Use the 4-step process (STEP 1. General/Worldview of the problem Area, STEP 2: The Specific Problem Area and the Problem, STEP 3: The Gap the Research Intends to Address, STEP 4: Researcher's Intuition) to write a problem statement.

Proper food safety training is essential to decrease incidences and overall rates of foodborne illnesses and outbreaks. Though many commercial restaurants should provide proper food safety training to food handler employees, this training is not always offered or effective. Here, we summarize the results of a primary literature study concerning the effectiveness of food safety training in commercial settings. The literature chosen for review contained only studies with experimental food safety training, with before and after training data. Through evaluation of these studies, the best practice for ensuring effective training and follow-through were the use of food safety training programs, which incorporated both knowledge and behavior-based training.

Practical Application

Food safety managers in food service establishments may consider reevaluating their current food safety training program to incorporate behavioral-based food safety training in addition to knowledge-based training.

Introduction

Though proper handwashing techniques, sanitation procedures, time-temperature requirements for foods, and other food safety training topics are all important issues in the restaurant industry, foodborne illnesses still prove to be a major problem in the United States. The Centers for Disease Control and Prevention (CDC) estimates 48 million people get sick, 128,000 hospitalized, and 3,000 die from a foodborne illness each year (CDC, 2018). Over three-quarters of these cases are attributed to improper food handling by restaurant food handlers (Almanza & Nesmith, 2004; Yu, Neal, Dawson, & Madera, 2018).

A significant percentage of outbreaks is traced back to restaurants; according to the CDC, 59% of foodborne disease outbreaks involved food service establishments (Adesokan, Akinseye, & Adesokan, 2015; CDC, 2011). The CDC identified five major risk factors in food service that are common sources of foodborne outbreaks: contaminated equipment, food from unsafe sources, improper holding times and temperature, inadequate cooking, and poor personal hygiene (FDA, 2009; Murphy, Kock, & Lee, 2011). All these risk factors come from human error and behavior and can be prevented through proper safety training.

Restaurant industry sales are continuing to rise, making food safety more important than ever for restaurants (Jones & Angulo, 2006). The restaurant industry has increased its sales by 26.5% from 2010 and is continually rising. In 2017, the National Restaurant Association reported industry sales of almost $800 billion (National Restaurant Association, 2017). This shows that the restaurant business is a very dynamic and ever-growing industry and food safety must be a top priority for these establishments (Jones & Angulo, 2006; Jones & Yackley, 2018).

Food handlers work with unpackaged food, food equipment or utensils, or with any surface where unwrapped food is stored (Washington State Department of Health), therefore are vital to food safety during the food service (Zanin, De Rosso, & Stedefeldt, 2017). Any level of mishandling food can play a large role in the occurrence of foodborne outbreaks. It is critical that food handlers be trained properly, to increase food safety, and to contribute to long-term benefits within the food industry (Egan, Grubb, Lumbers, & Adams, 2007). In the study reported by Hillers, Medeiros, Kendall, Chen, and DiMascola (2003), food safety experts identified food handler behaviors that will reduce incidence of foodborne pathogens. Keeping foods at safe temperatures, using a thermometer correctly to ensure food reaches proper temperature, and proper handwashing are all behaviors that can reduce exposure to pathogens such as Bacillus cereus, Clostridium perfringens, Campylobacter jejuni, Salmonella species, and Escherichia coli (Hillers etal., 2003). Because a significant percentage of foodborne illness has been traced back to improper food handler behavior (Roberts etal., 2008), proper education and training of food handlers is critical to help reduce outbreaks.

However, the fact remains that while many restaurants are employing various efforts to ensure food safety, people are still getting sick daily. Properly trained food handlers can minimize foodborne outbreaks (Yu etal., 2018) by gaining knowledge and skills that protect the public and themselves from foodborne illnesses. Because we continue to see the same problems repeatedly, it is important to determine the efficacy of food safety training, explore food handler behavior and attitudes, and explore ways to improve the food safety training system.

There may be various reasons for ineffective employee training. The theory behind most food safety training programs is that an increase of knowledge of food safety measures will result in improved behavior. Previous findings suggest that although food safety training might increase knowledge, it may not always translate to improved behavior (Adesokan etal., 2015; Seaman & Eves, 2006; Zanin etal., 2017). Training focuses on the presentation of science-based facts with an assessment or certification given to prove the food handler's knowledge is appropriate. This training is often conducted over a short time, without providing an opportunity to physically implement best practices and with limited reinforcement. Training is often narrow in focus and may be missing factors that influence behavior. Only focusing on facts and knowledge may not be enough to influence behavior (Chang, Lee, & Kwak, 2003) because it is often difficult to translate knowledge and theory into improved behavior (Yu etal., 2018). As knowledge of people and behavior evolves, so should training and education.

Studies have shown that there is a difference between the actual knowledge of proper food handling and the behavior exhibited by food handlers (Toku, Berberolu, & Dedeler, 2009). This problem may come from the presentation of the training material, quality of training materials, or effectiveness of the training material. Here, we analyze and discuss the results of our study on published results of food safety training, and the effects of different training methods on knowledge and behavior.

Methods

To evaluate the efficacy of food safety training programs, a review of current literature was conducted. Literature on the effect of food safety training on food handler behavior was found using the Washington State University (WSU) Library database, which can be found here: www.wsulibs.wsu.edu. Keywords and key phrases used in the search function included a combination of "food safety" or "training" or "intervention" or "practice" or "behavior" or "transference" or "effects" or "food handler."

The results were scientific articles exclusively from peer-reviewed journals. The search covered the publication years from 2000 to 2017. Literature was narrowed by the relevance of the article abstract. Selected articles were compiled and then grouped by category for data organization. Relevant data were noted, compiled, and organized into tables.

Results were narrowed down to those that provided experimental safety training. For the evaluation of food safety training and behavior, only experimental studies reporting before and after training data were chosen. This was to clearly show the before and after effects of the specific intervention strategy and how effective each strategy was in affecting food handler knowledge and behavior. Most of the experimental studies included data from employing a training seminar for a group and then measure the before and after effects. These studies included food handler behavior from all over the world and in different areas of food service.

Results

Six studies were chosen that met the desired criteria. Table1 outlines the specific study, country, number of participants, type of training intervention, measurement of knowledge and behavior changes, and a summary of conclusions from each study. Because few studies were found regarding this topic in the United States, studies throughout the world were included that had the same basic training design and methods. The training intervention each study employed was based on standardized guides and regulations specific to the country. Knowledge was measured using a quiz (or questionnaire). Behavior was measured either by researcher observational practices or by self-reported practices.