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Food safety training and evaluation of handwashing intention among fresh

produce farm workers


J.M. Soon
a, b,
*
, R.N. Baines
a,1
a
School of Agriculture, Royal Agricultural College, Cirencester, GL7 6JS Gloucestershire, UK
b
Department 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 2011
Received in revised form
27 July 2011
Accepted 2 August 2011
Keywords:
Farm food safety training
Fresh produce farm
Hand hygiene
Theory of Planned Behaviour
a b s t r a c t
Food safety training is mainly focused towards food service establishments. Therefore, this paper aims to
develop food safety educational and training materials for fresh produce farm workers. The Theory of
Planned Behaviour (TPB) model was used to investigate handwashing intentions among fresh produce
farm workers. The ndings in this study showed an immediate increase in knowledge gained between
pre- and post-training, suggesting that the educational and training programme was successful in
improving food safety knowledge of participants. The overall farm food safety knowledge gain was
signicant at t(41) 6.95, p < 0.001. Generally, all the participants preferred the You Tube video and
hand hygiene demonstration, reiterating the fact that practical and hands-on sessions will create a much
more vivid experience for workers. The TPB has provided a useful framework for understanding fresh
produce farm workers adherence to hand hygiene practices where the multiple regression model
explained approximately 57% of the variance in handwashing intention (p < 0.001). Furthermore,
perceived behavioural control was identied as the signicant predictor of handwashing intention
(p < 0.001). This suggests that participants were more likely to wash hands before harvesting or packing
fresh produce when they perceived fewer barriers to wash hands. The ndings here also suggest that for
handwashing behaviour, intention is not considered to be wholly within the fresh produce farm workers
control as the working environment is different from a food service establishment which have easier
access 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), shellsh (Pontrelli et al., 2008) and ingredients such as
peanut butter (CDC, 2009). Furthermore, the shift in consumption
trends towards eating minimally processed produce have also
resulted in the increase of foodborne outbreaks (Abadias, Usall,
Anguera, Solsona, & Vias, 2008). The driving force behind the
rapid growth of the fresh produce is argued to be the desire of
consumers to lead a healthy lifestyle. For example, FAO and WHO
introduced the 5-a-day campaign that encourage people to eat at
least ve servings of fruits and vegetables daily (FAO, 2006) and this
may have also led to an increase in the consumption of fresh
produce. In fact, 78% of the UK population is aware of the 5-a-day
message and 58% claimed consumption of 5 or more portions of
fruit and vegetables daily (Food Standards Agency, 2008). However
fresh produce and sprouted seeds have been implicated in
a number of documented outbreaks of illness in countries such as
the US and within the EU (Soon, Manning, Davies, & Baines, in
press). Based on the review, primary production was argued as
potential sources of foodborne outbreaks. More recently, one of the
largest reported outbreaks of haemolytic uremic syndrome (HUS)
and bloody diarrhoea caused by the Shiga toxin-producing
Escherichia coli O104:H4 occurred in Germany in May and June
2011 (Jansen & Kielstein, 2011) and the search for the source and
vehicle 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 genetically
related to the strain identied in Germany (Gault et al., 2011).
Subsequent investigations determined that both outbreaks were
linked to one lot of imported fenugreek seeds and the public were
advised not to grow sprouts for their own consumption and not to
eat sprouts or sprouted seeds unless cooked thoroughly (EFSA,
2011).
* Corresponding author. School of Agriculture, Royal Agricultural College, Ciren-
cester, GL7 6JS Gloucestershire, UK. Tel.: 44 7500 233538; fax: 44 01285 650219.
E-mail addresses: janmei.soon@rac.ac.uk, janmei.soon@yahoo.com (J.M. Soon),
richard.baines@rac.ac.uk (R.N. Baines).
1
Tel.: 44 01285 652531x2255.
Contents lists available at ScienceDirect
Food Control
j ournal homepage: www. el sevi er. com/ l ocat e/ f oodcont
0956-7135/$ e see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.foodcont.2011.08.012
Food Control 23 (2012) 437e448
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, & Proena, 2011) since
50e70% of the food illnesses in USA, UK, Netherlands, Korea were
associated with catering or food service establishments (Grifth,
2000; Jones & Angulo, 2006; Park, Kwak, & Chang, 2010). Some of
the main risk factors are inappropriate storage (32%), inadequate
heat treatment (26%) and cross contamination from raw to cooked
foods (25%) (Smerdon, Adak, OBrien, Gillespie, & Reacher, 2001;
Soon, Singh, & Baines, 2011). On the other hand, less food safety
training research have been conducted at the farm level (Jevsnik,
Hlebec, & Raspor, 2009; Nieto-Montenegro, Brown, & LaBorde,
2008; Rangarajan, Pritts, Reiners, & Pedersen, 2000). Therefore, in
this paper, we aim to use the Food Hygiene Training Model
(Seaman, 2010) with Jacob, Mathiasen and Powells (2010) recom-
mendations on developing food safety training materials for fresh
produce farm workers. The Theory of Planned Behaviour (TPB)
model was used to evaluate the factors inuencing the farm
workers intention for handwashing. The advantage of using the
TPB framework is that it helps to determine which factors best
predict the intent to perform a behaviour (Shapiro, Porticella, Jiang,
& Gravani, 2011). A better understanding of the beliefs among fresh
produce farm workers on their adherence to hand hygiene may
help in targeting specic components of the TPB for further
improvement.
Trainingis crucial toanyfoodsafetysystems. Poor staff trainingin
food hygiene is a real threat to the safety of food, hence effective
training is an important prerequisite to successful implementation
of a food safety management system (Arvanitoyannis & Kassaveti,
2009). To be effective, food safety training needs to target
changing the behaviour most likely to result in foodborne illnesses.
Most food hygiene training courses rely heavily on the provision of
information. Studies have shown that increasing knowledge does
not necessarily lead to changes in behaviours (Clayton, Grifth,
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
safety knowledge as at least fair; 60% did not wash their hands with
soap and water after touching raw poultry. Grifth (2000) argued
that behavioural change (i.e. the implementation of required
hygiene practices) is not easilyachievedandthat considerationmust
be given to motivation, constraints, barriers and facilities as well as
to cultural aspects. Food safety practices will only be implemented
given adequate resources and appropriate management culture
(Clayton & Grifth, 2008). In contrast, Scott, Pope, and Thompson
(2009) demonstrated that knowledge and food safety behaviour of
consumers increases following a food safety education programme
and suggested that educational programmes are an effective tool to
teach consumers about safe handling of food. Training programmes
which are more closely associated with the work site are potentially
more effective especially if supported by practical reinforcement of
the message (Rennie, 1994). Nieto-Montenegro et al. (2008) sug-
gested that to increase training programme effectiveness, one must
rst understand the food handlers behaviour and how this behav-
iour interacts with their beliefs and levels of knowledge. This can be
facilitated by use of theory-based models in the development of
educational materials (National Cancer Institute, 2005).
1.1. Developing effective food safety training materials
The majorityof foodborneillnesses arethought tobe preventable
if food safety principles are understood and practiced throughout
the entire food chain (Jacob, Mathiasen, & Powell, 2010). Interven-
tions such as improving food handling practices and food safety
campaigns are necessary to reduce foodborne illnesses (Wong et al.,
2004). However, Redmond and Grifth (2003) noticed that despite
educational efforts and food safety training, unsafe food handling
practices are still frequently used. Hence, Jacob et al. (2010) sug-
gested that effective food safety messages using new media may
effectively modify inappropriate human behaviours in the food
safety system (Table 1).
Successful training also requires careful planning by the trainer
and needs to be designed in a way to meet the needs of the
trainees; for example, some of the important points for effective
training adapted from the University of Maryland (2002) are:
Table 1
Factors to consider when developing food safety training materials (Jacob et al., 2010).
Factors to consider when
developing food safety training
materials
Comments References
Understand the target audience Food safety message should be developed according
to audiences needs, concerns and interests
Identify appropriate media
for distribution
Internet is increasingly being used as a communication
tool for food safety and health-related information
Redmond and Grifth (2006)
Challenge complacency People with an it will not happen to me attitude may ignore
risk communications, assuming that these messages are targeted
at more vulnerable population
Miles, Braxton, and Frewer (1999)
Enhance personal
perception of risk
Emphasise the human rather than the statistical aspects of a story.
Identifying individual victims further enhances public perception
of personal risk
Joint FAO/WHO Expert Consultation on
the Application of Risk Communication
to Food Standards and Safety Matters (1998)
Use narratives Narrative-based messages and messages incorporating fear
appeals are more favourably evaluated by farmers than
messages that simply inform or that rely on statistics
Morgan, Cole, Struttmann, and Piercy (2002)
Associate with audiences
lifestyle
Incorporate everyday context into food safety communications.
Personal shortcomings such as hunger, lack of money and/or
inability to access different foods contribute to different
food behaviours
Wilcock, Pun, Khanona, and Aung (2004)
Reinforce food safety messages Provide information in written, verbal or visual formats, but will
be most effective if used in combination with each other
Durant (2002)
Use clear language and
include graphics
Use clear, non-technical language appropriate to the target
audience and use pictorial materials to clarify messages.
Maintain consistency Contradictory messages can cause confusion and create
distrust in information
Pre-test and evaluate messages Pre-test on target audience on the context in which they will be
distributed and revised based on the results
McDermott et al. (2003)
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 438
(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) identies the
inuences that predict and change behaviours where behavioural
intention is inuenced by: a persons attitudes; beliefs about
whether individuals who are important to the person approve or
disapprove 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 identied as the most imme-
diate determinant of behaviour (Fishbein & Ajzen, 1975; Shapiro
et al., 2011). In this study, we aim to apply the TPB framework to
investigate handwashing intention among fresh produce farm
workers. According to the TPB, as a direct determinant of safe food
handling behaviour (i.e. hand hygiene practices), the behavioural
intention to adopt handwashing is inuenced by three sets of
beliefs: attitudes towards the handwashing practices, (individuals
positive or negative evaluation of performing a particular behav-
iour), subjective norms (perception of the social pressure to
perform or not perform the behaviour) and perceived behavioural
control (perception of the ease or difculty in performing the target
behaviour).
2. Materials and methods
2.1. Development of farm food safety educational and training
materials
The farm food safety educational and training materials were
designed according to the recommendations by Jacob et al. (2010),
Seaman (2010) and University of Maryland (2002). The Food
Hygiene Training Model (Fig. 2) developed by Seaman (2010)
incorporates the Health Action Model and several additional
components such as training needs analysis, knowledge or practical
skill assessment and evaluation and effects of the training pro-
gramme. This model is suited for the farm food safety training
design since this study aims to develop, test and evaluate the
effectiveness of the training materials.
The training contents were designed to suit the needs of the
farmers and the farm employees (Table 2) where four types of food
safety educational materials were prepared:
(i) A farm food safety educational and training booklet
(ii) Presentation slides (simplied 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 booklet
A farm food safety educational and training booklet was
developed and given to each participating farm (Table 2). This
booklet was used in combination with the slides for in-depth
explanation of farm food safety practices and preparation for
training.
2.1.2. Farm food safety slides
Slides were prepared and presented to the participants. The
slides were a simplied version of the booklet (available upon
request) (Table 3). Testimonial, trace back and lawsuit case studies
were included in the slides to enhance participants perceptions of
risk. Narrative based and pictorial materials were used to clarify
and reinforce food safety messages (Jacob et al., 2010).
2.1.3. You Tube video on farm food safety practices
A You Tube video for farm workers was shown to participants.
The video running time was 9.5 min. The video was adapted
from:http://www.foodsafety.ksu.edu/articles/701/keeping_food_
safe.mov(Food Safety Network, 2011).
2.1.4. Hand hygiene demonstration and practical session
Practical hand hygiene sessions using GloGerm

powder and
a handheldUVlight weredemonstratedtoparticipants onhowcross
contamination occurs and the effectiveness of handwashing
(Table 4). This step also serves to reinforce the food safety message
among participants (Durant, 2002). The use of visuals and hands-on
training in farmfood safety training creates an informal atmosphere
that can enhance learning. Visuals are also especially benecial to
train audience whose native language is not English (Rajagopal,
2010). Nicol, Watkins, Donovan, Wynaden, and Cadwallader
(2009) suggested that practical and hands-on sessions create
a 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. An
outline of the key issues of the farm food safety training strategy
such as the behavioural objective, targeted behaviours, target
audience (Redmond & Grifth, 2006) and training materials are
presented (Table 5).
The voluntary participants were identied fromthe 12 UK farms
which participated in a separate Farm Food Safety-Risk Assessment
Behavioural
Intention
(Are you likely to
wash hands before
harvesting or
packing fresh
produce?)
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?)
Perceived
behavioural
control
(Do you believe that
washing hands are
entirely up to you?)
Fig. 1. Theory of Planned Behaviour; Dotted boxes represent a scenario in hand hygiene practices aimed at fresh produce production (adapted from Montao & Kasprzyk, 2002;
National Cancer Institute, 2005).
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 439
Tool testing and evaluation study where six out of the 12 farms
participated in the farm food safety training study. The motivation
from farms to participate in the food safety research goes to show
that they are continuously trying to increase the safety and quality
of their farmed products. From the six farms a total of 62 fresh
produce farm workers participated. The participants were
restricted to those handling fresh produce directly (e.g. harvesting/
packing) on the farms. The training objectives were to ensure that
the farmers and producers understand the importance of farmfood
safety practices through the use of narrative based case studies and
afliation of participants working environment with potential
contamination sources as well as to increase hand hygiene aware-
ness among workers. The training method used encompasses both
oral and hands-on training of hand hygiene practices. At the end of
the training sessions, the farmers and trainees answered a short
questionnaire on the effectiveness of the trainer (rst author) and
delivery of the training.
2.3. Pre- and post-training questionnaires
Pre- and post-training farm food safety questionnaires were
developed in line with other studies (e.g. Clayton & Grifth, 2008;
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 System
e.g. Incentives
Belief System
e.g. Concerns about adverse
effects of non-compliance
Motivational System
e.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
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Fig. 2. The Food Hygiene Training Model (Seaman, 2010).
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 440
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 Planned
Behaviour components). Eight farmfoodsafetyknowledge questions
were administeredonthe pre- andpost-training tests andwere used
to measure the knowledge gained as a result of the training. An
Uncertain answer was included as a choice for the questions to
reduce the possibility of guessing. A series of questions related to
participant demographics (gender, age, years working on farm, level
of educationlevel) were included. The TPBsectionassessedattitudes,
subjective norms, perceived behavioural control and behavioural
intention for the handwashing behaviour (Table 6). The TPB ques-
tions contained direct measures of attitude, subjective norm and
intention. Perceived behavioural control was considered as two
components: (i) internal control due to ease/difcultyof carryingout
hand hygiene practices was measured with the statement, If I
wanted to, I could easily wash my hands before harvesting/packing
freshproduce (1stronglydisagree, 5stronglyagree). Meanwhile
(ii) external control was measured by the statement, Not having
enoughtimewouldmakeit moredifcult for metoproperlywashmy
hands (1 strongly disagree, 5 strongly agree).
The post-training questionnaire is made up two sections (i.e.
food safety knowledge and training evaluation). The questionnaires
were reviewed by a food safety educator for content and face val-
idity. Corrections were made based on the feedback. The revised
questionnaires and food safety educational and training materials
were pilot-tested with ve farmers afliated with the institution.
The test-retest reliability coefcient was 0.61.
One week prior to training, the participating farms represen-
tatives received a set of instructions for the training session and the
pre-training questionnaires. This prior training contact was
essential and was recommended by Fenton, LaBorde, Radhakrishna,
Brown, and Cutter (2006). On the day of training, the participating
farms employees were immediately trained and then completed
the post-training questionnaire. Anonymity was given in writing on
the questionnaire and verbally when administering the question-
naire. All the protocols for the evaluation of fresh produce farm
workers behaviour and knowledge were approved by the institu-
tions research and review board.
2.4. Statistical analysis
2.4.1. Statistical analysis of food safety knowledge
The data were analysed with SPSS for Windows (version 19.0,
2010, SPSS Inc, Chicago, IL). Chi-square and paired t-test analyses
were used to evaluate the pre- and post-training gain in food safety
knowledge. Friedman ANOVA and Wilcoxon signed-rank tests were
used to determine the participants preference of the types of
training materials.
2.4.2. Statistical analysis of behavioural components
Nonparametric bivariate correlations were calculated in order to
establishwhether anyof thepredictive constructs were relatedtothe
dependent variables (behavioural intention). Using the TPB as
a guide, the authors predicted that attitudes towards hand hygiene,
subjective norms regardinghandhygiene, andperceivedbehavioural
control over handwashingwouldpredict the intentiontowashhands
among the fresh produce farm workers. In other words, the more
favourable ones attitudes towards hand hygiene, the stronger ones
subjective norms regarding hand hygiene and the greater the
perceived control over handwashing, the stronger should be the
intentiontowashhands. Totest the hypothesis, a multiple regression
was 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 which
agreed to participate in the study. Thirty four percent of the
Table 2
Summary of farm food safety educational and training booklet contents.
1.0 Food safety breakdowns
Case studies such as Escherichia coli O157:H7 in bagged spinach and
hepatitis A virus in green onions were included to emphasise the
importance of food safety at the farm level.
Learning outcomes: Farm operators understand the importance
of farm food safety.
2.0 Farm food safety practices
Sources of produce contamination (e.g. water, manure, animals and
workers) and good agricultural practices were included in this section.
A case study example of lettuce production and the possible contamination
points during production was included as well.
Learning outcomes: Participants will gain awareness of the potential
contamination points in fresh produce production and know about their
effects and prevention measures.
3.0 Food Laws and Regulations
International food laws and national regulations such as Codex, EU General
Food Law 2005, Regulation (EC) No. 852/2004 and UK Food Safety Act 1990
were included. Product liability case studies were also included to
emphasise the effects of foodborne diseases.
Cost of foodborne diseases
a) Case study 1: Undercooked hamburger with E. coli O157:H7 e Lawsuit
$12.5 million
b) Case study 2: Hepatitis A in green onions e Lawsuit $6.25 million
Learning outcomes: Participants will gain insight into regulations that affect
production and trade of food and examples of severe consequences due to
inappropriate food handling practices.
Table 3
Summary of selected farm food safety educational slides explanations.
Example of slides explanations
Narrative-based testimonial
Mason Joness case study was included to enhance familiarity among
participants (since the study was conducted in the UK). In this case,
how does beef product relates to fresh produce? The slide was then
linked to the second
case study as shown below.
Narrative-based testimonial
From Mason Joness death which was due to E. coli in beef products,
this slide shows that E. coli has now adapted and spread to fresh
produce (i.e. Kyle Allgoods case study) (STOP Foodborne Illness, 2011).
How could the consumption of fresh produce which had always been
a safe and healthy option cause a serious foodborne outbreak? (This can
be further linked to the German E. coli O104:H4 outbreak).
Trace back investigation at the farm level
An example of how E. coli was traced back to the farm was shown
to participants (CFERT, 2007). This will enable participants to associate
with the eld working environment and to be aware of potential
sources of contamination in or near the farm (Wilcock et al., 2004).
Trace back investigation in the food supply chain
Another case study example showing how Hepatitis A could also be
transmitted to fresh produce due to infected farm workers. This case
study helps to reinforce the food safety message (Durant, 2002) and
farm workers play an important role in food safety.
Litigation case study
An example of the enormous consequences of fresh produce outbreak is
shown to the participants. For example, Mr Miller won a lawsuit totalling
3.63 million against Chi chis restaurant. But in exchange, he needs to pay
for it with Hepatitis A, a liver transplant and to be on anti-rejection drugs
for life (MarlerClark, 2005).
Farm food safety practices
Examples of potential contamination points during harvesting is
presented to associate participants working environment with
farm food safety practices.
Handwashing procedures
A pictorial handwashing steps is also demonstrated to the participants.
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 441
participants were male. The majority of the participants, 71%
(n 56) reported having a GCSE/A levels or tertiary education. All
have at least 1e3 years of farmworking experience. Ninety percent
of them were directly involved in harvesting and packing fresh
produce (Table 7).
3.2. Farm food safety training
3.2.1. Knowledge assessment
The responses given pre- and post-training are presented for the
participating fresh produce farm workers (Table 8). Signicant
differences in participants level of knowledge were observed in
ve of the eight variables examined. Participants knowledge of
situations about staff with cuts on hands should not handle fresh
produce directly increased in correct responses (52%) before
training to 100% of correct responses after training (c
2
28.56;
Table 4
Hand 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 5
Summary of farm food safety training strategy.
Food safety training strategy
Behavioural objective To understand specic food safety behaviours
especially during contact with fresh produce by
increasing hand hygiene awareness among eld
and packing workers
Targeted behaviours Adequate handwashing and hand drying before
handling fresh produce
Target audience Farm workers with direct contact with ready-to-eat
fresh produce
Farm food safety
training materials
(i) Farm food safety educational and training
booklet
(ii) Presentation slides
(iii) You Tube video
(iv) Hand hygiene demonstration and practical
session
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 442
df 1; p <0.001). The number of participants who were aware that
harvesting crates should not be kept directly on the ground
increased from 58% (before training) to 100% correct responses
(after training) (c
2
23.48; df 2; p < 0.001). Meanwhile the
participants who answered the handwashing question correctly
increased from55% to 93% (c
2
17.72; df 2; p <0.05). Ten percent
mentioned that they should wet hands, apply soap, rinse and dry
on their apron while 32% think that icking their hands dry would
be the correct option (Table 8).
Results of these questions showed an increase in immediate
knowledge gain between pre- and post-training suggesting that the
educational and training programme was successful in improving
food safety knowledge of participants. There were no signicant
differences for the rest of the questions such as only sick people
carry food poisoning bacteria in their gut or if blood dripped onto
produce, the affected produce should be thrown away. When the
authors examined the scores of these statements, it could be seen
that the pre-training scores were high, leaving little room for
improvement. This suggested a strong volunteer effect (Kirby &
Gardiner, 1997) from farm management where farms with
workers scoring high scores in farm food safety knowledge were
taking advantage of the training by the authors to maintain their
staffs knowledge or to serve as a refresher training course.
The overall farm food safety knowledge gain was assessed as
well by aggregating scores. The maximum score possible on the
knowledge assessment was eight, which was equivalent to the
number of questions. Each correct answer was given one point,
while incorrect and uncertain response was assigned zero point. A
t-test for the knowledge gain examined from the pre- and post-
training scores was signicant, t(41) 6.95, p < 0.001 while the
effect size, d 1.07 is large (d >0.8) indicating that the training had
a large effect on knowledge scores (Table 9).
The results obtained in this study revealed that more than half
of the participants were aware of farm food safety practices. In
particular, participants were well aware that staff with injured/cuts
on hand should not handle fresh produce directly, blood-stained
produce should be thrown away and birds are a source of Salmo-
nella spp.
3.2.2. Types of training materials
The participants were asked to rank (1-not useful at all; 5-very
useful) the types of training materials used during the farm food
safety training session. More than 80% of the participants rated the
You Tube video and hand hygiene demonstration as more practical
compared to the training booklet and presentation slides (Fig. 3).
The rankings of the types of training materials were found to be
signicant (c
2
(3) 88.12, p < 0.001). Wilcoxon tests were used to
follow up this nding. A Bonferroni correction was applied; hence
all effects were reported at a 0.0167 level of signicance (0.05/3). It
appeared that the presentation training slides were indifferent
compared to the training booklet, z 2.25, p 0.024 (more than
0.0167). However, the You Tube video and hand hygiene demon-
stration were ranked signicantly higher than the training booklet,
z 5.38, p < 0.001 (less than 0.0167). These ndings supported
the argument that the participants preferred the You Tube video
and hand hygiene demonstration as compared to the training
booklet or power point slides. The You Tube video included in this
study targeted fresh produce farm workers, was focused and
provided relevant farm food safety topics and this may have
allowed participants to associate the video to their working envi-
ronment and scenarios of potential cross contamination that could
occur in the eld and pack-house. This indicates that videos that are
focused and provide one concept per video are important to
maintain viewers interest (Rhoades & Ellis, 2010).
3.2.3. Farm food safety training evaluation
The participants also evaluated the farm food safety training
conducted at their farms. More than 80% of the participants
determined that the training contents were satisfactory and easy to
understand. 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 behaviour
Table 10 lists the descriptive statistics of the components of the
Theory of Planned Behaviour model of handwashing practices
Table 6
Items measuring variables (attitude, subjective norm, perceived behavioural control
and intention) of the Theory of Planned Behaviour.
Items Scale
a
Direct attitude
For me to wash my hands at work on a
regular basis is
(Not very important to
very important)
Proper handwashing is (Impractical to practical)
Proper handwashing is (Inconvenient to
convenient)
Subjective norm
I feel under pressure from my supervisor/manager
to wash my hands (subjective norms)
(Strongly disagree to
strongly agree)
People whom I respect (e.g. supervisor/boss)
will disapprove if I do not wash my
hands properly
(Strongly disagree to
strongly agree)
It is expected of me to wash my hands before
harvesting/packing
(Strongly disagree to
strongly agree)
Perceived behavioural control
If I wanted to, I could easily wash my hands
before harvesting/packing fresh produce
(Strongly disagree to
strongly agree)
Not having enough time would make it more
difcult for me to properly wash my hands
(Strongly disagree to
strongly agree)
Whether I wash my hands before harvesting/
packing is entirely up to me
(Strongly disagree to
strongly agree)
Behavioural intention
I always intend to wash my hands before
harvesting/packing fresh produce
(Very unlikely to very
likely)
a
Items were measured based on ve-point Likert scale and bipolar adjectives (e.g.
impractical e practical).
Table 7
Demographics of fresh produce farm participants.
Demographic items N (%)
Gender (n 62)
Male 34 (55)
Female 28 (45)
Age (n 62)
20 10 (16)
21e30 24 (39)
31e40 12 (19)
41e50 14 (23)
51e60 2 (3)
Education level (n 56)
None 16 (29)
GCSE/A levels 18 (32)
Degree/HND/ND
a
or equivalent 22 (39)
Years working on farm (n 58)
1e3 years 18 (31)
4e6 years 24 (41)
7e10 years 8 (14)
> 10 years 8 (14)
Job responsibilities (n 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.
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 443
where all the mean responses were towards the positive end of the
scales. This suggests that most participants have positive attitudes
and intentions but were also socially pressured to perform hand-
washing activities. However, the authors note that the positively
skewed perceived behavioural control would indicate that barriers
were very likely to prevent the participants from carrying out
handwashing before harvesting and packing.
3.3.2. Multiple regression analysis of hand hygiene intention
Multiple linear regression was performed to evaluate the TPB
model for handwashing intention behaviour. Intention to perform
the behaviour was predicted from direct attitudes, subjective
norms and perceived behavioural control. The regression model
explained about 57% of the variance of the intent to wash hands
where R
2
0.59, (Adjusted R
2
0.57). This was signicantly
different from zero F(3, 58) 27.72, MS
residual
0.101, p < 0.001.
However, only one predictor (perceived behavioural control)
contributed signicantly to the prediction of intention to wash
Table 8
Pre- and post-training of farm food safety knowledge gain.
Farm food safety
knowledge
Pre-training Post-training c
2
Signicance Cramers
V
Staff with cuts on hands should not
handle produce
n 62 (%) n 42 (%)
True32(52) True42(100) 28.56 df 1; p < 0.001 0.52
Uncertain-30 (48)
Only sick people carry bacteria which
causes food poisoning
True-12 (19) True-6 (14) 1.94 df 2; p 0.38 0.14
False48(78) False36(86)
Uncertain-2 (3)
Birds are a source of Salmonella spp. and
can transmit diseases to humans through
fresh produce
True54(87) True42(100) 5.87 df 2; p 0.053 0.24
False-4 (7)
Uncertain-4 (6)
Harvesting crates can be kept directly on
the ground/earth while harvesting
True-4 (7) False42(100) 23.48 df 2; p < 0.001 0.48
False36(58)
Uncertain-22 (35)
Staff should always wipe their hands
on their jeans or aprons before
harvesting/packing produce
True-8 (13) True-3 (7) 3.93 df 2; p 0.14 0.19
False50(81) False39(93)
Uncertain-4 (6)
If I cut my nger and blood dropped onto
fresh produce, I should bandage my nger
and make sure that:
(i) the blood-stained produce is wiped
and packed
4 (7) 0
(ii) the blood-stained produce
is thrown away
58 (93) 42 (100) 2.82 df 1; p 0.09 0.17
(iii) the blood-stained produce is
washed and packed
0 0
During harvesting, if I notice that
there are animal faeces/bird
droppings 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 members
not to harvest the affected produce
59 (95) 42 (100) 1.96 df 1; p 0.16 0.15
Which of the following is the correct
handwashing procedure?
(i) Wet hands, apply soap, scrub hands,
rinse and dry hands with paper towel
34 (55) 39 (93) 17.72 df 3, p < 0.05 0.41
(ii) Wet hands with water and scrub
hands 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 ick my hands dry
20 (32) 3 (7)
Note: Answer choices in bold indicate correct answer.
Table 9
Overall pre- and post-training test scores from knowledge assessment.
Pre-training (n 62) Post-training (n 42) T value
a
Signicance
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.
Fig. 3. Fresh produce farm workers preference of types of farm food safety training
materials (n 42).
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 444
hands (Fig. 5). This suggests that perceived behavioural control was
the most important factor in predicting intention to carry out hand
hygiene actions. That is, the participants were more likely to wash
hands before harvesting or packing fresh produce when they
perceived fewer barriers to wash hands.
The importance of control (Jenner, Watson, Miller, Jones, &Scott,
2002) and time (OBoyle, Henly, & Larson, 2001) had been
demonstrated in hand hygiene studies within a hospital setting.
Furthermore, attitudes were the consistent signicant predictor for
handwashing behaviour in other studies (OBoyle et al., 2001;
Pilling et al., 2008; Shapiro et al., 2011). In this study, even
though attitude and subjective norms were positively skewed, both
these components were not signicant predictors for handwashing
intention. However, the workers perceived controls were consid-
ered signicant predictor in carrying out hand hygiene actions and
this may be due to the fact that workers intend and want to wash
their hands but may not be able to do so due to perceived barriers.
The ndings here also suggest that for handwashing 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 easier access to hand-
washing facilities and potable water at all times. Most of the
participants in this study may have limited access to handwashing
facilities while in the eld and handwashing was clearly not
feasible when there were no facilities in place and available for use
(Gormley, Little, de Pinna, McLauchlin & the Food, Water and
Environmental Surveillance Network, 2009). Instead the farm
management can provide their workers with small bottles of
alcohol-based sanitiser to encourage hand hygiene practices.
Furthermore, nding ways to improve all three behavioural
components would be benecial in this context.
3.3.3. Handwashing practices
Results indicated that all participants always wash their hands
after using the toilet. Sixty percent of the participants washed their
hands frequently after coughing or sneezing, and 97% also washed
their hands before harvesting or packing fresh produce (Table 11).
There was a 100% self-reported compliance of handwashing after
using the toilet and 97% before harvesting or packing fresh produce.
However, Clayton, Grifth, and Price (2003) reported that unsuper-
vised handwashing will never be completely compliant in any
setting. Ina consumer foodsafetystudyinWales, some of thereasons
cited for not washing hands were laziness and lack of time. Mean-
while in a UK Food Standards Agency food safety study conducted
among food catering establishments, Todd, Greig, Bartleson, &
Michaels (2007) found that one-third of the caterers did not wash
their hands after using the toilet and 53% failed to wash their hands
before preparing food (cited by Todd et al., 2010). This lack of
compliance may not only be caused by time constraints, staff short-
ages or inadequate facilities, but may also be due to overcondent
managers andowners whobelieve their foodoperationunits are low
risk (Coleman & Roberts, 2005).
3.4. Importance of targeting specic beliefs
There are a number of lessons that canbe learnt fromthis study, in
particular, the components that made up TPB can be targeted in
educational interventions to improve behavioural intent. Farm
Fig. 4. Fresh produce farm workers evaluation of farm food safety training.
Table 10
Descriptive statistics of Theory of Planned Behaviour (TPB) components for hand-
washing behaviour (n 62).
TPB variables Composition of items Mean SD
Attitudes Mean of 3 items 4.75 0.45
Subjective Norms Mean of 3 items 4.12 0.70
Perceived Behavioural Mean of 3 items 4.04 0.96
Control
Behavioural Intention 4.65 0.48
The attitudes, subjective norms, perceived behavioural control and intention items
were measured on Likert and bipolar adjectives scales ranging from one to ve.
Higher numbers indicate more positive attitudes, subjective norms, perceived
control or intentions. Fig. 5. Theory of Planned Behaviour model for handwashing intention (*p < 0.001).
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 445
owners and managers should emphasise the positive outcomes of
handwashing (e.g. safe produce, less recall, hence more prot for the
farm and workers) and potential negative outcomes (causing food-
borne illnesses, product recall and lost business, hence affecting staff
wages). To improve attitudes, the farmfood safety training materials
included why food safety is important (e.g. by emphasising that
practicing good hand hygiene reduces the number of people getting
sick e through the use of Mason Joness and Kyle Allgoods case
studies during training). In addition, the supervisors and managers
should create an environment that cultivates handwashing by
putting up posters and reminders (in the workers native language)
and to be role models themselves. To improve subjective norms, the
authors stress that managers, colleagues, health inspectors and
customers would want them to properly perform the behaviours.
Perceived control can be improved by supplying adequate resources
and reminding employees to perform the behaviours (Pilling et al.,
2008). The more accessible the toilets and handwashing facilities
are, the greater the likelihood that they will be used (FDA, 1998); in
addition to providing mobile toilets with adequate handwashing
facilities, farm managers can also provide small bottles of hand
sanitisers for their staff. However, to move from perceived to actual
behaviour changes, additional studies on observing fresh produce
farm workers actual handwashing practices and frequency of
washing would be useful. Direct observation is recommended by
WHO as the most reliable method for measuring adherence rates to
hand hygiene (Boyce & Pittet, 2002) and it is also able to identify the
strengths andweaknesses of handhygienepractices. However, direct
observation may result in workers changing their behaviour (Haw-
thorne effect) when they know that they were being observed and
can result in falsely elevated compliance rates (Haas &Larson, 2007).
3.5. Providing knowledge is not sufcient
It is known that knowledge imparted by training courses cannot
be translated into desired changes in attitudes and behaviour
(Pilling et al., 2008; Seaman & Eves, 2006). Even though more than
half of the participants generally were aware of the correct way of
handwashing, and potential for cross contamination from hands to
fresh produce, this existing knowledge however did not motivate
their attitudes towards hand hygiene practices. Findings from this
study revealed that only perceived behavioural control was the
signicant predictor in handwashing intention. Thus motivation
from supervisors and management, the support and facilities given
to staff are critical to the success of food safety training. These will
contribute to changing attitudes and company culture, and have an
impact on behaviour and therefore on foodborne outbreaks caused
by food workers (Todd, Greig, Bartleson, & Michaels, 2007).
4. Conclusion
The ndings in this study showed an increase in immediate
knowledge gain between pre- and post-training suggesting that the
educational and training programme was successful in improving
food safety knowledge of participants. The overall farm food safety
knowledge gain was signicant at t(41) 6.95, p < 0.001.
Generally, all the participants preferred the You Tube video and
hand hygiene demonstration, reiterating the fact that practical and
hands-on sessions will create a much more vivid experience for the
workers. All the participants determined that the farm food safety
content was satisfactory and delivery of the educational and
training session was not too long or complicated. The TPB has
provided a useful framework for understanding fresh produce farm
workers adherence to hand hygiene practices. The multiple
regression model explained about 57% of the variance in hand-
washing intention (p < 0.001). Although mean attitude and
subjective norm scores were positive, they were not found to be
signicantly predictive of intention. Perceived behavioural control
was identied as the signicant predictor of handwashing inten-
tion (p < 0.001). This suggests that participants were more likely to
wash hands before harvesting or packing fresh produce when they
perceived fewer barriers to wash hands. Improving handwashing
intention and thus handwashing compliance requires appropriate
facilities, motivation from supervisors and management team and
continuous monitoring that goes beyond the occasional training.
5. Limitations of study
Non-participation e Six fresh produce farms declined to
participate in the study. Three farms indicated time constraints;
one farm explained that they do not have enough of staff to cater
for the training while conducting farm work and another declined
on the grounds that it was a large farm with over 100 harvesters
and its own quality control team to train the workers. One farm
(FarmK) also informed that their workers were paid hourly and the
training being conducted may not add value to their productivity.
From the reasons given for non-participation it may be argued that
the results are unlikely to be biased as the reasons for declining to
participate 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 determine
the behavioural intentions and food safety culture of farms that
may have different priorities (i.e. productivity vs. food safety/
training).
Selection bias e The farms were not chosen at random from the
12 fresh produce farms, but by a convenience approach dependent
on volunteering and willingness by growers (Ellis-Iversen et al.,
2007). This may have introduced selection bias.
Pre- and post-training knowledge e Participants answered the
knowledge questions immediately before and after the educational
and training programme which may have inuenced participants
knowledge gain (Scott et al., 2009). The authors suggest that future
studies could issue the pre-training tests and deliver the training
sessions followed by the post-training tests after a certain period.
Monitoring of knowledge gain and behavioural changes should be
carried out at a later stage to measure the impact of the food safety
education and training programme. During the post-training
session, there was a reduction in the number of participants due
to the staffs commitments in their work. Hence, there was
a decrease from 62 (during pre-training) to 42 participants during
the training and post-training tests.
Theory of Planned Behaviour e One major setback of the TPB
study was the absence of observed actual handwashing practices.
This study relies on self-reporting fromworkers and may not reect
actual practices. The rst author was not able to conduct hand
hygiene observation in the eld since most farms provide cubicle-
like mobile toilets with a handwashing sink attached within the
cubicle. This may be different from the food processing and food
Table 11
Self-reported handwashing practices of fresh produce farm workers.
Handwashing practices %
How often do you wash your hands after
using the toilet?
Always (100)
How often do you wash your hands after
coughing or sneezing?
Always (60)
Sometimes (6)
Rarely (3)
Never (28)
How often do you wash your hands before
harvesting/packing
fresh produce?
Always (97)
Sometimes (3)
J.M. Soon, R.N. Baines / Food Control 23 (2012) 437e448 446
service operations where designated handwashing facilities were
provided before gaining entry into food production or preparation
area. There was also a limit to the number of questions asked to
prevent putting off the fresh produce farm workers from partici-
pating. Finally, the TPB framework questions were limited to
measuring direct behaviours rather than both direct and indirect
behaviours.
Acknowledgements
The authors are extremely grateful to all participating farms
who have kindly responded to the study and to Jonathan Leach for
the hand hygiene demonstration photos. J.M. Soon acknowledges
the nancial support from the Ministry of Higher Education of
Malaysia.
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