Impact of Training on Employees' Handwashing Behaviors in School Nutrition Programs.

BACKGROUND: School nutrition employee behavior plays an important role in preventing foodborne outbreaks and protecting the almost 30 million children who partake in daily school lunch. OBJECTIVE: The study aim was to compare the impact of using a food safety training program with or without using a realistic-event video on handwashing behavior modification for school nutrition employees. DESIGN: A 2-group (control and experimental) pretest with 2 post-tests design was used. The control group received training without the video and the experimental group received the food safety training with a realistic-event video. Measurements used to address the purpose and objectives of this study included questionnaires and direct observations. PARTICIPANTS/SETTING: The sample consisted of 443 school nutrition employees responsible for food preparation and service affiliated with 21 school districts in 18 states. Approximately half of the sample attended the original unmodified training and the other half attended the modified training. Data were collected in the United States during 2017. A total of 338 employees participated in the observations and 443 participants completed the questionnaires during the 3 phases; 935 questionnaires were used for the analysis. INTERVENTION: The intervention involved a food safety training program embedded with a realistic-event video related to handwashing. The video used previous research to target antecedents to handwashing behavior among participants. MAIN OUTCOME MEASURES: Actual behavior was observed across 3 phases-pretraining, post training, and final-for both the control and experimental groups. In addition, indirect and direct measures of behavioral intentions for handwashing were measured. STATISTICAL ANALYSIS PERFORMED: For the observation data, a 2-way, fixed-effects, mixed-model procedure was used to analyze the data. Simple and multiple linear regression and contingency table analyses looking for differences among phases and treatments were used for questionnaire data analysis. RESULTS: Most practices were reported as in compliance (51.3% to 80.6%) for both the control and experimental groups during all phases. The experimental group had a higher behavioral intention of properly washing their hands than participants in the control group. CONCLUSIONS: The results showed that handwashing practices were in compliance most of the time for both the control and experimental groups during all 3 observation periods. Differences among the data collection periods on the theory of planned behavior constructs indicated no statistical effect of the treatment (exposure to the video) between the control and intervention groups.

Predicting and explaining behavioral intention and hand sanitizer use among US Army soldiers.

BACKGROUND: Using hand sanitizers can reduce bacterial contamination and is an efficient and inexpensive method of preventing infections. The purpose of this study was to explore the behavioral intention (low and absolute), attitudes, subjective norms, and perceived behavioral control of hand sanitizer use among US Army soldiers. METHODS: A questionnaire was developed following an expert panel (N = 5) review and 2 pilot studies (N = 35) to ensure questionnaire validity and clarity. Surveys were distributed among nontrainee soldiers during lunch periods. A total of 201 surveys were collected. RESULTS: Results indicated that attitudes, subjective norms, and perceived behavioral controls explained 64% of the variance in behavioral intention. Attitude remained the strongest predictor of behavior (ß = 0.70, P < .01), followed by subjective norms (ß = 0.18; P < .01), with significant differences between low and absolute intenders. CONCLUSIONS: Soldiers with absolute intention to use hand sanitizers hold significantly different behavioral and normative beliefs than low intenders. Other soldiers create negative social pressure about using hand sanitizers, indicating that if other soldiers use hand sanitizers, they will refuse to do so. Intervention to ensure use of hand sanitizer should focus on strengthening behavioral and normative beliefs among low intenders. This should increase the overall well being of the military.

Foodservice employees benefit from interventions targeting barriers to food safety.

The number of foodborne illnesses traced to improper food handling in restaurants indicates a need for research to improve food safety in these establishments. Therefore, this 2-year longitudinal study investigated the effectiveness of traditional ServSafe (National Restaurant Association Educational Foundation, Chicago, IL) food-safety training and a Theory of Planned Behavior intervention program targeting employees' perceived barriers and attitudes toward important food-safety behaviors. The effectiveness of the training and intervention was measured by knowledge scores and observed behavioral compliance rates related to food-safety practices. Employees were observed for handwashing, thermometer usage, and proper handling of work surfaces at baseline, after receiving ServSafe training, and again after exposure to the intervention targeting barriers and negative attitudes about food-safety practices. Repeated-measures analyses of variance indicated training improved handwashing knowledge, but the intervention was necessary to improve overall behavioral compliance and handwashing compliance. Results suggest that registered dietitians; dietetic technicians, registered; and foodservice managers should implement a combination of training and intervention to improve knowledge and compliance with food-safety behaviors, rather than relying on training alone. Challenges encountered while conducting this research are discussed, and recommendations are provided for researchers interested in conducting this type of research in the future.

Restaurant employees' perceptions of barriers to three food safety practices.

Limited research has been conducted to assess employees' perceptions of barriers to implementing food safety practices. Focus groups were conducted with two groups of restaurant employees to identify perceived barriers to implementing three food safety practices: handwashing, using thermometers, and cleaning work surfaces. Ten focus groups were conducted with 34 employees who did not receive training (Group A). Twenty focus groups were conducted with 125 employees after they had participated in a formal ServSafe training program (Group B). The following barriers were identified in at least one focus group in both Group A and Group B for all three practices: time constraints, inconvenience, inadequate training, and inadequate resources. In Group A, additional barriers identified most often were a lack of space and other tasks competing with cleaning work surfaces; inconvenient location of sinks and dry skin from handwashing; and lack of working thermometers and thermometers in inconvenient locations. Additional barriers identified most often by Group B were no incentive to do it and the manager not monitoring whether employees cleaned work surfaces; inconvenient location of sinks and dry skin from handwashing; and lack of working thermometers and manager not monitoring the use of thermometers. Results will be used to develop and implement interventions to overcome perceived barriers that training appears not to address. Knowledge of perceived barriers among employees can assist food and nutrition professionals in facilitating employees in overcoming these barriers and ultimately improve compliance with food safety practices.

Identifying specific beliefs to target to improve restaurant employees' intentions for performing three important food safety behaviors.

Current national food safety training programs appear ineffective at improving food safety practices in foodservice operations, given the substantial number of Americans affected by foodborne illnesses after eating in restaurants each year. The Theory of Planned Behavior (TpB) was used to identify important beliefs that may be targeted to improve foodservice employees' intentions for three food safety behaviors that have the most substantial affect on public health: hand washing, using thermometers, and proper handling of food contact surfaces. In a cross-sectional design, foodservice employees (n=190) across three midwestern states completed a survey assessing TpB components and knowledge for the three food safety behaviors. Multiple regression analyses were performed on the TpB components for each behavior. Independent-samples t tests identified TpB beliefs that discriminated between participants who absolutely intend to perform the behaviors and those with lower intention. Employees' attitudes were the one consistent predictor of intentions for performing all three behaviors. However, a unique combination of important predictors existed for each separate behavior. Interventions for improving employees' behavioral intentions for food safety should focus on TpB components that predict intentions for each behavior and should bring all employees' beliefs in line with those of the employees who already intend to perform the food safety behaviors. Registered dietitians; dietetic technicians, registered; and foodservice managers can use these results to enhance training sessions and motivational programs to improve employees' food safety behaviors. Results also assist these professionals in recognizing their responsibility for enforcing and providing adequate resources for proper food safety behaviors.