 11% of all respondents always or often wash their hands with soap and water before consuming a meal in nature. If we compare the results with a previous study among general Slovenian consumers [2], we see that 86% of consumers always wash their hands before preparing food. In the study by Jevšnik et al. [2], it was found that more than half of respondents washed their hands for less than 10 s, and 57% of respondents washed their hands with soap and warm water after handling raw red meat, chicken, or fish.

The interviewees presented different opinions about the importance of hand hygiene while consuming food during activities in nature. Some believe hand hygiene is of significant importance and recognise it as a preventive measure to reduce the risk of infection. They wash their hands using water from streams, plastic bottles, with soap and warm water in mountain lodges, or they ‘wash’ their hands with snow (3.5.4.3.M2: ‘I also wipe them in snow’.). They also stressed that during mountaineering activities, the opportunities for hand hygiene are often limited, or it is even impossible to wash their hands, for example, when there is no water available for several days, or it is half an hour’s hike away, or the only water available was needed for hydration. 3.5.1.1.M2 had the following thoughts on the topic: ‘… She came straight from the toilet without washing her hands. You cannot do things like that! If you have the opportunity, of course, you wash your hands, and even if there is not an opportunity, there is always some way. Often, when I see water running somewhere, I say to myself, oh, right, great, I can wash my hands. Sometimes, I even wash them with water from my bottle if I know I have enough.” 3.5.4.3.M2 described hand washing: ‘Sometimes you wash them in snow, or some dew, sometimes you wipe them on your trousers. Soap is rare—you usually do not have it’. It was also highlighted that the hand hygiene issue had become more popular during the SARS-CoV-2 pandemic. Some people use disinfecting/hygiene wipes (3.5.3.1.M1: ‘If I have to relieve myself, I use the alcohol wipes I carry with me’.). Some are against using them (3.5.3.3.M2 ‘I am not a fan’, 3.5.3.4.M3 ‘I never have them with me’). Some do not find hand hygiene important while touching ‘natural things’, as illustrated by the following statement by 3.5.2.1.M1: ‘If my hands are dirty from soil, rocks, anything, it means I have touched natural things while climbing, and before I start eating, I do not wash my hands. It is nature—it cannot be poisonous’.

The interviewed mountaineers take care of food hygiene by wiping the food against their trousers or in snow and stress that it suffices. (3.6.3.3.M3 ‘It is a different feeling’). They avoid direct contact with their hands by using packaging (3.6.2.3.M4: ‘If my sandwich is wrapped in plastic wrap, I wrap it so that I hold it by the wrapper’.), or they hold the food with a paper tissue (3.6.2.1.M2 ‘I hold a sandwich with a tissue’). When cleaning their utensils, much like when cleaning hands, they use any resource available (3.6.3.2M8 ‘rubbed the spoon in snow and wiped it off a bit’. and ‘We cleaned the food off mechanically’). BH (3.6.3.3.M5) gave an interesting description of washing the dishes: ‘You only wash the dishes in nearby streams. Cows may be grazing nearby. First, you wipe off the food remains with a paper towel. No dishwashing liquid—no way—it must not go into the environment. You wash more carelessly’.

3.5. Experience with Foodborne Diseases

Regarding FBD during a trip in nature or in the mountains, a small group of respondent (9.9% mountaineers, 4.2% excursionists) have experienced it; there was no significant difference in shares between the groups. (p > 0.05; p = 0.104). As the most likely reason for FBD, the interviewees identified poor options for personal hygiene (56% of the interviewees), food in alpine lodges (52%), or perishable food prepared at home (34%); 30% see drinking water from natural sources as a plausible reason because the water was not filtered (disinfected).

Within the analysed theme ‘Experience with foodborne diseases’, we identified four categories with associated subcategories: (1) location, (2) cause, (3) consequence, and (4) what helped. Some of the interviewees experienced FBD during their mountaineering activities. These happened in domestic or foreign mountains; they also reported getting FBD from eating a meal in an alpine lodge. The cause of FBD were beverages (water, cold drinks, ginger ale), food, especially desserts (strawberry cake with cream), meat (leftover meat, sausage, bean soup and cured meat), or food coming in contact with animals (2.2.3.2. M8 ‘soup, and the container had been nibbled on’; 2.2.3.3. M6 ‘contaminated water, an animal carcass was in it’). They faced the following health issues: indigestion (vomiting, diarrhea, lack of appetite), dehydration, overall weakness (weight loss, they were confined to bed, exhausted or unable to walk), pain (in the abdomen, stomach, kidneys), and cramps; the consequences also manifested in their psyche (they were frightened). M1 vividly described his food poisoning: ‘I got sick in Bolivia when we were climbing Ilimani in Cordillera Real. Before the ascent, we went to a hotel to have a good meal. It was a three-star restaurant, and we had a big meal. It was good, too. Then, I saw some strawberry cakes with cream. I had passed them about three times, and I could not stop myself, and I ordered one. Then, my friend had one, too. They were good, I must say. We ate them, but then before dawn, I do not know who had to go to the toilet first, and then it started […] After three days, we were very weak […]’.

M4: ‘I got really sick in Peru. I drank the water up there. It was high up, almost below the glaciers. I knew I must not drink it downstream because there are cows and cow patties, but I did not know cows can get so high up such steep slopes; also I saw a porter, a local, drink that water. They are immune; they can do many things we tourists may not. Well, I got sick overnight. I vomited something awful. We thought it was the altitude, but I knew it was the water. I had trouble for a while; I am thin as it is, and then I came home looking like a skeleton. Weak. On the way back, they put me on a horse, because I could not walk. I was a bit delusional, and my pal got infected by some sweets, but that was in India, and he had the opposite. He got so constipated that he had a belly like a pregnant woman. Imagine not going to the toilet for a week or more’.

In some cases, people needed to be hospitalised. Some of them had positive insights from the otherwise bad experience, as they learned something about more appropriate food handling during their future activities in nature. (2.3.6.1.M2: ‘It will not happen to me again’.; 2.3.6.2.M3: ‘You really have to be very careful […] put chlorine tablets in it.”) When dealing with health issues due to FBD, they were given medicine, select food (2.4.2.1.M1 ‘coca tea’), hospitalisation, and rest.

Respondents attached great importance to the alpine association in terms of educating about the health status of foods, especially in the area of member education and training (in schools for alpinists and mountaineers, in exams, training courses, online, and before visiting more ‘exotic’ states) because in their opinion this is an important and wide-ranging topic. They also warn about the problem of less-experienced mountaineers going on longer expeditions, especially abroad or to less developed countries (3.7.5.1. ‘You have to be more careful’), and they do not even know how to use chlorine tablets, for example. They believe that the SARS-CoV-2 pandemic is a good opportunity to warn them, especially where there are larger groups of people (in lodges, on busses). They also see a role for the alpine association in raising awareness among mountain visitors about the dangers of FBD and contamination risks, preventive measures, and ensuring hygiene standards in mountain lodges (e.g., placing hand disinfectants, monitoring if measures are observed). In the respondents’ opinion, this is necessary because of the mass of visitors (3.7.5.2.M4: ‘Just think about one and a half million people eating breakfast together and then driving for an hour to some starting point, where they “leave their mark”. That is a million and a half of those “marks”, and then there are the animals who contaminate them’.). They also highlighted the individuals’ responsibility to learn about preventive actions and to have the means to take the basic hygiene measures while eating when travelling. They also note that there always needs to compromise between sufficient gear and weight. They concluded that personal hygiene is important and that disinfectant wipes can help provide it and that you can get seriously ill if you do not follow the preventive measures. Respondent M3 warned about individuals’ responsibility: ‘You need to be careful, this is your free time, your vacation, your holiday, and it would be really bad if you got sick’. Common sense needs to be applied, because it is impossible to guarantee 100% food safety in the mountains, especially on longer tours that last several days. Against such a background, there is a constant and urgent need to improve domestic food hygiene knowledge and practice [30,31,32]. However, consumer education activities are expensive to organise, maintain, and evaluate. Thus, it is particularly important to identify, target, and reach higher risk consumer groups correctly [30,31,32,33,34].

4. Conclusions

With our analysis we established that:

• The respondents take most of the food on tour with them. The energy density of food and sufficient hydration are important for them.
• Almost 90% of mountaineers and excursionists believe that they can recognise food safety by smell and taste. Statistically significantly more mountaineers prioritise food enjoyment to safety compared to excursionists. Mountaineers also believe they are more resilient to FBD and are significantly less worried about FBD than excursionists. Nevertheless, some interviewed mountaineers also stressed the importance of properly preserved or sufficiently cooked food being aware of health risks due to FBD while mountaineering. To others, food safety poses no additional concern, and they usually disregard best-before date of the foods.
• When buying food in stores and preparing food at home, the mountaineers in comparison to the excursionists, less often observe food safety measures and less often consider food safety while consuming food during their outdoor activities. Their attitude and perception reflect their belief that they cannot contract FBD during mountaineering. Such a behaviour presents a high risk and could lead to serious health issues during expeditions.
• A small share of the participating mountaineers and excursionists reported a history of FBD during their tour in nature or in the mountains due to poor possibilities of maintaining adequate personal hygiene, keeping food in mountain lodges, and consuming home-prepared perishable food and water from natural sources.
• The majority of food safety knowledge was obtained during regular schooling by mountaineers and by excursionists. The respondents stressed the necessity that the alpine association organise training courses and educate about food safety. They also believe that the SARS-CoV-2 pandemic is a good opportunity to raise awareness about the dangers of FBD infection risk among people visiting mountains.