title: Meta-analysis of food safety training on hand hygiene knowledge and attitudes among food handlers.
abstract: 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.
authors.affiliation: School of Agriculture, Royal Agricultural College, Cirencester, Gloucestershire GL7 6JS, UK. janmei.soon@student.rac.ac.uk
authors.forename: Jan Mei
authors.initials: JM
authors.lastname: Soon
authors.forename: Richard
authors.initials: R
authors.lastname: Baines
authors.forename: Phillip
authors.initials: P
authors.lastname: Seaman
mesh_terms: D005511:Food Handling / Q000379:methods* / Q000592:standards*; D059022:Food Safety; D005522:Food Services / Q000592:standards*; D006235:Hand Disinfection; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D010559:Personnel Management / Q000592:standards; D000078329:Workforce