Journal of health research in community

Introduction
Cockroaches are among the most common and serious urban pests. They act as mechanical vectors of numerous pathogens, including bacteria, protozoa, and viruses, and serve as potent allergens associated with asthma and hypersensitivity reactions [1]. Food-handling establishments, due to constant the availability of food, water, and shelter, provide ideal habitats for cockroach proliferation. Effective pest management requires not only entomological surveillance but also an understanding of human factors, specifically the knowledge, attitudes, and practices (KAP) of food handlers. Previous studies have shown that high infestation rates often stem from a lack of awareness regarding transmission risks [2], and that, even when knowledge is adequate, it may not translate into effective practices [3]. This study aimed to:
 a) determine the frequency and species composition of cockroaches infesting food-preparation and distribution centers in Bojnord city, Northern Khorasan Province, Iran; 
b) assess the levels of KAP among food-facility staff regarding cockroaches and related health risks; 
 c) identify gaps between knowledge, attitudes, and actual pest-control behaviors to inform evidence-based interventions. 

Methods 
This cross-sectional descriptive-analytical study was conducted during the spring and summer of 2023 after receiving ethics approval. The study comprised two phases:
Phase 1) Entomological survey: Using cluster sampling, 211 urban sites were inspected, including restaurants, fast-food shops, hotels, roadside eateries, bakeries, food warehouses, supermarkets, and hospital kitchens. Cockroach infestation was assessed using sticky traps and bait traps placed in areas of high cockroach activity, including inside cabinets, under sinks, behind refrigerators, near waste containers, and along wall margins. Traps were placed one meter apart and collected after one week. Manual catch was also performed. Specimens were transported to the laboratory and identified using valid taxonomic keys [1]. Infestation prevalence was calculated as  Equation 1: 

1. Infested sites/total sites×100. 
Phase 2) KAP survey: A researcher-developed questionnaire was administered to 52 food handlers working in infested sites, defined as sites with at least one cockroach species. Proportional stratified random sampling was applied across eight strata: restaurants (n=13), kebab/fast-food establishments (n=10), hotels (n=5), roadside eateries (n=4), bakeries (n=8), food warehouses (n=3), and supermarkets (n=9). The questionnaire included 15 knowledge items (scored 0–30), 3 attitude items (5-point Likert, range: 3–15), and 5 practice items (4-point Likert, range: 5–20). Scores were categorized as good (>75%), moderate (50–75%), and poor (<50%) [3]. Face and content validity were assessed by a panel of experts, and reliability was confirmed using Cronbach’s alpha (knowledge=0.87, attitude=0.81, and practice=0.92). Informed consent was obtained from all participants. 
Data were analyzed using SPSS software, version version 21. Descriptive statistics, independent t-tests, Pearson correlation, linear regression analysis, and chi-square tests were applied, with statistical significance set at P<0.05. 

Results
Of the 211 inspected sites, 52 (24.5%) were infested with cockroaches. The highest infestation rate was found in food-production facilities (53.8%, n=28), followed by food-distribution centers (32.6%, n=17), hospital/healthcare kitchens (7.7%, n=4), and other public places (5.7%, n=3). Two species were identified: Blattella germanica (German cockroach) was the dominant species, accounting for 96.5% of all specimens, while Periplaneta americana (American cockroach) comprised only 3.5%. This predominance of B. germanica is consistent with findings from other Iranian cities [4] and is attributed to its high reproductive capacity and environmental adaptability [1]. 
Among the 52 food handlers surveyed, 63.5% were male and 36.5% female. The Mean age was 38.66 years. Educational levels were as follows: illiterate, 13.5%; middle school, 23.1%; high school diploma, 38.5%; and university education, 25.0%. 
The mean knowledge score (20.37±2.30) indicated moderate to high knowledge, and the mean attitude score (12.63±1.45) reflected favorable attitudes. However, the mean practice score (11.91±2.49) was poor and showed the greatest variability among the three variables, indicating substantial diversity in actual pest-control behaviors (Table 1).


These findings are similar to those reported by previous studies [3], where adequate knowledge did not translate into effective practiced. Linear regression analysis showed that for each one-unit increase in knowledge, the practice increased by 0.218 units (β=0.218, P=0.233), and for each one-unit increase in attitude, the practice increased by 0.268 units (β=0.268, P=0.145). Although both knowledge and attitude had positive relationships with practice, neither relationship was statistically significant (P>0.05)

Conclusion 
The overall infestation rate (24.5%) and the predominance of B. germanica (96.5%) in Bojnord are consistent with findings from other Iranian cities, such as Yasuj [4], although the rate is lower than that in warmer, more humid regions such as Ahvaz because of climatic differences (temperate mountainous versus hot and humid) [4]. The high infestation rate in food-production facilities underscores the critical role of kitchens as primary habitats for cockroaches, driven by food residues, moisture, and darkness. 
The most striking finding is the clear disconnect between moderate-to-high knowledge and favorable attitudes, on the one hand, and poor practices, on the other. This knowledge–practice gap, which has also been reported internationally [5], suggests that merely providing information is insufficient to change behavior. Practical barriers likely include limited access to effective control tools, inadequate environmental hygiene, a lack of hands-on training, and insufficient supervision [3]. As noted by Nasirian [2], successful cockroach control requires converting awareness into effective performance through continuous practical interventions. These results emphasize the urgent need for targeted practical training, the provision of proper pest-control equipment, and continuous monitoring—not just awareness campaigns—to achieve sustainable cockroach management.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Golestan University of Medical Sciences (Code: IR.GOUMS.REC.1401.073). All participants provided written informed consent. Data were collected anonymously and kept confidential. 

Funding
This research was funded by Golestan University of Medical Sciences and North Khorasan University of Medical Sciences (Gtand No.:: 112497).

Authors contributions
Conceptualization, design: Ali Zafarzadeh; Data collection: Kourosh Arzamani; Data analysis and interpretation: Ali Zafarzadeh and Kourosh Arzamani; Writing, statistical analysis, editing & review: Seyed Kamal Mirkarimi, Ali Zafarzadeh, and Jaswant Singh. 

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgments
The authors would like to thank Hamid Reza Shorka, Ahmad Mousazadeh, and Fatemeh Kohestani for their assistance in conducting this study. 

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