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PII: S0963-9969(17)30345-9
DOI: doi: 10.1016/j.foodres.2017.07.042
Reference: FRIN 6839
To appear in: Food Research International
Received date: 13 April 2017
Revised date: 7 July 2017
Accepted date: 13 July 2017
Please cite this article as: Laís Mariano Zanin, Diogo Thimoteo da Cunha, Veridiana Vera
de Rosso, Vanessa Dias Capriles, Elke Stedefeldt , Knowledge, attitudes and practices of
food handlers in food safety: An integrative review, Food Research International (2017),
doi: 10.1016/j.foodres.2017.07.042
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a
GeQual—Study Group of Food Quality. Programa de Pós-Graduação em
Nutrição, Universidade Federal de São Paulo. Botucatu St., 862 – ZipCode:
PT
04023-062, São Paulo – SP, Brazil. zanin.lais@gmail.com
b
GeQual—Study Group of Food Quality. Faculdade de Ciências Aplicadas,
RI
Universidade Estadual de Campinas. Pedro Zaccaria St., 1300 - ZipCode:
SC
13484-350, Limeira - SP, Brazil. diogo.cunha@fca.unicamp.br
c
GeQual—Study Group of Food Quality. Departamento de Biociências,
NU
Universidade Federal de São Paulo, Campus Baixada Santista. Silva Jardim
St., 136 – ZipCode: 11015-020, Santos – SP, Brazil. veriderosso@yahoo.com
d
GeQual—Study Group of Food Quality. Departamento de Biociências,
MA
*Corresponding author
CE
Postal Adress: Pedro de Toledo St., 859 – ZipCode: 04039-032, São Paulo –
SP, Brazil
e-mail: elkesnutri@gmail.com | +55 (11) 98201.6468
Abstract
This study presents an overview of the relationship between knowledge,
attitudes and practices (KAP) of food handlers with training in food safety, in
addition to proposing reflections on the training of food handlers, considering its
responsibility for food safety and health of consumers. The review was based
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training. The evaluation of KAP is the first step to understand the food handler´s
point of view. After this evaluation other diagnostic strategies become
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necessary to enhance this understanding.
Keywords: Foodborne disease; Food handlers; Training; Food safety;
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Diagnostic strategies. NU
1 Introduction
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globalization process has shown a significant impact on the food safety (Scott,
2003). This globalization process has focused on production, distribution, and
marketing on a large scale and seeks to meet the needs of the expanding
global population. An asymmetry of information in the globalization of food,
however, can lead to market failures characterized by the presence of
biological, chemical and physical hazards. To make credible and sustainable
legal and policy decisions, the decision-making process must be based on
strong evidence. Considering the growing complexity of the food safety field,
innovative approaches are required to improve prioritization, accounting for the
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& Kivanç, 2006; Ko, 2013; Da Cunha, Stedefeldt & De Rosso, 2014a). The
premise of the KAP model is that the food handler, provided with knowledge,
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are able to improve their food safety practices voluntarily. So, training, the most
widely used strategy to improve food safety (Medeiros, Cavalli, Salay &
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Proença, 2011), may be effective. On the other hand, some authors disagree,
arguing that training, and thus knowledge alone, are not sufficient to improve
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practices (Rennie, 1994; Park, Kwak & Chang, 2010; Da Cunha et al., 2014a).
Current evidence for the effectiveness of food hygiene training is
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2000; Bas et al., 2006; Ansari-Lari, Soodbakhsh & Lakzadeh, 2010; Soares,
Almeida, Cerqueira, Carvalho & Nunes, 2012; McIntyre, Vallaster, Wilcott,
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2 Methodology
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The conduct of the review and the process of identification, selection and
classification of articles were based on the method of integrative literature
review. This method comprises the review, criticism and synthesis of
representative topics of literature aiming a new structure and perspective of the
subject studied (Torraco, 2005).
The search of the articles was conducted in the bases of ScienceDirect,
Medline and Lilacs databases, and the Web of Knowledge platform that
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includes the foundations of Web of Science, Derwent Innovations Index and
Scielo Citation Index database. The search was limited to full text articles
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written in English, Portuguese and Spanish (domain language of the authors),
published since 2000. It was used the following descriptors, using the Boolean
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terms: (food handler), (knowledge, attitudes and practices) and (training).
Only studies that addressed the triad “knowledge, attitudes and practices” of
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food handlers regarding food safety were included in this review. Were included
either studies that authors assessed a training strategy or compared trained
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food handlers from untrained ones. The studies that addressed only
"knowledge" or "attitudes" or "practice", or a combination of two these terms
were included only to account the number of articles published in the area and
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not for the integrative review. The criteria for exclusion of the articles were: not
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specifically KAP approach in food safety, not KAP approach to food handlers,
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step to include was the reading of the articles in full. Were consulted 253
articles and 36 original articles were selected fulfilling the inclusion and
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management and public policy stakeholders, regardless of the country's
economic status, since most foodborne outbreaks occurs due inadequate food
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handling (FDA, 2009; Todd, Greig, Bartleson & Michaels, 2007). Notably, there
is increasing government involvement in controlling and regulating the sector to
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ensure food quality and reduce FBD. The different level of government
involvement in food safety regulation reflects the practices developed locally
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and consequently the studies conducted in those countries (Martinez, Fearne,
Caswell & Henson, 2007). There is no precise explanation on why most studies
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management systems than food handlers’ behavior. Figure 1 shows the number
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of articles published each year and separated in articles that addressed only
“knowledge” or “attitudes” or “practice” or a combination of two these terms and
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articles that addressed the triad “knowledge, attitudes and practices” of food
handlers regarding food safety that are included in the inclusion criteria of this
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review.
It is observed in Figure 1 that the study of KAP of food handlers on food
safety is an emerging research topic. From 36 studies included, 18 were
published between 2013 and 2017. This growing interest of the scientific
community corroborates two main hypotheses: 1) the behavior of food handlers
relates directly to the FBD due to inadequate practices in: hand, equipment and
utensils hygiene; maintenance of temperature of food ready for consumption;
cooking temperature; and thawing (Chan & Chan, 2008). Such improper
practices indicate that food handlers are the main responsible of FBD outbreaks
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(FDA, 2009; Lima, Loiko, Casarin, Tondo, 2013), therefore, the food safety
training to food handlers is one of the most critical interventions on FBD
prevention (WHO, 2013); 2) Even with the development of new technologies
and management systems of quality, the incidence of FBD has not reduced and
can be noticed even the emergence of some pathogens such as
Campylobacter, Shigella and Cryptosporidium (Nyachuba, 2010).
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Figure 1 - Overview of publication´s number on knowledge, attitudes and
practices of food handlers in food safety, published each year between the
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years 2000 and February 2017.
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The need to evaluate the training from the point of view of the food handler,
taking into account the beliefs and behavior, is due to the assumption that the
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traditional training cannot be transformative, in which the handler does not apply
the knowledge gained in their practices (Ehiri, Morris & McEwen, 1997; Ansari-
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Lari et al., 2010; Siow & Sani, 2011; Ko, 2013). So these assessments can be
used as diagnostic strategies for planning effective and specific training
programs for each handler in a particular function (Zanin, Da Cunha, Stedefeldt
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Table 1 shows the main characteristics of each article included in this review.
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Table 1 - Description of the studies that relate knowledge, attitudes and practices of food handlers with training in food safety.
P T
- There is a difference between training and
Dudeja et al.
India n=264
- Meaningful and focused trainings can contribute to
improve both the safety and quality of food.
R I teaching food handlers.
- Attitudes are a reflection of traditional beliefs,
which can serve as obstacles to appropriate
(2017) Tertiary care hospital.
is inconclusive.
S C
- Research on food safety training of food handlers
practices.
- Positive attitudes can improve practice and
vice versa.
N U
- Training for caterers has been shown to improve
food safety knowledge and hygiene awareness and - Good knowledge levels, attitudes and self-
A
n=265 may result in improved food safety practices. reported practices.
Rebouças et Brazil
25% with no training. - It’s necessary a recycling of these trainings. - Although some self-reporting practices have
al. (2017)
Hotels' restaurants.
M
- The participation of the handlers in training,
showing in this way the creation of a positive culture
been adequate, there were divergences in
observed practice.
n=180
100% with no training.
D
among the handlers.
E
- Training should therefore be provided which
PT
Various points of the integrates basic hygiene and new food safety - The food safety and hygiene knowledge of
seafood distribution programs conforming to national regulations. seafood distributors was poor.
Vietnam
Luu et al.
(2017)
E
chain (30 middlemen
traders, 60 seafood
C
handlers, and 70
- Training should be: 1) more practical (i.e.
demonstrations) rather than theoretical. 2) the
provision of guidance and information in the form of
- Most of the participants in this study exhibited
poor fish handling practices.
n=26
42% with no training.
manuals, short booklets, or videos.
frequent training programs should be organized to self-reported practice level of the food handlers
improve the attitude, knowledge and expertise of was satisfactory, some of the hygiene aspects
the food handlers. need to be stressed.
- Education and food safety training should be
provided frequently to the food service staff in order
to minimize foodborne hazards.
- The training must be risk-based with
P T
Kunadu et Ghana
n=278
With no percentage of
training.
consequences of failure clearly expressed and
understood at all levels.
- The negative attitudes would however advocate
R I - Insufficient food safety knowledge and
C
practices.
al. (2016) Food services motivation and training; not just education.
(hospital, schools and
prison).
S
- Techniques employed in training must also be
tailored to accommodate the low education levels of
the food handlers.
U
Samapundo
et al.
Vietnam
(2016)
n=40
95% with no training.
Street food vendor
N
- The training of street food vendors should be
A
prioritized in governments efforts to improve the
- Poor food safety knowledge levels, attitudes
and unhygienic practices.
- Regulations governing street food safety has
(four districts).
M
safety of street foods. not yet transformed the knowledge, attitudes
and practices of the food handler.
Faour‐Klingb Lebanon
n=80
46% with no training.
E D
- Critical need for food safety education and
technical guidance fostered by synergistic
participation of the private and public sector to
- Substantial gaps in their knowledge and self-
reported practices.
eil et al. (2015) 50 food service
establishments.
E
- The conditions in which street food vendors
n=80 operate are mostly unacceptable from a food
C
- Food vendors trained had a significantly greater
78.7% with no training. safety point of view.
Samapundo Haiti food safety attitudes than untrained.
et al.
20
(2015)
A C
Street food vendors
(four different
communes).
- There is an urgent need to organize formal
training in food hygiene and food safety.
- Trained handlers have a higher knowledge
and attitudes score than the not trained ones.
- Knowledge and attitudes have not been
translated into observed practices.
n=909 - Food-handlers' suggestions for training needs
- KAP of food-handlers were poor.
3.1% with no training. included: appropriate location of the training venue
Vietnam - Positive effects of educational level on
Vo et al. 26 canteens of at the work place involvement of managers, fewer
(2015) knowledge and practices, although knowledge
factories and 40 trainees per course, more practical exercises, and
alone was not enough to change practices.
canteens of schools. longer course duration, be more interactive with
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n=193
T
66.3% with no training. - KAP combined with the Theory of Planned
- Attitude score and the age of the worker were
Seafood handlers Behavior can support the development of
Zanin et al.
Brazil
(2015)
(fishery and
warehouse workers
appropriate training programs.
- Long periods without training can negatively affect
I P
related to the self-reported practice scores.
- Knowledge and attitudes did not always
from 2 different
states).
n=171
the sanitary conditions.
N
(resort).
n=183
Da Cunha et
al.
Brazil
(2014a)
31.7% with no training.
119 food services
(Diversified).
M A
- The investment in the theoretical training seems to
be insufficient to ensure appropriate practices.
- Knowledge did not translate into attitudes,
self-reported and observed practices.
Malaysia
n=112
73.2% with no training.
E D
- The training program should not only be
theoretical but also practical, targeting the activities
- The knowledge score was low.
- The knowledge influenced the attitudes and
Sani & Siow
(2014) 11 food services
(University).
P T of handlers.
- The training should be performed for all handlers
to minimize the dangers of FBD.
self-reported practices, however, handlers can
not apply the knowledge learned in appropriate
self-reported practices in some subjects.
McIntyre et Canada
C
n=698
28.52% with no
E - Importance of ongoing training.
- The practical training in the workplace can - Trained handlers had better scores for
al. (2013)
A Ctraining.
Various food services.
n=85
increase knowledge and appropriate practices.
- The knowledge acquired by training is lost over
time.
attitudes and self-reported practices that those
untrained.
n=421
With no percentage of
- Training is essential to ensure the perception and
T
- Knowledge is flawed, indicating that food
P
Ko
Taiwan
(2013)
training.
Restaurants with
knowledge.
- Although training increases knowledge, it does not
always result in positive behavior change.
R I handlers believe that training is not important.
- Attitude is the mediator between knowledge
and practice (self-reported).
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certification HACCP.
- More specific training programs should be set to - Low knowledge scores.
n=166
the handlers. - Practices (self-reported) of inappropriate
7.8% with no training.
Soares et al. Brazil (2012)
90 food services
(Public schools).
methodologies.
N U
- It is necessary to evaluate the impact of the
knowledge acquired in training to develop specific
handling are not always the results of low
education, it may simply be reflecting a
dominant practice.
Abdul-
Mutalib et al.
Malaysia
(2012)
n=64
With no percentage of
training.
M A
- Training should strengthen the knowledge of food
handlers, avoiding irrelevant information.
- Having proper knowledge can lead to good
attitudes and even good practice (self-
reported).
Various food services.
n=209
With no frequent
E D - Knowledge was not translated into observed
Bassyouni et
al.
Egypt
(2012)
training.
P
Four food services T - The training prior to work starting and continuous
observation are important to ensure food safety.
practices, but it was translated into self-
reported practices for some themes.
E
(University canteens).
- Training is the key to food hygiene.
C
- Training seemed to be a strong predictor of
- Training, instruction and adequate supervision
n= 361 attitudes and practices in food safety.
C
Rahman et Malaysia increase the potential of food vendors.
29.6% with no training. - Knowledge was not converted into self-
al. (2012) - Monitoring, training of basic principles of food
A
Street food vendors.
n=105
safety and the continued microbiological
surveillance are essential to optimize food hygiene.
reported practices, even to the trained
handlers.
- Handlers find training is insufficient /
Garayoa et Spain 58.1% with no training. - Perform specific training for each handler repetitive.
al. (2011) 20 food services according to their activities. - Knowledge has not translated into self-
(Diverse cuisines). reported practices.
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- Food handlers should attend specific training - 80% of food handlers had insufficient
n=92
Cuprasitrut Thailand related to the basic principles of food safety and knowledge, negative attitudes and inadequate
79.3% with no training.
et al. (2011) personal hygiene rules to improve their practices in self-reported practices.
68 food services.
food handling. - Knowledge correlated with practice.
- Knowledge and self-reported practices can
Choudhury India
n=80
With no percentage of - Training interventions should be designed to inflict
T
improve with the transmission of an interactive
P
I
training.
et al. (2011) training. maximum interest and response of food handlers.
- Post-training: improved knowledge and self-
R
Various food services.
reported practices.
SC
n=65
72.3% with no training. - Training improves knowledge but does not always - The handlers had an average score of
Malaysia
Siow & Sani Cafeterias and produce a positive change in attitudes. knowledge, most had positive attitudes and an
(2011)
canteens of a
university.
N U
- Training should encourage positive attitudes. average score of self-reported practices.
Ansari-Lari
et al.
Iran
(2010)
n=97
6% with no training.
1 Meat Processing
Plant. M A
- Increased knowledge does not always result in
positive behavior change.
- Training must be evaluated to guarantee its
effectiveness.
- Despite adequate knowledge and positive
attitudes, the self-reported practices are not
acceptable.
n=502
19.7% with no training.
E D
- Food safety can be a field in which education and
- The knowledge in food hygiene is insufficient
to promote positive attitudes and safe
Buccheri et
al.
Italy
(2010)
10 food services
P
(clinics of mentalT training can be organized in order to integrate the
behavioral sciences to public health.
behaviors (self-reported practices).
- Continued training with an alternative
C
n=73 E
illnesses).
A C
100% with no training.
Three food services
(hospitals).
can be a result of lack of training, taken in attitudes
and safe behaviors (empirical) with household tools.
- Attitudes did not translate into self-reported
practices.
n=100
- The reliability assessment of the KAP
Naing, Zain, Malaysia With no percentage of - The questionnaire shows good reliability for
questionnaire helps planning health education
& Abdullah (2007) training. the evaluation of KAP (self-reported practices).
programs for food handlers.
Various food services.
n=764
Bas et al.
Turkey 47.8% with no training.
- The effectiveness of hygiene training is uncertain.
- Training in food safety should be offered to all
P T
- Knowledge gap in food safety.
- Low scores of self-reported attitudes and
I
(2006) 109 various food
handlers continuously. practices.
services.
n=254
R
SC
- The difference between beliefs and practices - Gap in knowledge.
Askarian et Iran 37.9% with no training.
implies the fact that some people, even trained, do - Beliefs remained and there was no
al. (2004) Food services
not understand the real purpose of training. improvement in self-reported practices.
U
(hospitals).
n=164 - Foodservice employees had a significant amount
N
- Although food safety knowledge scores were
EUA 58.5% with no training. of food safety knowledge, and employees with food
Sneed et al. high, food-handling practices were not always
Malaysia
40 assisted-living
facilities.
n=430
57.2% with no training. M A
safety certification scored higher than those with no
certification, respectively.
- Training programs need to be evaluated to ensure
consistent with accepted standards.
- Low score of knowledge, positive attitudes,
lack of adequate self-reported practices in
D
(2002) effectiveness.
Various food services. daily activities.
n=382
With no percentage of
T E - Young and trained handlers have more
knowledge.
- Positive attitudes in older handlers in
Angelillo et
al.
Italy
(2001)
training.
Food services
(hospitals).
E P - To ensure the implementation of HACCP rigorous
training should be implemented.
hospitals with fewer beds.
- Attitudes are not transformed into self-
reported practices in some areas of food
C C safety.
A
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In seven selected articles, the authors concluded that attitudes were not
translated into practices (Angelillo et al., 2000; Zain & Naing, 2002; Askarian,
Kabir, Aminbaig, Memish & Jafari, 2004; Naing et al., 2007; Tokuç, Ekuklu,
Berberoglu, Bilge & Dedeler, 2009; Faour-Klingbeil, Kuri & Tood, 2015;
Samapundo, Climat, Xhaferi & Devlieghere, 2015); four studies stated that
knowledge has not translated into practices (Garayoa, Vitas, Díez-Leturia &
García-Jalon 2011; Bassyouni, El-Sherbiny, Hefzy & Wegdan, 2012; Rahman,
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Arif, Bakar & Tambi, 2012; Vo, Le, Le, Minh & Nuorti, 2015); three that
knowledge has translated neither into attitudes nor into practices (Buccheri,
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Mammina, Giammanco, Giammanco & Casuccio, 2010; Da Cunha et al.,
2014a; Pacholewicz et al., 2016); and in four others the knowledge and
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attitudes has not translated into practice (Ansari-Lari et al., 2010; Iiu et al.,
2015; Samapundo et al., 2015; Zanin et al., 2015). i.e. 50% of the articles
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selected asserted that there was no translation of knowledge into attitudes /
practices or attitudes into practices.
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These results, while interesting, are not new. Ehiri and Morris (1996), cited
training that does not change food-handling practices. Many aspects influence
the change of food safety practices e.g. the strategy approach used to train/
D
educate food handlers (Egan et al., 2007); physical structure of food service
E
(Tannenbaum & Yukl, 1992); place where the training has been conducted
PT
programme, few guidelines are indicated in this context. Such factors may
reinforce the understanding that theoretical training solves the problems of good
manufacturing practices in food services.
In six studies, the authors concluded that the knowledge level was
equivalent with practices (Siow & Sani, 2011; Cuprasitrut, Srisorrachatr & Malai,
2011; Tan, Bakar, Karim, Lee & Mahyudin, 2013; Sani & Siow, 2014; Kunadu,
Ofosu, Aboagye & Tano-Debrah, 2016; Luu, Davies & Dunne, 2017). However,
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in three of them, they found inadequate knowledge and practices in some
subjects (Cuprasitrut et al., 2011; Tan et al., 2013; Sani & Siow, 2014). The
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transformation of knowledge into practice runs through several aspects such:
experience, risk perceptions, attitudes and emotions (Wachinger, Renn, Begg
SC
and Kuhlicke, 2013). The individual tends to consider a decision, practice and
practice mitigation intuitively based on the risk that a decision or action leads to
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or aggravates a negative event, which is also called perceived risk (Slovic,
1987). Risk judgments involve what people think and how they feel about this
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risk, strongly affecting food handler behavior (Da Cunha et al., 2015). Risk
perception is subjective and based on experience, and understanding it is
important to the success of food safety communication and the absorption of
D
In other two articles, food handlers surveyed reported that training was
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not important (Garayoa et al., 2011; Ko, 2013). This affirmation may be
dangerous. Training is an effective tool for improving knowledge, as noted
CE
problem is ignoring all the aspects aforementioned that affects the translation of
knowledge into practice.
It was observed in two intervention studies through training, that the
trained food handlers had better scores practices (Choudhury, Mahanta,
Goswami & Mazumder, 2011; McIntyre et al., 2013). However, in the study of
McIntyre et al. (2013) and Samapundo et al. (2015) trained handlers had higher
scores of attitudes, and the study of Choudhury et al. (2011) they had higher
scores of knowledge than those not trained. This knowledge allied to attitudes
may act as precursor to behavioral change (Mullan, Wong & Kothe, 2010).
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Yiannas (2009) identifies some relevant actions, such as valuing people,
recognizing the improvement of attitudes; encouraging initiatives, delegating
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authority and conducting evaluations.
The last aspect of KAP triad is practice. The assessment practices can be
SC
performed in two ways, from questionnaires, called self-reported practice, and
from the observation of the work of the food handler, called the observed
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practices. Of the selected articles, 26 assessed the self-reported practices,
eight evaluated the observed practices and three assessed both self-reported
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practices and the observed practices. The self-reported practice may pose as
bias in the research by considering the food handler can present an excessively
positive and biased view of their practices (Da Cunha, Stedefeldt & De Rosso,
D
2014b).
E
The good satisfaction with the job also been related with introduced
appropriate practices (Rebouças, Santiago, Martins, Menezes, Araújo, &
Almeida, 2017). Such practices are a major factor in food safety, nevertheless
converting knowledge into adequate practices is a complex process, but it can
have the effect of reducing the risk of FBD and consequently the health care of
the consumer (Sani & Siow, 2014; Iiu et al., 2015).
Most of the studies, covered in this review, evaluate KAP and are limited to
these scores, characterizing them with the solution (or cause) of the negligence
of good manufacturing practices. However, KAP scores may be only used as
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handlers (Samapundo et a., 2015; Samapundo, Thanh, Xhaferi & Devlieghere,
2016) and the participation of the handlers in training, show the creation of a
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positive culture among the handlers (Rebouças et al., 2017).
Ko (2013) evaluated handlers who believed that training was flawed, and
SC
Garayoa et al. (2011) evaluated handlers who considered training insufficient or
repetitive. Thus, the techniques used for the training of food handlers should be
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proposed to minimize theoretical concepts (Medeiros et al., 2011; Luu et al.,
2017), since they seem to be insufficient, because are not related to the
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knowledge, perceptions (Naing et al., 2007; Ko, 2013), and should be offered to
E
all food handlers (Sani & Siow, 2014), including workers by all sector of food
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the education levels of the food handlers (Kunadu, Ofosu, Aboisagye & Tano-
Debrah, 2016); use languages according to food handler ethnicity and
encourage positive attitudes (Sani & Siow, 2014). The content of the
information, the form of communication and who communicates are
determinants.
Food services are a multifaceted scenario containing complex situations in
which the risks are multifactorial and associated with some uncertainty and/or
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ambiguity. In this sense, contextual and environmental diversity may reflect the
intensity of risk that is related to exposure to hazards social, economic, and
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political environment. Thus, the risk-based training with consequences of
failure clearly expressed is fundamental (Kunadu et al., 2016).
SC
Integrating basic hygiene and new food safety programs according to
national regulations (Luu et al., 2017), since basic hygiene is a prerequisite of
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any food safety program, is a way of the training to meet the different
complexities of food services. The training should be continuously assessed
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(Zain & Naing, 2002; Ansari-Lari et al., 2010; Soares et al., 2012), creating a
feedback.
The management should encourage and motivate the staff through practical
D
training ensuring safe practices in food handling (Tan et al., 2013; Da Cunha et
E
Most current training in food safety uses the method of providing the
information, following the model of KAP, widely criticized and with perceived
limitations (Ehiri & Morris, 1996). However, in this review 50% of the selected
studies reported that knowledge was not translated into attitudes or practices
change, presenting its main disadvantage point and exemplifying the model's
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hygiene and sanitary food handling (Ehiri et al., 1997; Ko, 2013). The trainer
and managers should provide motivation and self-efficacy to food handlers
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(Seaman & Eves, 2006; Stedefeldt, Zanin, Da Cunha, De Rosso, Capriles, &
Saccol, 2015; Al-Shabib et al., 2016), these attributes will ensure that even
SC
when there is no supervision, all good practices are carried out.
Some factors have been discussed as important to improve food safety
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performance: e.g. presence of trained food handlers (Hislop & Shaw, 2009;
Choudhury et al., 2011); presence of a qualified manager to supervise food
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safety and to lead (Cotterchio et al., 1998; Kassa, Silverman & Baroudi, 2010),
so that critical points and risk situations are observed there is a need to qualify
the manager and knowledge of the legislation; suitable environment
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Cunha et al., 2013; Stedefeldt et al., 2015) are minimum requirements for food
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safety.
The consequences of FBD in the risk perspective must be worked and
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factor may hinder the real effectiveness (or ineffectiveness) of training based on
KAP model.
Some food hygiene training models have been created and tested based
on permanent strategies. Da Cunha et al. (2013) established and tested a
training model with school food handlers. This model was applied during two
years and three main strategies were used: 1) theoretical training every six
months, 2) implementation of action plans in situ every three weeks and 3)
weekly visits to motivate food handlers and monitor good practices. The
proposed intervention improved school compliance with the food safety laws.
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19
Dudeja, Singh, Sahni, Kaur & Goel (2017) adopted a training methodology
with an emotional content and personal touch based on booklet, short films,
lectures, posters display concluding that was useful in improving the knowledge,
creating a positive attitude and enhancing the food safety practices of food
handlers. According to the authors (Dudeja et al., 2017) and with the
discussions presented in this article food handlers training is a means but not
an end in itself because training does not always lead to improved practices
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Training strategies can be challenging since, as reported, many factors
can direct influence the training efficacy and thus, the food safety practices. As
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example, foodservices may hire temporary workers, low paid and with low
education level (Cavalli & Salay, 2007), factors that undermine change in food
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safety practices (Mortlock, Peters & Griffith, 2000).
The psychosocial aspects of food safety, namely the beliefs, self-efficacy,
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locus of control and stage of change, have been studied in the food safety field
(Byrd-Bredbenner et al., 2007a, b). In considering the above, researchers have
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studied ways to identify the nuances of behavior and their theories and to
propose diagnostic strategies and training to improve food handler practices, in
addition to the attending health legislation. From this perspective, carefully
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activity is thought to obey the purposes of social, cultural, political and economic
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in monitoring and correcting improper practices (Egan et al., 2007; Seaman &
Eves, 2006).
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4) Provide a suitable environment, with the necessary resources,
equipment and utensils for the implementation of good manufacturing practices
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(Tannenbaum and Yukl, 1992; Tracey et al., 1995).
5) Provide motivation. Feelings such as motivation and self-efficacy play
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important roles in enhancing training and the adoption of adequate practices
(Seaman & Eves, 2006).
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6) Establish goals and present them to the group. A goal, when feasible,
may motivate the fulfillment of tasks (Ray et al., 1997).
7) Evaluate the impact of the acquired knowledge. The evaluation of
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results allows for the development of their own training methodologies (Garayoa
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socioeconomic status and low education, a high employee turnover, the cost of
interventions for food safety and dissatisfaction with pay (Mortlock et al., 2000;
Seaman & Eves, 2006). Therefore, these factors must be evaluated with the
intention to cause changes. For example, improving the socioeconomic
situation and decreasing the worker turnover.
4 Conclusion
In general, in the studies included in this paper is discussed that there is no
translation of knowledge into attitudes / practices or attitudes into practices after
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21
training. Some satisfactory results were observed in this triad when more
advanced techniques of education and training were used.
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KAP is limited to these answers and not to deliver refined conclusions about the
behavior of the food handler and on action strategies related to psychological
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factors that affect practices.
The researcher’s apprehension that the evaluation of KAP is the first step to
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understand the food handler´s point of view. After this evaluation other
diagnostic strategies become necessary to enhance this understanding,
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especially considering the gap in the studies included. Consequently models
and longitudinal strategies, with environmental suitability, considering
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psychological, social factors and experience that shapes the behavior of food
handlers can be designed in the hope of promoting food safety and minimize
the causative factors of FBD.
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Funding
“This research did not receive any specific grant from funding agencies in the
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Figure 1
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Published articles
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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Feb
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Years
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Studies that adressed only "knowledge" ou "attitude" or "practice", or a combination of these two terms
Studies that adressed the triad "knowledge, attitudes and practices" of food handlers regarding food safety (included in this
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Figure 2
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Highlights
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Studies with evaluations of observed practice are still scarce.
KAP are important for identifying how efficient training in food safety is.
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