Meta-analysis of food safety training on hand hygiene knowledge and attitudes among food handlers
Open accessAbstract
Research has shown that traditional food safety training programs and strategies to promote hand hygiene increases knowledge of the subject. However, very few studies have been conducted to evaluate the impact of food safety training on food handlers' attitudes about good hand hygiene practices. The objective of this meta-analytical study was to assess the extent to which food safety training or intervention strategies increased knowledge of and attitudes about hand hygiene. A systematic review of food safety training articles was conducted. Additional studies were identified from abstracts from food safety conferences and food science education conferences. Search terms included combinations of "food safety," "food hygiene," "training," "education," "hand washing," "hand hygiene," "knowledge," "attitudes," "practices," "behavior," and "food handlers." Only before- and after-training approaches and cohort studies with training (intervention group) and without training (control group) in hand hygiene knowledge and including attitudes in food handlers were evaluated. All pooled analyses were based on a random effects model. Meta-analysis values for nine food safety training and intervention studies on hand hygiene knowledge among food handlers were significantly higher than those of the control (without training), with an effect size (Hedges' g) of 1.284 (95% confidence interval [CI] ∼ 0.830 to 1.738). Meta-analysis of five food safety training and intervention studies in which hand hygiene attitudes and self-reported practices were monitored produced a summary effect size of 0.683 (95% CI ∼ 0.523 to 0.843). Food safety training increased knowledge and improved attitudes about hand hygiene practices. Refresher training and long-term reinforcement of good food handling behaviors may also be beneficial for sustaining good hand washing practices.
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The summarized effect size for attitude was SMD = 0.28, suggesting a moderate effect for positive attitude of food handlers.
“Considering the summarized effect size, a SMD = 0.28 suggests a moderate effect for the positive attitude of food handlers; this is similar to previous studies [57,58,66].”
From A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers (2020) · cites this paper as [58]
The Synthesis of results reports a summary effect size of 0.683 (95% CI 0.523–0.843) for hand hygiene attitudes and self-reported practices, not 0.28. The paper supports an improvement in attitudes, but its reported summary estimate contradicts the number attributed to it. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe only meta-analysis of interventions to train food handlers found trained handlers had around 30% improvement in knowledge over controls (n = 9 studies) and 70% improvement in practices, but this was based on self-reported practices, which are prone to exaggeration.
“However, the only meta-analysis of interventions to train food handlers, found trained handlers had around 30% improvement in knowledge over controls (n = 9 studies) and 70% improvement in practices, but this was based on self-reported practices, which are prone to exaggeration [106].”
From Food Safety in Low and Middle Income Countries (2015) · cites this paper as [106]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredKnowledge is probably easier to measure than attitude or practice.
“This result is consistent with previous studies [58,107], and a significant amount of information is available, so it is probably easier to measure knowledge than attitude or practice.”
From A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers (2020) · cites this paper as [58]
The Data analysis section reports knowledge data from nine studies versus attitude data from five. The Discussion notes bias in self-reported attitudes and the complexity of monitoring behavior. These observations are consistent with the citing sentence’s tentative inference, but the paper does not state that knowledge is easier to measure than attitude or practice. (LLM, conf=0.78)
Experimental — accuracy not yet measuredFurther evidence of the effects of training interventions on the knowledge, attitudes and practices toward food safety and hygiene of food handlers from different processes along the food supply chain is needed.
“Despite the effort made [57,58], further evidence of the effects of training interventions on the knowledge, attitudes and practices toward food safety and hygiene of food handlers from different processes along the food supply chain is needed.”
From A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers (2020) · cites this paper as [58]
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- Authors
- SOON, J. M., BAINES, R., & SEAMAN, P.
- Affiliations
- Universiti Malaysia Kelantan (MY)
- Royal Agricultural University (GB)
- Corresponding author
- SOON, JAN MEI
- ORCID
- SOON, JAN MEI
- Venue
- Journal of Food Protection
- Publisher
- Elsevier BV
- Published
- 2012-04
- Volume
- 75
- Issue
- 4
- Pages
- 793-804
- ISSN
- 0362-028X (ISSN-L)
- OpenAlex
- W2328770276
- Cited by
- 127
- References
- 78
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 8 · 2023: 11 · 2022: 6 · 2021: 13 · 2020: 14 · 2019: 15 · 2018: 13 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 6 · 2013: 6 · 2012: 1
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Food Protection (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Higher Education, Malaysia
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Food Safety and Hygiene
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
- Keywords
- food safety training, hand hygiene, food handlers, hand washing, knowledge, attitudes, food handler education, refresher training, food handling behavior
- MeSH terms
- Workforce, Food Handling, Food Services, Hand Disinfection, Health Education, Humans, Hygiene, Health Knowledge, Attitudes, Practice, Personnel Management, Food Safety
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