Food Protection Trends - January/February 2022 - 16

Effect of intervention on self-efficacy
The self-efficacy level of participants was measured before
and after intervention for both control and intervention
groups (Table 4). The pretest self-efficacy scores were similar
for both groups. There were no significant differences in the
self-efficacy scores for both practices for the control group,
pre- and posttest (P > 0.05). After the intervention, the
treatment group had a significantly higher self-efficacy score
for hand washing (P < 0.01) and contamination prevention
(P < 0.01). The results show that participants perceived
higher confidence in performing the two selected practices at
their workplace after undergoing the intervention program.
Effect of intervention on food safety behavior
The study was initially benchmarked against the 7-step
hand-washing practice recommended by the Ministry of
Health Malaysia (2013) (31). However, preliminary studies
showed that none of the respondents washed their hands
using the 7-step hand-washing technique and that the use of
hand soap was rare. Thus, in the measurement of behavioral
compliance, researchers observed the number of occasions
when the selected practice was performed, regardless of
adherence to the recommended procedure.
The observed food safety behavior of food handlers,
expressed as behavioral compliance score, is tabulated in
Table 5. At baseline, participants generally exhibited higher
compliance for contamination prevention compared to hand
washing. Hand-washing compliance was deficient, ranging
from 2.86 to 9.09, before intervention. After the intervention
program, the control group showed no behavioral compliance
changes for both practices, pre- and posttest (P > 0.05). In
contrast, the treatment group showed significant improvement
in hand washing (P < 0.01) and contamination prevention
behavior (P < 0.001) after the 14-day intervention. For
contamination prevention behavior, the score increased
by 28.21 points (from 62.37 to 90.58). For hand- washing
practices, the score significantly increased by 13.18 points
(from 9.09 to 22.27). Even though the postintervention handwashing
behavior compliance score was only 22.27%, after the
intervention there was an increase among participants in the
overall frequency of soap use and the use of the 7-step handwashing
technique, as shown in Fig. 1.
DISCUSSION
This study shows that, at baseline, school canteen food
handlers exhibited poor compliance in hand washing
and moderate compliance in contamination prevention
behaviors. The results echoed findings from previous
studies that reported that hand-washing frequency is
low in foodservice operations, with poor adherence to
recommended techniques (36, 51, 53).
After the intervention, which comprised on-site food safety
training and a self-efficacy building program, results showed a
significant increase in the knowledge, self-efficacy, and behavior
of food handlers. The improvement is believed to be due to the
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Food Protection Trends January/February
use of multiple-component intervention strategies. Education
is an important way to deliver consistent knowledge to food
handlers. Instead of the usual formal classroom training, an
on-site interactive training method using an iPad was selected,
incorporating videos, demonstrations, and hands-on handwashing
activity. In a study to develop food safety educational
materials for farm workers, Soon and Baines (2012) reported
that, rather than using slides and educational booklets, practical
and hands-on training sessions were preferred because these
methods generate a more intense and realistic experience that
garners food-handlers' interest (52). Food safety knowledge
acquired through training can enhance food handlers' belief that
they are able to perform the desired behaviors (25).
The self-efficacy building program in this study was
incorporated with Bandura's (2004) principal sources of
information for self-efficacy, which are mastery of skill, verbal
persuasion, and role modeling (6). The combination of activities
helped build food handlers' self-efficacy. When food handlers
have strong self-efficacy, they believe that they have the ability
to perform proper food safety steps, which may subsequently
influence their intention to practice what is being taught.
According to Yu et al. (2018) (62), food handlers could be
hindered from transferring knowledge gained from training into
actual practice because they might be overwhelmed with work
and might be cognitively overloaded. It was suggested that food
handlers should be allowed to practice and apply new skills
learned on the job. Seaman and Eves (2006) (46) highlighted
that the time interval right after training is crucial in setting
the base for future use of the skill. Therefore, because coaching
the trainee to translate learned knowledge into practice during
this critical period is essential, a 10-min daily practice time was
allocated for 2 weeks to give food handlers the opportunity to
master the skills taught during training. Combined with verbal
persuasion by a superior and role modeling by a selected peer,
these factors synergistically influence the participants to believe
that they can perform the behavior.
The positive findings of this study are in line with those
of several past self-efficacy-based intervention studies
conducted on foot self-care among elderly diabetic people
(48), physical activity of the elderly (4), and duration of
breastfeeding (11), despite the different methodology and
mechanism used. Nevertheless, no direct comparison could
be made with food safety literature because there was a lack
of intervention studies targeting self-efficacy in foodservice.
Various intervention approaches to improve food safety
behavior have been reported in the literature, with variable
effectiveness. Among these, education combined with
motivational strategy (15, 35) and role modeling (35)
showed promising results. Previous studies have attempted
various strategies to produce positive changes in different
food safety behaviors. Among the targeted behaviors were
hand washing (17, 35, 36, 60, 61), handling of work surfaces
(60, 61), using thermometers (60, 61), hairnet usage (35),
jewelry usage (35), and general food hygiene (32). Although
cross-contamination is a critical risk area for food safety, no
Food Protection Trends - January/February 2022

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