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Food Control 23 (2012) 437e448

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Food Control

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Food safety training and evaluation of handwashing intention among freshproduce farm workers

J.M. Soon a,b,*, R.N. Baines a,1

a School of Agriculture, Royal Agricultural College, Cirencester, GL7 6JS Gloucestershire, UKbDepartment of Agro Industry, Faculty of Agro Industry and Natural Resources, Universiti Malaysia Kelantan, 16100 Pengkalan Chepa, Kelantan, Malaysia

a r t i c l e i n f o

Article history:Received 29 June 2011Received in revised form27 July 2011Accepted 2 August 2011

Keywords:Farm food safety trainingFresh produce farmHand hygieneTheory of Planned Behaviour

* Corresponding author. School of Agriculture, Royacester, GL7 6JS Gloucestershire, UK. Tel.: þ44 7500 233

E-mail addresses: janmei.soon@rac.ac.uk, janmei.srichard.baines@rac.ac.uk (R.N. Baines).

1 Tel.: þ44 01285 652531x2255.

0956-7135/$ e see front matter � 2011 Elsevier Ltd.doi:10.1016/j.foodcont.2011.08.012

a b s t r a c t

Food safety training is mainly focused towards food service establishments. Therefore, this paper aims todevelop food safety educational and training materials for fresh produce farm workers. The Theory ofPlanned Behaviour (TPB) model was used to investigate handwashing intentions among fresh producefarm workers. The findings in this study showed an immediate increase in knowledge gained betweenpre- and post-training, suggesting that the educational and training programme was successful inimproving food safety knowledge of participants. The overall farm food safety knowledge gain wassignificant at t(41) ¼ �6.95, p < 0.001. Generally, all the participants preferred the You Tube video andhand hygiene demonstration, reiterating the fact that practical and hands-on sessions will create a muchmore vivid experience for workers. The TPB has provided a useful framework for understanding freshproduce farm workers’ adherence to hand hygiene practices where the multiple regression modelexplained approximately 57% of the variance in handwashing intention (p < 0.001). Furthermore,perceived behavioural control was identified as the significant predictor of handwashing intention(p < 0.001). This suggests that participants were more likely to wash hands before harvesting or packingfresh produce when they perceived fewer barriers to wash hands. The findings here also suggest that forhandwashing behaviour, intention is not considered to be wholly within the fresh produce farmworkers’control as the working environment is different from a food service establishment which have easieraccess to handwashing facilities and potable water at all times.

� 2011 Elsevier Ltd. All rights reserved.

1. Introduction

Foodborne outbreaks appear to shift from the traditional prob-lems associated with foods from animal origin to fresh produce(CDC, 2008), shellfish (Pontrelli et al., 2008) and ingredients such aspeanut butter (CDC, 2009). Furthermore, the shift in consumptiontrends towards eating minimally processed produce have alsoresulted in the increase of foodborne outbreaks (Abadias, Usall,Anguera, Solsona, & Viñas, 2008). The driving force behind therapid growth of the fresh produce is argued to be the desire ofconsumers to lead a healthy lifestyle. For example, FAO and WHOintroduced the “5-a-day” campaign that encourage people to eat atleast five servings of fruits and vegetables daily (FAO, 2006) and thismay have also led to an increase in the consumption of freshproduce. In fact, 78% of the UK population is aware of the 5-a-day

l Agricultural College, Ciren-538; fax: þ44 01285 650219.oon@yahoo.com (J.M. Soon),

All rights reserved.

message and 58% claimed consumption of 5 or more portions offruit and vegetables daily (Food Standards Agency, 2008). Howeverfresh produce and sprouted seeds have been implicated ina number of documented outbreaks of illness in countries such asthe US and within the EU (Soon, Manning, Davies, & Baines, inpress). Based on the review, primary production was argued aspotential sources of foodborne outbreaks. More recently, one of thelargest reported outbreaks of haemolytic uremic syndrome (HUS)and bloody diarrhoea caused by the Shiga toxin-producingEscherichia coli O104:H4 occurred in Germany in May and June2011 (Jansen & Kielstein, 2011) and the search for the source andvehicle of outbreak implicated an organic sprout farm (Struelens,Palm, & Takkinen, 2011). Another outbreak in occurred in south-west France in June and the causative strain was geneticallyrelated to the strain identified in Germany (Gault et al., 2011).Subsequent investigations determined that both outbreaks werelinked to one lot of imported fenugreek seeds and the public wereadvised not to grow sprouts for their own consumption and not toeat sprouts or sprouted seeds unless cooked thoroughly (EFSA,2011).

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448438

Food safety training has generally targeted food service estab-lishments (Capunzo, Cavallo, Boccia, Brunetti, Buonoma & Mazza,2005; Coleman & Roberts, 2005; Costello, Gaddis, Tamplin, &Morris, 1997; Medeiros, Cavalli, Salay, & Proença, 2011) since50e70% of the food illnesses in USA, UK, Netherlands, Korea wereassociated with catering or food service establishments (Griffith,2000; Jones & Angulo, 2006; Park, Kwak, & Chang, 2010). Some ofthe main risk factors are inappropriate storage (32%), inadequateheat treatment (26%) and cross contamination from raw to cookedfoods (25%) (Smerdon, Adak, O’Brien, Gillespie, & Reacher, 2001;Soon, Singh, & Baines, 2011). On the other hand, less food safetytraining research have been conducted at the farm level (Jev�snik,Hlebec, & Raspor, 2009; Nieto-Montenegro, Brown, & LaBorde,2008; Rangarajan, Pritts, Reiners, & Pedersen, 2000). Therefore, inthis paper, we aim to use the Food Hygiene Training Model(Seaman, 2010) with Jacob, Mathiasen and Powell’s (2010) recom-mendations on developing food safety training materials for freshproduce farm workers. The Theory of Planned Behaviour (TPB)model was used to evaluate the factors influencing the farmworkers’ intention for handwashing. The advantage of using theTPB framework is that it helps to determine which factors bestpredict the intent to perform a behaviour (Shapiro, Porticella, Jiang,& Gravani, 2011). A better understanding of the beliefs among freshproduce farm workers on their adherence to hand hygiene mayhelp in targeting specific components of the TPB for furtherimprovement.

Training is crucial toany food safety systems.Poor staff training infood hygiene is a real threat to the safety of food, hence effectivetraining is an important prerequisite to successful implementationof a food safety management system (Arvanitoyannis & Kassaveti,2009). To be effective, food safety training needs to targetchanging the behaviour most likely to result in foodborne illnesses.Most food hygiene training courses rely heavily on the provision ofinformation. Studies have shown that increasing knowledge doesnot necessarily lead to changes in behaviours (Clayton, Griffith,Price, & Peters, 2002; Ehiri, Morris, & McEwen, 1997; Rennie,1994). For example, a study by Byrd-Bredbenner et al. (2007)found that although 97% of the participants rated their own food

Table 1Factors to consider when developing food safety training materials (Jacob et al., 2010).

Factors to consider whendeveloping food safety trainingmaterials

Comments

Understand the target audience Food safety message should be developedto audience’s needs, concerns and interest

Identify appropriate mediafor distribution

Internet is increasingly being used as a comtool for food safety and health-related info

Challenge complacency People with an “it will not happen to me”risk communications, assuming that theseat more vulnerable population

Enhance personalperception of risk

Emphasise the human rather than the statIdentifying individual victims further enhaof personal risk

Use narratives Narrative-based messages and messages inappeals are more favourably evaluated bymessages that simply inform or that rely o

Associate with audience’slifestyle

Incorporate everyday context into food saPersonal shortcomings such as hunger, lacinability to access different foods contribufood behaviours

Reinforce food safety messages Provide information in written, verbal or vbe most effective if used in combination w

Use clear language andinclude graphics

Use clear, non-technical language appropraudience and use pictorial materials to cla

Maintain consistency Contradictory messages can cause confusiodistrust in information

Pre-test and evaluate messages Pre-test on target audience on the contextdistributed and revised based on the resul

safety knowledge as at least fair; 60% did not wash their hands withsoap and water after touching raw poultry. Griffith (2000) arguedthat behavioural change (i.e. the implementation of requiredhygienepractices) is noteasilyachievedand that considerationmustbe given to motivation, constraints, barriers and facilities as well asto cultural aspects. Food safety practices will only be implementedgiven adequate resources and appropriate management culture(Clayton & Griffith, 2008). In contrast, Scott, Pope, and Thompson(2009) demonstrated that knowledge and food safety behaviour ofconsumers increases following a food safety education programmeand suggested that educational programmes are an effective tool toteach consumers about safe handling of food. Training programmeswhich aremore closely associatedwith thework site are potentiallymore effective especially if supported by practical reinforcement ofthe message (Rennie, 1994). Nieto-Montenegro et al. (2008) sug-gested that to increase training programme effectiveness, one mustfirst understand the food handlers’ behaviour and how this behav-iour interacts with their beliefs and levels of knowledge. This can befacilitated by use of theory-based models in the development ofeducational materials (National Cancer Institute, 2005).

1.1. Developing effective food safety training materials

Themajorityof foodborne illnesses are thought to bepreventableif food safety principles are understood and practiced throughoutthe entire food chain (Jacob, Mathiasen, & Powell, 2010). Interven-tions such as improving food handling practices and food safetycampaigns are necessary to reduce foodborne illnesses (Wong et al.,2004). However, Redmond and Griffith (2003) noticed that despiteeducational efforts and food safety training, unsafe food handlingpractices are still frequently used. Hence, Jacob et al. (2010) sug-gested that effective food safety messages using new media mayeffectively modify inappropriate human behaviours in the foodsafety system (Table 1).

Successful training also requires careful planning by the trainerand needs to be designed in a way to meet the needs of thetrainees; for example, some of the important points for effectivetraining adapted from the University of Maryland (2002) are:

References

accordingsmunicationrmation

Redmond and Griffith (2006)

attitude may ignoremessages are targeted

Miles, Braxton, and Frewer (1999)

istical aspects of a story.nces public perception

Joint FAO/WHO Expert Consultation onthe Application of Risk Communicationto Food Standards and Safety Matters (1998)

corporating fearfarmers thann statistics

Morgan, Cole, Struttmann, and Piercy (2002)

fety communications.k of money and/orte to different

Wilcock, Pun, Khanona, and Aung (2004)

isual formats, but willith each other

Durant (2002)

iate to the targetrify messages.n and create

in which they will bets

McDermott et al. (2003)

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 439

(i) Identify training participants and date for training(ii) Assess training participants’ needs and set training objectives(iii) Prepare training content, select training methods and prepare

materials(iv) Develop evaluation strategy (evaluation of training course and

of participants post-training)(v) Organise, deliver and evaluate training course

1.2. Theory of Planned Behaviour (TPB)

The Theory of Planned Behaviour (TPB) (Fig. 1) identifies theinfluences that predict and change behaviours where behaviouralintention is influenced by: a person’s attitudes; beliefs aboutwhether individuals who are important to the person approve ordisapprove of the behaviour; and perceived control over perform-ing the behaviour (National Cancer Institute, 2005; Pilling,Brannon, Shanklin, Howells, & Roberts, 2008).

Behavioural intention has been identified as the most imme-diate determinant of behaviour (Fishbein & Ajzen, 1975; Shapiroet al., 2011). In this study, we aim to apply the TPB framework toinvestigate handwashing intention among fresh produce farmworkers. According to the TPB, as a direct determinant of safe foodhandling behaviour (i.e. hand hygiene practices), the behaviouralintention to adopt handwashing is influenced by three sets ofbeliefs: attitudes towards the handwashing practices, (individual’spositive or negative evaluation of performing a particular behav-iour), subjective norms (perception of the social pressure toperform or not perform the behaviour) and perceived behaviouralcontrol (perception of the ease or difficulty in performing the targetbehaviour).

2. Materials and methods

2.1. Development of farm food safety educational and trainingmaterials

The farm food safety educational and training materials weredesigned according to the recommendations by Jacob et al. (2010),Seaman (2010) and University of Maryland (2002). The FoodHygiene Training Model (Fig. 2) developed by Seaman (2010)incorporates the Health Action Model and several additionalcomponents such as training needs analysis, knowledge or practicalskill assessment and evaluation and effects of the training pro-gramme. This model is suited for the farm food safety trainingdesign since this study aims to develop, test and evaluate theeffectiveness of the training materials.

The training contents were designed to suit the needs of thefarmers and the farm employees (Table 2) where four types of foodsafety educational materials were prepared:

Attitude

(Do you see the behaviour of hand

hygiene practices as important or

unimportant?)

Subjective norm

(Do you agree/disagree that most people will

approve/disapprove of you practising hand hygiene?)

Fig. 1. Theory of Planned Behaviour; Dotted boxes represent a scenario in hand hygiene prNational Cancer Institute, 2005).

(i) A farm food safety educational and training booklet(ii) Presentation slides (simplified version of training booklet)(iii) You Tube video on fresh produce farm safety practices

(adapted from Safe Food Network)(iv) Practical hand hygiene demonstration using the GloGerm� kit

2.1.1. Educational bookletA farm food safety educational and training booklet was

developed and given to each participating farm (Table 2). Thisbooklet was used in combination with the slides for in-depthexplanation of farm food safety practices and preparation fortraining.

2.1.2. Farm food safety slidesSlides were prepared and presented to the participants. The

slides were a simplified version of the booklet (available uponrequest) (Table 3). Testimonial, trace back and lawsuit case studieswere included in the slides to enhance participants’ perceptions ofrisk. Narrative based and pictorial materials were used to clarifyand reinforce food safety messages (Jacob et al., 2010).

2.1.3. You Tube video on farm food safety practicesA You Tube video for farm workers was shown to participants.

The video running time was 9.5 min. The video was adaptedfrom:http://www.foodsafety.ksu.edu/articles/701/keeping_food_safe.mov(Food Safety Network, 2011).

2.1.4. Hand hygiene demonstration and practical sessionPractical hand hygiene sessions using GloGerm� powder and

ahandheldUV lightweredemonstrated toparticipantsonhowcrosscontamination occurs and the effectiveness of handwashing(Table 4). This step also serves to reinforce the food safety messageamong participants (Durant, 2002). The use of visuals and hands-ontraining in farm food safety training creates an informal atmospherethat can enhance learning. Visuals are also especially beneficial totrain audience whose native language is not English (Rajagopal,2010). Nicol, Watkins, Donovan, Wynaden, and Cadwallader(2009) suggested that practical and hands-on sessions createa much better vivid experience for the farmworkers.

2.2. Design of farm food safety training study

This study followed the design of a “before-after” approach. Anoutline of the key issues of the farm food safety training strategysuch as the behavioural objective, targeted behaviours, targetaudience (Redmond & Griffith, 2006) and training materials arepresented (Table 5).

The voluntary participants were identified from the 12 UK farmswhich participated in a separate Farm Food Safety-Risk Assessment

Behavioural Intention

(Are you likely to wash hands before

harvesting or packing fresh

produce?)

Perceived behavioural

control

(Do you believe that washing hands are entirely up to you?)

actices aimed at fresh produce production (adapted from Montaño & Kasprzyk, 2002;

Overall performance measures (Individual and Organisational)

Unsafe food handling practices

Habits / routines Safe food handling practices

Decision process

Behavioural Intention

Farm workers’ evaluation of the training programme

Appropriate environmental and work place conditions

e.g. Space, toilet facilities

Relevant skills and knowledge e.g. farm workers own ability to apply knowledge and skills in

workplace

Motivational Systeme.g. Incentives

Belief System e.g. Concerns about adverse effects of non-compliance

Motivational Systeme.g. Encouragements

Knowledge test and / or practical skill assessment

Knowledge gained Practical skills gained

Choice of Training Programme e.g. Considerations include language, cost, duration, location, certification, relevance to

work activities, style of delivery

Documented TNA (Training Needs Analysis)

Identification of Training Needs e.g. Who needs training, what level, why do they need it and when do they need it

Pro

visi

on o

f R

esou

rces

e.

g. M

oney

, tim

e, e

quip

men

t, m

anpo

wer

etc

. Influences of Norm

s and Significant Others

e.g. Support for change from appropriately trained w

ork[place personnel

Fig. 2. The Food Hygiene Training Model (Seaman, 2010).

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448440

Tool testing and evaluation study where six out of the 12 farmsparticipated in the farm food safety training study. The motivationfrom farms to participate in the food safety research goes to showthat they are continuously trying to increase the safety and qualityof their farmed products. From the six farms a total of 62 freshproduce farm workers participated. The participants wererestricted to those handling fresh produce directly (e.g. harvesting/packing) on the farms. The training objectives were to ensure thatthe farmers and producers understand the importance of farm foodsafety practices through the use of narrative based case studies andaffiliation of participants working environment with potential

contamination sources as well as to increase hand hygiene aware-ness among workers. The training method used encompasses bothoral and hands-on training of hand hygiene practices. At the end ofthe training sessions, the farmers and trainees answered a shortquestionnaire on the effectiveness of the trainer (first author) anddelivery of the training.

2.3. Pre- and post-training questionnaires

Pre- and post-training farm food safety questionnaires weredeveloped in line with other studies (e.g. Clayton & Griffith, 2008;

Table 2Summary of farm food safety educational and training booklet contents.

1.0 Food safety breakdownsCase studies such as Escherichia coli O157:H7 in bagged spinach andhepatitis A virus in green onions were included to emphasise theimportance of food safety at the farm level.Learning outcomes: Farm operators understand the importanceof farm food safety.

2.0 Farm food safety practicesSources of produce contamination (e.g. water, manure, animals andworkers) and good agricultural practices were included in this section.A case study example of lettuce production and the possible contaminationpoints during production was included as well.Learning outcomes: Participants will gain awareness of the potentialcontamination points in fresh produce production and know about theireffects and prevention measures.

3.0 Food Laws and RegulationsInternational food laws and national regulations such as Codex, EU GeneralFood Law 2005, Regulation (EC) No. 852/2004 and UK Food Safety Act 1990were included. Product liability case studies were also included toemphasise the effects of foodborne diseases.Cost of foodborne diseasesa) Case study 1: Undercooked hamburger with E. coli O157:H7 e Lawsuit

$12.5 millionb) Case study 2: Hepatitis A in green onions e Lawsuit $6.25 million

Learning outcomes: Participants will gain insight into regulations that affectproduction and trade of food and examples of severe consequences due toinappropriate food handling practices.

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 441

FDA, 2005; Penn State University, 2010; Pilling et al., 2008; Seymour,1999). The pre-training questionnaire consisted of three sections (i.e.demographics, food safety knowledge and Theory of PlannedBehaviour components). Eight farm food safety knowledge questionswere administered on thepre- andpost-training tests andwere used

Table 3Summary of selected farm food safety educational slides’ explanations.

Example of slides’ explanations

Narrative-based testimonialMason Jones’s case study was included to enhance familiarity amongparticipants (since the study was conducted in the UK). In this case,how does beef product relates to fresh produce? The slide was thenlinked to the secondcase study as shown below.

Narrative-based testimonialFrom Mason Jones’s death which was due to E. coli in beef products,this slide shows that E. coli has now adapted and spread to freshproduce (i.e. Kyle Allgood’s case study) (STOP Foodborne Illness, 2011).How could the consumption of fresh produce which had always beena safe and healthy option cause a serious foodborne outbreak? (This canbe further linked to the German E. coli O104:H4 outbreak).

Trace back investigation at the farm levelAn example of how E. coli was traced back to the farm was shownto participants (CFERT, 2007). This will enable participants to associatewith the field working environment and to be aware of potentialsources of contamination in or near the farm (Wilcock et al., 2004).

Trace back investigation in the food supply chainAnother case study example showing how Hepatitis A could also betransmitted to fresh produce due to infected farm workers. This casestudy helps to reinforce the food safety message (Durant, 2002) andfarm workers play an important role in food safety.

Litigation case studyAn example of the enormous consequences of fresh produce outbreak isshown to the participants. For example, Mr Miller won a lawsuit totalling£3.63 million against Chi chi’s restaurant. But in exchange, he needs to payfor it with Hepatitis A, a liver transplant and to be on anti-rejection drugsfor life (MarlerClark, 2005).

Farm food safety practicesExamples of potential contamination points during harvesting ispresented to associate participants’ working environment withfarm food safety practices.

Handwashing proceduresA pictorial handwashing steps is also demonstrated to the participants.

to measure the knowledge gained as a result of the training. An“Uncertain” answer was included as a choice for the questions toreduce the possibility of guessing. A series of questions related toparticipant demographics (gender, age, years working on farm, levelof education level)were included. TheTPB sectionassessed attitudes,subjective norms, perceived behavioural control and behaviouralintention for the handwashing behaviour (Table 6). The TPB ques-tions contained direct measures of attitude, subjective norm andintention. Perceived behavioural control was considered as twocomponents: (i) internal control due to ease/difficulty of carryingouthand hygiene practices was measured with the statement, “If Iwanted to, I could easily wash my hands before harvesting/packingfreshproduce” (1¼ stronglydisagree, 5¼ stronglyagree).Meanwhile(ii) external control was measured by the statement, “Not havingenoughtimewouldmake itmoredifficult formetoproperlywashmyhands” (1 ¼ strongly disagree, 5 ¼ strongly agree).

The post-training questionnaire is made up two sections (i.e.food safety knowledge and training evaluation). The questionnaireswere reviewed by a food safety educator for content and face val-idity. Corrections were made based on the feedback. The revisedquestionnaires and food safety educational and training materialswere pilot-tested with five farmers affiliated with the institution.The test-retest reliability coefficient was 0.61.

One week prior to training, the participating farms’ represen-tatives received a set of instructions for the training session and thepre-training questionnaires. This prior training contact wasessential andwas recommended by Fenton, LaBorde, Radhakrishna,Brown, and Cutter (2006). On the day of training, the participatingfarms’ employees were immediately trained and then completedthe post-training questionnaire. Anonymity was given inwriting onthe questionnaire and verbally when administering the question-naire. All the protocols for the evaluation of fresh produce farmworkers’ behaviour and knowledge were approved by the institu-tion’s research and review board.

2.4. Statistical analysis

2.4.1. Statistical analysis of food safety knowledgeThe data were analysed with SPSS for Windows (version 19.0,

2010, SPSS Inc, Chicago, IL). Chi-square and paired t-test analyseswere used to evaluate the pre- and post-training gain in food safetyknowledge. Friedman ANOVA andWilcoxon signed-rank tests wereused to determine the participants’ preference of the types oftraining materials.

2.4.2. Statistical analysis of behavioural componentsNonparametric bivariate correlations were calculated in order to

establishwhetheranyof thepredictive constructswere related to thedependent variables (behavioural intention). Using the TPB asa guide, the authors predicted that attitudes towards hand hygiene,subjectivenorms regardinghandhygiene, andperceivedbehaviouralcontrol overhandwashingwouldpredict the intention towashhandsamong the fresh produce farm workers. In other words, the morefavourable one’s attitudes towards hand hygiene, the stronger one’ssubjective norms regarding hand hygiene and the greater theperceived control over handwashing, the stronger should be theintention towash hands. To test thehypothesis, amultiple regressionwas used to predict the intent to wash hand (p � 0.05).

3. Results and discussion

3.1. Demographics

The participants represented six UK fresh produce farms whichagreed to participate in the study. Thirty four percent of the

Table 4Hand hygiene demonstration (Editor: coloured version for Web only).

Hand hygiene and cross contamination demonstration

Tomatoes under visible light; contamination unseen with naked eyes

Tomatoes under UV light; contamination could be seen under UV light

Contamination seen under UV light

Table 5Summary of farm food safety training strategy.

Food safety training strategy

Behavioural objective To understand specific food safety behavioursespecially during contact with fresh produce byincreasing hand hygiene awareness among fieldand packing workers

Targeted behaviours Adequate handwashing and hand drying beforehandling fresh produce

Target audience Farm workers with direct contact with ready-to-eatfresh produce

Farm food safetytraining materials

(i) Farm food safety educational and trainingbooklet

(ii) Presentation slides(iii) You Tube video(iv) Hand hygiene demonstration and practical

session

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448442

participants were male. The majority of the participants, 71%(n ¼ 56) reported having a GCSE/A levels or tertiary education. Allhave at least 1e3 years of farmworking experience. Ninety percentof them were directly involved in harvesting and packing freshproduce (Table 7).

3.2. Farm food safety training

3.2.1. Knowledge assessmentThe responses given pre- and post-training are presented for the

participating fresh produce farm workers (Table 8). Significantdifferences in participants’ level of knowledge were observed infive of the eight variables examined. Participants’ knowledge ofsituations about staff with cuts on hands should not handle freshproduce directly increased in correct responses (52%) beforetraining to 100% of correct responses after training (c2 ¼ 28.56;

Table 6Items measuring variables (attitude, subjective norm, perceived behavioural controland intention) of the Theory of Planned Behaviour.

Items Scalea

Direct attitudeFor me to wash my hands at work on aregular basis is

(Not very important tovery important)

Proper handwashing is (Impractical to practical)Proper handwashing is (Inconvenient to

convenient)Subjective norm

I feel under pressure from my supervisor/managerto wash my hands (subjective norms)

(Strongly disagree tostrongly agree)

People whom I respect (e.g. supervisor/boss)will disapprove if I do not wash myhands properly

(Strongly disagree tostrongly agree)

It is expected of me to wash my hands beforeharvesting/packing

(Strongly disagree tostrongly agree)

Perceived behavioural controlIf I wanted to, I could easily wash my handsbefore harvesting/packing fresh produce

(Strongly disagree tostrongly agree)

Not having enough time would make it moredifficult for me to properly wash my hands

(Strongly disagree tostrongly agree)

Whether I wash my hands before harvesting/packing is entirely up to me

(Strongly disagree tostrongly agree)

Behavioural intentionI always intend to wash my hands beforeharvesting/packing fresh produce

(Very unlikely to verylikely)

a Itemsweremeasured based on five-point Likert scale and bipolar adjectives (e.g.impractical e practical).

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 443

df¼ 1; p< 0.001). The number of participants whowere aware thatharvesting crates should not be kept directly on the groundincreased from 58% (before training) to 100% correct responses(after training) (c2 ¼ 23.48; df ¼ 2; p < 0.001). Meanwhile theparticipants who answered the handwashing question correctlyincreased from55% to 93% (c2¼17.72; df¼ 2; p< 0.05). Ten percentmentioned that they should wet hands, apply soap, rinse and dryon their apron while 32% think that flicking their hands dry wouldbe the correct option (Table 8).

Results of these questions showed an increase in immediateknowledge gain between pre- and post-training suggesting that theeducational and training programme was successful in improving

Table 7Demographics of fresh produce farm participants.

Demographic items N (%)

Gender (n ¼ 62)Male 34 (55)Female 28 (45)Age (n ¼ 62)� 20 10 (16)21e30 24 (39)31e40 12 (19)41e50 14 (23)51e60 2 (3)Education level (n ¼ 56)None 16 (29)GCSE/A levels 18 (32)Degree/HND/NDa or equivalent 22 (39)Years working on farm (n ¼ 58)1e3 years 18 (31)4e6 years 24 (41)7e10 years 8 (14)> 10 years 8 (14)Job responsibilities (n ¼ 62)Harvesting 20 (32)Pack-house 22 (35)Farm supervisor/manager

(e.g. planting supervisor/harvesting supervisor)14 (23)

Tractor driver 6 (10)

a HND: Higher National Diploma; ND: National Diploma.

food safety knowledge of participants. There were no significantdifferences for the rest of the questions such as ‘only sick peoplecarry food poisoning bacteria in their gut’ or ‘if blood dripped ontoproduce, the affected produce should be thrown away’. When theauthors examined the scores of these statements, it could be seenthat the pre-training scores were high, leaving little room forimprovement. This suggested a strong volunteer effect (Kirby &Gardiner, 1997) from farm management where farms withworkers scoring high scores in farm food safety knowledge weretaking advantage of the training by the authors to maintain theirstaff’s knowledge or to serve as a refresher training course.

The overall farm food safety knowledge gain was assessed aswell by aggregating scores. The maximum score possible on theknowledge assessment was eight, which was equivalent to thenumber of questions. Each correct answer was given one point,while incorrect and uncertain response was assigned zero point. At-test for the knowledge gain examined from the pre- and post-training scores was significant, t(41) ¼ �6.95, p < 0.001 while theeffect size, d¼ 1.07 is large (d> 0.8) indicating that the training hada large effect on knowledge scores (Table 9).

The results obtained in this study revealed that more than halfof the participants were aware of farm food safety practices. Inparticular, participants were well aware that staff with injured/cutson hand should not handle fresh produce directly, blood-stainedproduce should be thrown away and birds are a source of Salmo-nella spp.

3.2.2. Types of training materialsThe participants were asked to rank (1-not useful at all; 5-very

useful) the types of training materials used during the farm foodsafety training session. More than 80% of the participants rated theYou Tube video and hand hygiene demonstration as more practicalcompared to the training booklet and presentation slides (Fig. 3).The rankings of the types of training materials were found to besignificant (c2(3) ¼ 88.12, p < 0.001). Wilcoxon tests were used tofollow up this finding. A Bonferroni correction was applied; henceall effects were reported at a 0.0167 level of significance (0.05/3). Itappeared that the presentation training slides were indifferentcompared to the training booklet, z ¼ �2.25, p ¼ 0.024 (more than0.0167). However, the You Tube video and hand hygiene demon-stration were ranked significantly higher than the training booklet,z ¼ �5.38, p < 0.001 (less than 0.0167). These findings supportedthe argument that the participants preferred the You Tube videoand hand hygiene demonstration as compared to the trainingbooklet or power point slides. The You Tube video included in thisstudy targeted fresh produce farm workers, was focused andprovided relevant farm food safety topics and this may haveallowed participants to associate the video to their working envi-ronment and scenarios of potential cross contamination that couldoccur in the field and pack-house. This indicates that videos that arefocused and provide one concept per video are important tomaintain viewers’ interest (Rhoades & Ellis, 2010).

3.2.3. Farm food safety training evaluationThe participants also evaluated the farm food safety training

conducted at their farms. More than 80% of the participantsdetermined that the training contents were satisfactory and easy tounderstand. None found the training as too long or complicated(Fig. 4).

3.3. Theory of Planned Behaviour

3.3.1. Variability of predictors across handwashing behaviourTable 10 lists the descriptive statistics of the components of the

Theory of Planned Behaviour model of handwashing practices

Table 8Pre- and post-training of farm food safety knowledge gain.

Farm food safetyknowledge

Pre-training Post-training c2 Significance Cramer’sV

Staff with cuts on hands should nothandle produce

n ¼ 62 (%) n ¼ 42 (%)True�32(52) True�42(100) 28.56 df ¼ 1; p < 0.001 0.52Uncertain-30 (48)

Only sick people carry bacteria whichcauses food poisoning

True-12 (19) True-6 (14) 1.94 df ¼ 2; p ¼ 0.38 0.14False�48(78) False�36(86)Uncertain-2 (3)

Birds are a source of Salmonella spp. andcan transmit diseases to humans throughfresh produce

True�54(87) True�42(100) 5.87 df ¼ 2; p ¼ 0.053 0.24False-4 (7)Uncertain-4 (6)

Harvesting crates can be kept directly onthe ground/earth while harvesting

True-4 (7) False�42(100) 23.48 df ¼ 2; p < 0.001 0.48False�36(58)Uncertain-22 (35)

Staff should always wipe their handson their jeans or aprons beforeharvesting/packing produce

True-8 (13) True-3 (7) 3.93 df ¼ 2; p ¼ 0.14 0.19False�50(81) False�39(93)Uncertain-4 (6)

If I cut my finger and blood dropped ontofresh produce, I should bandage my fingerand make sure that:(i) the blood-stained produce is wiped

and packed4 (7) 0

(ii) the blood-stained produceis thrown away

58 (93) 42 (100) 2.82 df ¼ 1; p ¼ 0.09 0.17

(iii) the blood-stained produce iswashed and packed

0 0

During harvesting, if I notice thatthere are animal faeces/birddroppings on the produce, I should:(i) harvest the produce anyway e my

boss will scold me for not harvesting it!0

(ii) harvest and wash the produce 3 (5)(iii) do not harvest the produce and

inform other harvesting membersnot to harvest the affected produce

59 (95) 42 (100) 1.96 df ¼ 1; p ¼ 0.16 0.15

Which of the following is the correcthandwashing procedure?(i) Wet hands, apply soap, scrub hands,

rinse and dry hands with paper towel34 (55) 39 (93) 17.72 df ¼ 3, p < 0.05 0.41

(ii) Wet hands with water and scrubhands and rinse

2 (3)

(iii) Wet hands, apply soap, scrub hands,rinse and dry my hands with my apron

6 (10)

(iv) Wet hands, apply soap, scrub hands,rinse and flick my hands dry

20 (32) 3 (7)

Note: Answer choices in bold indicate correct answer.

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448444

where all the mean responses were towards the positive end of thescales. This suggests that most participants have positive attitudesand intentions but were also socially pressured to perform hand-washing activities. However, the authors note that the positivelyskewed perceived behavioural control would indicate that barrierswere very likely to prevent the participants from carrying outhandwashing before harvesting and packing.

3.3.2. Multiple regression analysis of hand hygiene intentionMultiple linear regression was performed to evaluate the TPB

model for handwashing intention behaviour. Intention to performthe behaviour was predicted from direct attitudes, subjectivenorms and perceived behavioural control. The regression modelexplained about 57% of the variance of the intent to wash handswhere R2 ¼ 0.59, (Adjusted R2 ¼ 0.57). This was significantly

Table 9Overall pre- and post-training test scores from knowledge assessment.

Pre-training (n ¼ 62) Post-training (n ¼ 42) T valuea Significance

5.74 � 1.77 7.76 � 0.43 �6.95 p < 0.001

a t value from paired t-test of knowledge scores before and after training.

different from zero F(3, 58) ¼ 27.72, MSresidual ¼ 0.101, p < 0.001.However, only one predictor (perceived behavioural control)contributed significantly to the prediction of intention to wash

Fig. 3. Fresh produce farm workers’ preference of types of farm food safety trainingmaterials (n ¼ 42).

Fig. 4. Fresh produce farm workers’ evaluation of farm food safety training.

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 445

hands (Fig. 5). This suggests that perceived behavioural control wasthe most important factor in predicting intention to carry out handhygiene actions. That is, the participants were more likely to washhands before harvesting or packing fresh produce when theyperceived fewer barriers to wash hands.

The importance of control (Jenner, Watson, Miller, Jones, & Scott,2002) and time (O’Boyle, Henly, & Larson, 2001) had beendemonstrated in hand hygiene studies within a hospital setting.Furthermore, attitudes were the consistent significant predictor forhandwashing behaviour in other studies (O’Boyle et al., 2001;Pilling et al., 2008; Shapiro et al., 2011). In this study, eventhough attitude and subjective norms were positively skewed, boththese components were not significant predictors for handwashingintention. However, the workers’ perceived controls were consid-ered significant predictor in carrying out hand hygiene actions andthis may be due to the fact that workers intend and want to washtheir hands but may not be able to do so due to perceived barriers.The findings here also suggest that for handwashing behaviour,intention is not considered to be wholly within the fresh producefarmworkers’ control as the working environment is different froma food service establishment which have easier access to hand-washing facilities and potable water at all times. Most of theparticipants in this study may have limited access to handwashingfacilities while in the field and handwashing was clearly notfeasible when there were no facilities in place and available for use(Gormley, Little, de Pinna, McLauchlin & the Food, Water andEnvironmental Surveillance Network, 2009). Instead the farmmanagement can provide their workers with small bottles ofalcohol-based sanitiser to encourage hand hygiene practices.

Table 10Descriptive statistics of Theory of Planned Behaviour (TPB) components for hand-washing behaviour (n ¼ 62).

TPB variables Composition of items Mean SD

Attitudes Mean of 3 items 4.75 0.45Subjective Norms Mean of 3 items 4.12 0.70Perceived Behavioural Mean of 3 items 4.04 0.96ControlBehavioural Intention 4.65 0.48

The attitudes, subjective norms, perceived behavioural control and intention itemswere measured on Likert and bipolar adjectives scales ranging from one to five.Higher numbers indicate more positive attitudes, subjective norms, perceivedcontrol or intentions.

Furthermore, finding ways to improve all three behaviouralcomponents would be beneficial in this context.

3.3.3. Handwashing practicesResults indicated that all participants always wash their hands

after using the toilet. Sixty percent of the participants washed theirhands frequently after coughing or sneezing, and 97% also washedtheir hands before harvesting or packing fresh produce (Table 11).

Therewas a 100% self-reported compliance of handwashing afterusing the toilet and 97% before harvesting or packing fresh produce.However, Clayton, Griffith, and Price (2003) reported that unsuper-vised handwashing will never be completely compliant in anysetting. In a consumer food safety study inWales, someof the reasonscited for not washing hands were laziness and lack of time. Mean-while in a UK Food Standards Agency food safety study conductedamong food catering establishments, Todd, Greig, Bartleson, &Michaels (2007) found that one-third of the caterers did not washtheir hands after using the toilet and 53% failed to wash their handsbefore preparing food (cited by Todd et al., 2010). This lack ofcompliance may not only be caused by time constraints, staff short-ages or inadequate facilities, but may also be due to overconfidentmanagers andownerswhobelieve their food operationunits are lowrisk (Coleman & Roberts, 2005).

3.4. Importance of targeting specific beliefs

There are anumberof lessons that canbe learnt fromthis study, inparticular, the components that made up TPB can be targeted ineducational interventions to improve behavioural intent. Farm

Fig. 5. Theory of Planned Behaviour model for handwashing intention (*p < 0.001).

Table 11Self-reported handwashing practices of fresh produce farm workers.

Handwashing practices %

How often do you wash your hands afterusing the toilet?

Always (100)

How often do you wash your hands aftercoughing or sneezing?

Always (60)Sometimes (6)Rarely (3)Never (28)

How often do you wash your hands beforeharvesting/packingfresh produce?

Always (97)Sometimes (3)

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448446

owners and managers should emphasise the positive outcomes ofhandwashing (e.g. safe produce, less recall, hencemore profit for thefarm and workers) and potential negative outcomes (causing food-borne illnesses, product recall and lost business, hence affecting staffwages). To improve attitudes, the farm food safety trainingmaterialsincluded ‘why food safety is important’ (e.g. by emphasising thatpracticing good hand hygiene reduces the number of people gettingsick e through the use of Mason Jones’s and Kyle Allgood’s casestudies during training). In addition, the supervisors and managersshould create an environment that cultivates handwashing byputting up posters and reminders (in the workers’ native language)and to be role models themselves. To improve subjective norms, theauthors stress that managers, colleagues, health inspectors andcustomers would want them to properly perform the behaviours.Perceived control can be improved by supplying adequate resourcesand reminding employees to perform the behaviours (Pilling et al.,2008). The more accessible the toilets and handwashing facilitiesare, the greater the likelihood that they will be used (FDA, 1998); inaddition to providing mobile toilets with adequate handwashingfacilities, farm managers can also provide small bottles of handsanitisers for their staff. However, to move from perceived to actualbehaviour changes, additional studies on observing fresh producefarm workers’ actual handwashing practices and frequency ofwashing would be useful. Direct observation is recommended byWHO as the most reliable method for measuring adherence rates tohand hygiene (Boyce & Pittet, 2002) and it is also able to identify thestrengths andweaknesses of handhygienepractices.However, directobservation may result in workers changing their behaviour (Haw-thorne effect) when they know that they were being observed andcan result in falsely elevated compliance rates (Haas & Larson, 2007).

3.5. Providing knowledge is not sufficient

It is known that knowledge imparted by training courses cannotbe translated into desired changes in attitudes and behaviour(Pilling et al., 2008; Seaman & Eves, 2006). Even though more thanhalf of the participants generally were aware of the correct way ofhandwashing, and potential for cross contamination from hands tofresh produce, this existing knowledge however did not motivatetheir attitudes towards hand hygiene practices. Findings from thisstudy revealed that only perceived behavioural control was thesignificant predictor in handwashing intention. Thus motivationfrom supervisors and management, the support and facilities givento staff are critical to the success of food safety training. These willcontribute to changing attitudes and company culture, and have animpact on behaviour and therefore on foodborne outbreaks causedby food workers (Todd, Greig, Bartleson, & Michaels, 2007).

4. Conclusion

The findings in this study showed an increase in immediateknowledge gain between pre- and post-training suggesting that the

educational and training programme was successful in improvingfood safety knowledge of participants. The overall farm food safetyknowledge gain was significant at t(41) ¼ �6.95, p < 0.001.Generally, all the participants preferred the You Tube video andhand hygiene demonstration, reiterating the fact that practical andhands-on sessions will create a much more vivid experience for theworkers. All the participants determined that the farm food safetycontent was satisfactory and delivery of the educational andtraining session was not too long or complicated. The TPB hasprovided a useful framework for understanding fresh produce farmworkers’ adherence to hand hygiene practices. The multipleregression model explained about 57% of the variance in hand-washing intention (p < 0.001). Although mean attitude andsubjective norm scores were positive, they were not found to besignificantly predictive of intention. Perceived behavioural controlwas identified as the significant predictor of handwashing inten-tion (p < 0.001). This suggests that participants were more likely towash hands before harvesting or packing fresh produce when theyperceived fewer barriers to wash hands. Improving handwashingintention and thus handwashing compliance requires appropriatefacilities, motivation from supervisors and management team andcontinuous monitoring that goes beyond the occasional training.

5. Limitations of study

Non-participation e Six fresh produce farms declined toparticipate in the study. Three farms indicated time constraints;one farm explained that they do not have enough of staff to caterfor the training while conducting farm work and another declinedon the grounds that it was a large farm with over 100 harvestersand its own quality control team to train the workers. One farm(Farm K) also informed that their workers were paid hourly and thetraining being conducted may not add value to their productivity.From the reasons given for non-participation it may be argued thatthe results are unlikely to be biased as the reasons for declining toparticipate were not related to less favourable food safety knowl-edge and practices among non-participating farms (Kirby &Gardiner, 1997). However, it would be interesting to determinethe behavioural intentions and food safety culture of farms thatmay have different priorities (i.e. productivity vs. food safety/training).

Selection bias e The farms were not chosen at random from the12 fresh produce farms, but by a convenience approach dependenton volunteering and willingness by growers (Ellis-Iversen et al.,2007). This may have introduced selection bias.

Pre- and post-training knowledge e Participants answered theknowledge questions immediately before and after the educationaland training programme which may have influenced participants’knowledge gain (Scott et al., 2009). The authors suggest that futurestudies could issue the pre-training tests and deliver the trainingsessions followed by the post-training tests after a certain period.Monitoring of knowledge gain and behavioural changes should becarried out at a later stage to measure the impact of the food safetyeducation and training programme. During the post-trainingsession, there was a reduction in the number of participants dueto the staff’s commitments in their work. Hence, there wasa decrease from 62 (during pre-training) to 42 participants duringthe training and post-training tests.

Theory of Planned Behaviour e One major setback of the TPBstudy was the absence of observed actual handwashing practices.This study relies on self-reporting fromworkers andmay not reflectactual practices. The first author was not able to conduct handhygiene observation in the field since most farms provide cubicle-like mobile toilets with a handwashing sink attached within thecubicle. This may be different from the food processing and food

J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 447

service operations where designated handwashing facilities wereprovided before gaining entry into food production or preparationarea. There was also a limit to the number of questions asked toprevent putting off the fresh produce farm workers from partici-pating. Finally, the TPB framework questions were limited tomeasuring direct behaviours rather than both direct and indirectbehaviours.

Acknowledgements

The authors are extremely grateful to all participating farmswho have kindly responded to the study and to Jonathan Leach forthe hand hygiene demonstration photos. J.M. Soon acknowledgesthe financial support from the Ministry of Higher Education ofMalaysia.

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