Food Protection Trends - May/June 2021 - 267

commodity organizations, and various state departments of
agriculture are utilizing the PSA Grower Training to help the
produce industry meet the educational requirements in the
FSMA PSR.
Pre- and posttest knowledge assessments are standard tools
used to evaluate the effectiveness and impact of extension
programs to measure how much participants learned through
the program and their understanding of presented materials
(1, 22). Pre- and posttest assessments were used in studies to
assess the culture of fresh produce safety within a leafy greenproducing community and to assess the current knowledge
and attitudes of small-scale growers related to good agricultural
practices and good manufacturing practices (12, 13, 20).
This form of assessment has also been utilized to evaluate
many types of food safety education. Specifically, Nayak et
al. (2015) found that pretest scores were accurate measures
of participants' beginning knowledge in good agricultural
practices workshops (12). Furthermore, in targeted food safety
workshops, Dittmar et al. (2014) found that the use of pre- and
posttest knowledge assessments were a useful tool to show
participants' knowledge gain during courses (5).
Researchers have found that knowledge gain alone is
associated with limited behavioral change and that an increase
in knowledge can influence individuals to make more informed
choices, which may or may not result in a behavioral change
(10). Pratt and Bowman (2008) suggest that the likelihood of
knowledge being incorporated by individuals into their lives
increases when specific knowledge and skills are identified
and supported; this creates the foundation for new behaviors
(15). Nayak et al. (2015) utilized the extension framework
of Rockwell and Bennett's seven hierarchical steps to explain
behavioral change among individuals who participate in
programming (12). The authors mentioned that this is
more likely to occur after their knowledge, attitudes, skills,
aspirations, and intentions have changed.
The objective of this study is to determine to what extent
participation in the FDA-approved PSA Grower Training
promoted knowledge change among produce growers from

10 states within the North Central Region (NCR) of the
United States over 2 years and how this knowledge change
translated into behavioral change 12 months after the
training, measured through a self-reported survey.
MATERIALS AND METHODS
Knowledge assessment tool development
The knowledge assessment tool was developed and piloted
by Dr. Catherine Shoulders at the University of Arkansas
(21) and is at a 9.5 reading level according to Microsoft Word
2016 readability statistics and Flesch-Kincaid Grade Level.
The exam questions were validated using Cronbach's alpha,
which yielded internal consistency and face and content
validity (21). Divergent validity was established through
pilot tests with growers (n = 23) and graduate students (n =
15) (21). Table 1 lists which knowledge assessment questions
relate to which PSA Grower Training module. Examples
of the type of questions asked and the modules they relate
to include " Which of the following options can be used
as an indicator of fecal contamination of a water source? "
(module 5, Agricultural Water: Part I Production Water;
Part II Postharvest Water) and " Which of the following has
the responsibility of developing a Farm Food Safety Plan? "
(module 7, How to Develop a Farm Food Safety Plan). Each
question was assigned 1 point, which required the module
scores to be rescaled to a 5-point scale to make comparisons
across modules. This knowledge assessment tool is in
ongoing use as a research tool and, thus, is not shared with
the general public. Iowa State University approved the use of
the knowledge assessment tool by the Office for Responsible
Research, Human Research Institutional Review Board (no.
18-004) (14).
Administration of pretest and posttest knowledge assessment
Each PSA Grower Training Course was administered over
8 h, in person. The knowledge assessment was administered
before (pretest) and after (posttest) the training as a
paper copy in eight NCR states in year 1 (October 2017 to

TABLE 1. Knowledge assessment questions linked to specific Produce Safety Alliance
(PSA) Grower Training modules
Knowledge assessment questions

PSA Grower Training module

1, 2, 3, 4, and 18
5 and 6
7, 8, 9, and 10
11, 12, 13, and 14
15, 16, and 17
19, 20, and 21
22, 23, 24, and 25

Module 1: Introduction to Produce Safety
Module 2: Worker Health, Hygiene, and Training
Module 3: Soil Amendments
Module 4: Wildlife, Domesticated Animals, and Land Use
Module 5: Agricultural Water: Part I Production Water; Part II Postharvest Water
Module 6: Postharvest Handling and Sanitation
Module 7: How to Develop a Farm Food Safety Plan

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