Needs assessment and development of intervention to improve food safety behavior among food handlers in selected school canteens in the Klang Valley, Malaysia

In Malaysia, the number of foodborne outbreaks in schools has increased over the years. One of the main contributing factors is the improper handling of food among food handlers. The study aimed to develop an intervention to improve two selected food safety behaviors (handwashing and preventing contamination of ready-to-eat food) among food handlers at public school canteens. An-extended Health Action Model (HAM) was used as a framework to conduct a needs assessment, using a mixed-method approach comprising of focus group, survey and direct observation. A total of seven focus group discussions with food handlers (n=64) were first carried out to identify their perceived barriers and motivation to perform handwashing and preventing food contamination, which were used as part of the instrument adaptation and validation process. This was followed by a baseline survey (n=211) on food handlers’ knowledge , belief, norm, motivation, habit, and behavioral intention according to the HAM constructs. The proposed research model extends HAM by incorporating five dimensions of beliefs (i.e., self-efficacy, perceived susceptibility, severity, barriers, and benefits) and four dimensions of motivation (law and enforcement, reward, internal motivation, and resources). Analysis using PLS-SEM (v3.0) revealed that norm and knowledge significantly influenced belief, ultimately affecting food handlers’ intention to perform handwashing practices (p≤0.001), instead, the intention-behavior relationship, specifically for contamination prevention, was not supported in this study (p>0.05). Importance and Performance Matrix Analysis (IPMA) revealed that selfefficacy was identified as a priority variable to focus on the development of the intervention. An educational intervention program focusing on enhancing self-efficacy was developed and tested using a treatment group (n=31) and a control group (n=30). The effectiveness of the intervention package was evaluated after a 14-day intervention period. The intervention program produced a significant increase (p<0.001) in the behavioral compliance, knowledge and self-efficacy scores. Even though there are rooms for improvement, the post-intervention handwashing compliance score shows an increase in the overall frequency of soap use and compliance with the correct handwashing technique among the participants. Findings from this study provide valuable information on the possible use of the HAM model to develop a customized food safety educational program to improve food safety behavior among school food handlers. This study is the first one known to test the HAM using observational food safety behavioral data empirically. Future studies should focus on identifying other variables that may bridge the intention-behaviour gap, especially for contamination prevention.

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