Food Protection Trends - January/February 2022 - 17

comparison could be made because of the lack of studies on
this specific behavior.
In this study, even though both targeted food safety
behaviors for the treatment group improved significantly
after intervention, improvement in contamination prevention
was higher than in hand-washing behavior (increase of
28.21 versus 13.18 points, respectively). For contamination
prevention, the mediocre preintervention compliance score
(62.37 ± 21.66) increased to 90.58 ± 11.93 postintervention.
On the other hand, the postintervention hand washing
compliance score increased from 9.09 to 22.27%. An increase
of hand hygiene compliance from 7 to 16% (17) and from
29 to 50.8% (36) was also reported in other studies. It is
believed that the improvement was less obvious for hand
washing because good hand hygiene requires continuous
effort and time. In a study to develop food safety educational
materials and training strategies for the mushroom industry,
Nieto-Montenegro et al. (2008) (35) highlighted that
enforcing hand washing compliance was more difficult than
enforcing hairnet and jewelry usage rules at the worksite.
There is a higher frequency of hand washing opportunities
compared to other food safety practices (14); also, the
fire-fighting mode of school foodservice operations makes
it difficult for food handlers to consistently perform handwashing,
especially during peak hours. School canteen food
handlers in Malaysia have to multitask continuously, doing
food preparation, service, and cleaning. The low profit margin
of Malaysian school foodservice operations (57) could also
be a factor that influences canteen owners' willingness to
invest in more manpower and resources for their school
foodservice operations.
CONCLUSIONS/RECOMMENDATIONS
The intervention produced significant increases in
behavioral compliance, knowledge, and self-efficacy scores for
both contamination prevention and hand-washing behaviors.
Findings from this study provide insight into the potential
use of self-efficacy-based intervention in the Malaysian
school canteen setting. Some of the techniques used in
the intervention, i.e., hands-on interactive training, verbal
persuasion, and allocated practice time, could be incorporated
into the compulsory food handler training program.
Even though the number of participants that use soap
and follow the 7-step hand-washing technique increased
after intervention, there is room for improvement in the
hand-washing behavioral compliance score. In addition
to the intervention program, specific barriers that hinder
food handlers from performing hand washing need to be
addressed. Time barriers, highlighted in many studies, are not
something that can be set aside. This barrier can be reduced
by providing adequate manpower and resources to generate
a conducive environment for food handlers to perform food
safety practices.
The study is not without limitations. Direct observation
in school foodservice operations is an expensive, laborintensive,
and time-consuming method. Excessive time
was required for data collection and recruitment, not
forgetting the problem caused by the high turnover rate of
food handlers. The study took approximately 2 years, and
the contracts of most of the school canteen contractors
who participated in the study expired the same year. Thus, a
longer intervention period and postintervention follow-up
could not be carried out, and the long-term effectiveness of
the intervention remains uncertain. Future research should
conduct data collection on a time schedule that is compatible
with the duration of school canteen contracts to allow
evaluation of whether the positive changes in behavior will be
retained over a longer period.
In addition, the improvement is believed to be the result
of the use of multiple-component intervention strategies,
comprising on-site food safety training and a self-efficacy
building program. Because the effect of the intervention was
measured as a whole, the specific impact of implementing
the self-efficacy program alone could not be established. It is
recommended that future study include a third (food safety
training only) and fourth treatment group (self-efficacy
building program only) to determine the specific effect of
each treatment.
All the schools that participated in the study are nationally
funded schools that are run by small-scale family businesses.
Due to the low number of food handlers per school (from
four to nine), many supervisors and owners are the main
chefs on the premises and are equally involved in food preparation,
service, and cleaning. Due to the nature of operations
in Malaysian school foodservice, the participants comprised
both supervisor-owners and operators. Future studies could
investigate the effect of intervention on different groups, i.e.,
operators and supervisors.
Lastly, use of video-recording technology is recommended
to overcome some of the limitations of the direct-observation
method, such as the possibility of the Hawthorne effect.
Despite the limitations noted, this study is a pioneering work
that provides essential information on the use of self-efficacybased
educational intervention in school foodservice.
ACKNOWLEDGMENTS
The research work was funded by Malaysia Research
University Network (MRUN-5539144). Ethics approval was
obtained from the Ethics Committee for Research Involving
Human Subject, Universiti Putra Malaysia. Special thanks
to the Ministry of Education Malaysia, State Education
Department, and school authorities for allowing this study to
be conducted in schools. The authors are also thankful to all
the participants for participating in the study.
APPENDIX A. SUPPLEMENTARY MATERIAL
Appendix - shows the Food safety observation form
related to this article.
January/February Food Protection Trends
17
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