DEVELOPMENT OF INTERVENTIONS TO IMPROVE FOOD HANDLERS HAND WASHING PRACTICES IN SELECTED SCHOOL CANTEENS IN
THE KLANG VALLEY, MALAYSIA
IZZAH AZ ZAHRA BINTI AHMAD
FSTM 2019 23
DEVELOPMENT OF INTERVENTIONS TO IMPROVE FOOD HANDLERS
HAND WASHING PRACTICES IN SELECTED SCHOOL CANTEENS IN
THE KLANG VALLEY, MALAYSIA
By
IZZAH AZ ZAHRA BINTI AHMAD
Thesis Submitted to the School of Graduate Studies, Universiti Putra Malaysia,
in Fulfilment of the Requirements for the Degree of Master of Science
January 2019
© COPYRIG
HT UPM
All material contained within the thesis, including without limitation text, logos,
icons, photographs and all other artwork, is copyright material of Universiti Putra
Malaysia unless otherwise stated. Use may be made of any material contained within
the thesis for non-commercial purposes from the copyright holder. Commercial use
of material may only be made with the express, prior, written permission of
Universiti Putra Malaysia
Copyright © Universiti Putra Malaysia
© COPYRIG
HT UPM
i
Abstract of thesis presented to the Senate of Universiti Putra Malaysia in fulfilment
of the requirement for the degree of Master of Science
DEVELOPMENT OF INTERVENTIONS TO IMPROVE FOOD HANDLERS
HAND WASHING PRACTICES IN SELECTED SCHOOL CANTEENS IN
THE KLANG VALLEY, MALAYSIA
By
IZZAH AZ ZAHRA BINTI AHMAD
January 2019
Chairman: Ungku Fatimah Ungku Zainal Abidin, PhD
Faculty: Food Science and Technology
In Malaysia, most of the reported cases of food poisoning occurred in public school
canteen and because of that various efforts are made by Malaysian government to
improve food safety practice in school canteen. However, despite the efforts the
number of food poisoning cases still reported today. The food handlers in the
institutional foodservice such as public school canteen must follow the proper food
safety practice to prevent the outbreak of foodborne diseases. Addressing the hand
washing practices is one way to improve food safety practices. It has been reported
by prior studies that food handlers in Malaysia have low compliance rate of hand
washing practices. And, there are lack of intervention studies to improve food
handlers hand washing practices especially in Malaysia. Most of food safety
intervention studies more focused on knowledge, although there are many possible
factors beyond knowledge that affecting food safety practices. Therefore, the main
objectives in this study is to develop hand washing intervention based on factors that
affecting food handlers hand washing practices. Among others the objectives in this
study is to elicit the beliefs of hand washing practices among food handlers and to
identify specific factors that influence their hand washing practices. To achieve the
objectives, this study employed mixed-methods approach which involved phase one
and phase two. In the Phase One, a series of seven focus group discussions were held
with food handlers from school canteen to assess food handlers’ beliefs on the hand
washing practices at their workplace. The guide questions based on The Theory of
Planned Behavior was employed during focus group discussion and the themes
emerged were categorized according to the theory framework. Next, phase two
involved survey and development of intervention. Findings from focus group
discussion were used in survey instrument development. Then, a survey was
conducted with 83 food handlers from public school canteen. The PLS-SEM
analysed of survey revealed that only subjective norm significantly and positively
predicts the food handlers’ intention to perform proper hand washing practices based
on the path coefficient of 0.748 (p<.001). These suggests that food handlers’
subjective norms (e.g. manager, school administration, customer, co-worker, health
© COPYRIG
HT UPM
ii
officer) positively influence the food handlers hand washing practices. The
development of intervention was continued afterward by incorporated the subjective
norm factor and feedback performances was developed as main intervention with the
integration of poster reminder and installation of soap and paper towel dispensers.
The effectiveness of interventions was measured through the direct observation of
food handlers hand washing practices in control group and intervention group during
pre and post observation. The results of interventions do not significantly improve
the hand washing compliance rate of food handlers. This could be due to various
factors that affect interventions such as the way feedback performance were given,
habit of food handlers and absent or lack of food safety culture in food handlers’
workplace. Although the implemented interventions do not improved hand washing
compliance rate among food handlers, the finding still provides a valuable
information to the management of school canteen, school administration and public
authorities in their efforts to improved food safety practice in general and hand
washing practices.
© COPYRIG
HT UPM
iii
Abstrak tesis yang dikemukakan kepada Senat Universiti Putra Malaysia sebagai
memenuhi keperluan untuk ijazah Master Sains
PEMBANGUNAN INTERVENSI BAGI MENINGKATKAN AMALAN-
AMALAN MENCUCI TANGAN PENGENDALI MAKANAN DI KANTIN-
KANTIN SEKOLAH TERPILIH DI LEMBAH KLANG, MALAYSIA
Oleh
IZZAH AZ ZAHRA BINTI AHMAD
Januari 2019
Pengerusi: Ungku Fatimah Ungku Zainal Abidin, PhD
Fakulti: Sains dan Teknologi Makanan
Di Malaysia, kebanyakan laporan kes keracunan makanan berlaku di kantin sekolah
awam dan oleh kerana itu pelbagai usaha dilaksanakan oleh kerajaan Malaysia untuk
meningkatkan amalan keselamatan makanan di kantin sekolah. Namun begitu kes
keracunan makanan masih banyak dilaporkan sehingga hari ini. Pengendali makanan
yang bekerja didalam institusi perkhidmatan makanan seperti kantin sekolah awam
mesti mengikut amalan keselamatan makanan yang betul untuk mencegah penyakit
wabak makanan. Menekankan amalan mencuci tangan dengan betul adalah salah satu
cara untuk meningkatkan amalan keselamatan makanan. Kajian terdahulu
melaporkan bahawa pengendali makanan di Malaysia mempunyai kadar pematuhan
yang rendah terhadap amalan mencuci tangan. Dan terdapat juga kekurangan kajian
intervensi bagi memperbaiki amalan mencuci tangan oleh pengendali makanan
terutamanya di Malaysia. Kebanyakan kajian intervensi bagi keselamatan makanan
lebih tertumpu kepada pengetahuan, walaupun terdapat banyak faktor selain
pengetahuan yang boleh mempengaruhi amalan keselamatan makanan. Oleh itu,
matlamat utama dalam kajian ini adalah membangunkan intervensi terhadap amalan
mencuci tangan berdasarkan faktor-faktor yang mempengaruhi amalan mencuci
tangan pengendali makanan. Selain itu, objektif lain dalam kajian ini adalah untuk
mendapatkan kepercayaan amalan mencuci tangan di kalangan pengendali makanan
dan mengenal pasti faktor-faktor tertentu yang mempengaruhi amalan mencuci
tangan mereka. Bagi mencapai objektif berikut, kajian ini menggunakan kaedah
pendekatan campuran berturutan yang melibatkan fasa pertama dan fasa kedua.
Dalam fasa pertama tujuh siri perbincangan kumpulan fokus telah diadakan dengan
pengendali makanan dari kantin sekolah untuk menilai kepercayaan mereka terhadap
amalan mencuci tangan di tempat kerja. Soalan panduan berdasarkan Teori Panduan
Perilaku Tingkah Laku Yang Dirancang telah digunakan semasa perbincangan
kumpulan fokus dan tema yang muncul daripada kumpulan fokus dikategorikan
mengikut kerangka teori (Teori Panduan Perilaku Tingkah Laku Yang Dirancang).
Seterusnya, fasa kedua melibatkan kajian soal selidik dan pembangunan intervensi.
Penemuan daripada perbincangan kumpulan fokus digunakan bagi pembangunan
© COPYRIG
HT UPM
iv
instrument kajian soal selidik. Kemudian, kajian soal selidik dijalankan dengan 83
pengendali makanan dari kantin sekolah awam. Perisian PLS-SEM yang digunakan
untuk menganalisa kajian soal selidik mendedahkan hanya norma subjektif yang
signifikan dan positif dalam meramalkan niat pengendali makanan untuk
melaksanakan amalan mencuci tangan yang betul (0.748 (p <.001)). Ini menunjukkan
bahawa norma subjektif untuk pengendali makanan (Pengurus, pentadbiran sekolah,
pelanggan, rakan sekerja, pegawai kesihatan) secara positif mempengaruhi amalan
pencuci tangan pengendali makanan. Seterusnya, intervensi dibangunkan dengan
memasukkan faktor norma subjektif dan laporan prestasi maklum balas digunakan
sebagai intervensi utama dengan mengabungkan poster peringatan dan memasang
sabun dan tisu kertas dispenser. Keberkesanan intervensi diukur melalui pemerhatian
secara langsung amalan mencuci tangan oleh pengendali makanan dalam kumpulan
kawalan dan kumpulan intervensi sebelum dan selepas pemerhatian. Keputusan
daripada intervensi tidak dapat meningkatkan pematuhan amalan mencuci tangan
pengendali makanan secara signifikan. Perkara ini mungkin disebabkan oleh
pelbagai faktor yang memberi kesan kepada intervensi sebagai contoh cara memberi
maklumbalas, kebiasaan pengendali makanan dan tiada budaya keselamatan
makanan di tempat kerja pengendali makanan. Walaupun intervensi yang
dilaksanakan tidak meningkatkan kadar pematuhan mencuci tangan di kalangan
pengendali makanan, hasil kajian memberikan keputusan yang berharga kepada
pengurusan kantin sekolah, pentadbiran sekolah dan pihak berkuasa awam dalam
usaha untuk meningkatkan amalan keselamatan makanan secara keseluruhandan
amalan mencuci tangan secara khusus.
© COPYRIG
HT UPM
v
ACKNOWLEDGEMENTS
In the name of Allah, Most Gracious, Most Merciful. May the blessing of Allah fill
all the life of people surround me with happiness and peace in this world and in the
afterlife.
First, I would like to express my immense gratitude to my families for their love,
support, encouragement and prayer throughout the research and writing of this
master thesis. For my mother, my ummi and kak yah, thank you so much for all the
love that you all have showered on me. May Allah SWT have mercy upon them and
grant them all the highest ranks of Jannah. To my Abah (Ahmad bin Abdul Rahman),
may Allah SWT bless you with a good health and abundance of happiness in this
dunya and akhirah. I am very fortunate and grateful to my sisters and brothers for
their prayer and support. May Allah SWT bless all of you with good health,
prosperity and endless happiness in this dunia and akhirah. To my wonderful nieces
and nephew, please stay healthy, cute and happy!
Next, I would like to express the deepest appreciation to the people who have
supported and helped me throughout this learning journey. First and foremost, I owe
my deepest gratitude to my supervisor, Dr Ungku Fatimah Ungku Zainal Abidin. Her
valuable guidance, advice, continuous support and consideration helped me in all
time of research and writing of this thesis. As supervisor, she has taught me
incredible lesson as researcher and person. I am highly indebted to her. Besides, I
give deep thanks to the members of my supervisory committee, Dr Nor Ainy and Dr
Noor Khaizura for all of their advice and insightful comment I am extremely grateful
to have all of them as my mentors during this learning journey. Last but not least,
special and heartfelt thanks to all my friends for their constant love and support.
© COPYRIG
HT UPM
© COPYRIG
HT UPM
vii
This thesis was submitted to the Senate of Universiti Putra Malaysia and has been
accepted as fulfilment of the requirement for the degree of Master of Science. The
members of the Supervisory Committee were as follows:
Ungku Fatimah Ungku Zainal Abidin, PhD
Senior Lecturer
Faculty of Food Science and Technology
Universiti Putra Malaysia
(Chairman)
Nor Ainy Mahyudin, PhD
Associate Professor
Faculty of Food Science and Technology
Universiti Putra Malaysia
(Member)
Khaizura Mahmud @ Ab Rashid, PhD
Senior Lecturer
Faculty of Food Science and Technology
Universiti Putra Malaysia
(Member)
______________________________
ROBIAH BINTI YUNUS, PhD
Professor and Dean
School of Graduate Studies
Universiti Putra Malaysia
Date:
© COPYRIG
HT UPM
viii
Declaration by graduate student
I hereby confirm that:
• this thesis is my original work;
• quotations, illustrations and citations have been duly referenced;
• this thesis has not been submitted previously or concurrently for any other
degree at any other institutions;
• intellectual property from the thesis and copyright of thesis are fully-owned by
Universiti Putra Malaysia, as according to the Universiti Putra Malaysia
(Research) Rules 2012;
• written permission must be obtained from supervisor and the office of Deputy
Vice-Chancellor (Research and Innovation) before thesis is published (in the
form of written, printed or in electronic form) including books, journals,
modules, proceedings, popular writings, seminar papers, manuscripts, posters,
reports, lecture notes, learning modules or any other materials as stated in the
Universiti Putra Malaysia (Research) Rules 2012;
• there is no plagiarism or data falsification/fabrication in the thesis, and scholarly
integrity is upheld as according to the Universiti Putra Malaysia (Graduate
Studies) Rules 2003 (Revision 2012-2013) and the Universiti Putra Malaysia
(Research) Rules 2012. The thesis has undergone plagiarism detection software.
Signature: ________________________ Date: __________________
Name and Matric No.: Izzah Az Zahra Ahmad (GS41526)
© COPYRIG
HT UPM
ix
Declaration by Members of Supervisory Committee
This is to confirm that:
• the research conducted and the writing of this thesis was under our supervision;
• supervision responsibilities as stated in the Universiti Putra Malaysia (Graduate
Studies) Rules 2003 (Revision 2012-2013) are adhered to.
Signature:
Name of Chairman of
Supervisory
Committee:
Ungku Fatimah Ungku Zainal Abidin
Signature:
Name of Member of
Supervisory
Committee:
Nor Ainy Mahyudin, PhD
Signature:
Name of Member of
Supervisory
Committee:
Noor Khaizura Mahmud @ Ab Rashid, PhD
© COPYRIG
HT UPM
x
TABLE OF CONTENTS
Page
ABSTRACT i
ABSTRAK iii
ACKNOWLEDGEMENTS v
APPROVAL vi
DECLARATION viii
LIST OF TABLES xiv LIST OF FIGURES xv LIST OF ABBREVIATIONS xvi
CHAPTER
1 INTRODUCTION 1 1.1 Introduction 1 1.2 Background of Study 1
1.3 Problem Statement 4 1.4 Research Objectives 5 1.5 Significance of Study 5
1.6 Thesis Organization 5
2 LITERATURE REVIEW 7 2.1 Introduction 7
2.2 Foodservice Operations 7
2.2.1 Food safety in foodservice operations 9 2.2.2 Hand hygiene practice and hand washing practices
in foodservice operations 10
2.3 Factors that Influence Food Safety Practices in Foodservice
Industry 11 2.3.1 Food handlers’ characteristics 15 2.3.2 Food handlers’ knowledge 15 2.3.3 Attitude, beliefs, and motivation 16 2.3.4 Environment (infrastructure and resources) 17
2.3.5 Management 17 2.3.6 Policies and enforcement (at local, state, and federal levels) 18 2.3.7 Social norms 18
2.4 Factors that Influence Hand Washing Practices in
Foodservice Industry 19 2.4.1 Knowledge 19 2.4.2 Attitude, beliefs, and motivation 22
2.4.3 Environment (infrastructure and resources) 22 2.4.4 Management 23 2.4.5 Policies and enforcement 23 2.4.6 Social norms 23
2.5 Interventions for Improved Food Safety Practices 24 2.5.1 Food safety interventions on knowledge, attitude, and
practices 24
© COPYRIG
HT UPM
xi
2.5.2 Food safety interventions on behavior 27
2.6 Interventions for Improved Hand Washing Practices 27 2.7 Key Theories as Underlying Basis for Studies on Hand
Washing Practices 28
2.7.1 Theory of planned behavior (TPB) 29 Behavioral beliefs and attitude 30 Normative beliefs and subjective norms 30 Control beliefs and perceived behavioral control 30 Intention 31
The application of TPB in studies on food safety 31 2.7.2 Other social cognition models 32
Health belief model (HBM) 32 Health action process approach (HAPA) 32 The transtheoretical model (stages of change) 33
3 METHODOLOGY 34 3.1 Introduction 34 3.2 Research Design 34 3.3 Research Sample 35
3.4 Phase One 36 3.4.1 Focus group sample 37
3.4.2 Development of guiding questions for focus group
discussion 37 3.4.3 Data collection 38
3.4.4 Data coding and analysis 38 3.5 Phase Two 40
3.5.1 Questionnaire survey instrument 40 Generation of questionnaire survey items 40
Development of questionnaire constructs and
items 40
Sampling strategy 42
Distribution of questionnaire surveys 43 Data analysis 43
3.5.2 Development of hand washing intervention 44 Sample 45 Data collection (pre-observation and
post-observation) 45 Data analysis 47
4 RESULTS AND DISCUSSION 48 4.1 Introduction 48 4.2 Phase One: Results and Discussion 49
4.2.1 Demographic profile of focus group participants 49 4.2.2 Focus group discussion (themes) 51
Behavioral beliefs (Advantages and
disadvantages) 52 Control beliefs (Facilitators and barriers) 55 Normative beliefs 59
© COPYRIG
HT UPM
xii
4.3 Phase Two: Results and Discussion 61
4.3.1 Data screening 61 4.3.2 Demographic profile of participants in questionnaire survey 61 4.3.3 Analysis of questionnaire survey responses 63
Measurement model 64 Structural model 66
4.3.4 Questionnaire survey discussion 68 4.3.5 Demographic profile of intervention participants 71
The compliance rate of hand washing practices 73
The comparison between control group
and intervention group in pre-test and post-test 76 The compliance rate of seven-step procedure
of hand washing practices 76 4.3.6 The impact of intervention on hand washing practices
among food handlers 77 4.4 Chapter Summary 80
5 SUMMARY, CONCLUSION AND RECOMMENDATIONS
FOR FUTURE RESEARCH 81
5.1 Introduction 81 5.2 Summary of Findings 81
5.2.1 Objective 1: To elicit the beliefs on the hand washing
practices among food handlers at the school canteen 81 5.2.2 Objective 2: To identify the specific factors that influence
hand washing practices among food handlers 82 5.2.3 Objective 3: To develop the intervention to improve
hand washing practices among food handlers at the
school canteen 82
5.2.4 Objective 4: To evaluate the effectiveness of the
developed intervention on hand washing practices among
food handlers 82
5.3 Implications of Study 83 5.4 Limitations of Study and Recommendations for Future Research 84
5.5 Conclusion 86
REFERENCES 87 APPENDICES 101 BIODATA OF STUDENT 176
LIST OF PUBLICATIONS 177
© COPYRIG
HT UPM
xiii
LIST OF TABLES
Table Page
2.1 Facilitators and barriers that influence food safety practices in the
foodservice operations
12
2.2 Facilitators and barriers that influence hand washing practices in
the foodservice operations
20
2.3 Food safety interventions on knowledge, attitude, practices, and
behavior
25
3.1 (a) The number of schools, student enrolment, and teachers in 2016 36
3.1 (b) The number of schools, student enrolment, and teachers in Klang
Valley between 2015 and 2016
36
3.2 Phases of thematic analysis 39
3.3 Items of salient beliefs with respect to hand washing practices 41
4.1 Intrepretation of Cohen’ Kappa 49
4.2 Demographic profile of focus group participants 50
4.3 Emerging themes from the focus group discussions 51
4.4 Demographic profile of respondents in the questionnaire survey 62
4.5 Assessment of the measurement model 65
4.6 Discriminant validity (intercorrelations) of constructs 66
4.7 Results of hypotheses testing 69
4.8 Demographic profile of intervention participants 72
4.9 Compliance rate of hand washing practices for control group and
intervention group
74
4.10 Comparison of pre observation and post-observation of hand
washing compliance rates for control group and intervention
group.
75
4.11 The comparison between control group and intervention in pre-test
and post-test.
76
4.12 Total number of food handlers who performed seven-step
procedure of hand washing practices in control group and
intervention group
77
© COPYRIG
HT UPM
xiv
LIST OF FIGURES
Figure
Page
2.1 The Diversity of Foodservice Industry 8
2.2 Theory of Planned Behavior 30
3.1 Flowchart of Methodology 35
3.2 Local Municipalities in Greater Klang Valley 35
4.1 Intervention Process of Study 48
4.2 Research Model based on Theory of Planned Behavior 63
4.3 Structural Equation Model 67
© COPYRIG
HT UPM
xv
LIST OF ABBREVIATIONS
WHO World Health Organization
CDC Centers for Disease Control and Prevention
USD United States Dollar
MOH Ministry of Health
MOE Ministry of Education
DOSM Department of Statistics Malaysia
HACCP Hazard Analysis and Critical Control Points
HBM Health Belief Model
HAPA Health Action Process Approach
TPB Theory of Planned Behavior
TRA Theory of Reasoned Action
FDA US Food Drug and Administration
ECDC European Centre for Disease Prevention and Control
(ECDC)
EFSA European Food Safe Authority
NDSC National Disease Surveillance Centre
RTE Ready to Eat
FSQ Food Safety Quality
CAT Coding Analaysis Toolkit
IBM-SPSS International Business Machine - The Statistical Package for
the Social Sciences
PLS-SEM Path Least Square-Structural Equation Modeling
HOF Hand Washing Observation Form
AVE Average Variance Extracted
VIF The Variance Inflation Factor
HTMT Heterotrait-Monotrait Ratio of Correlations
ABIM Angkatan Belia Islam Malaysia
JAIN Jabatan Agama Islam Negeri
KEMAS Kemajuan Masyarakat
MARA The Majlis Amanah Rakyat
SMK Sekolah Menengah Kebangsaan
SKJC Sekolah Kebangsaan Jenis Cina
SKJT Sekolah Kebangsaan Jenis Tamil
SK Sekolah Kebangsaan
© COPYRIG
HT UPM
1
CHAPTER 1
INTRODUCTION
1.1 Introduction
This chapter presents the background of study on the implications of foodborne
diseases in the institutional foodservice, the importance of hand washing practices,
and the interventions to improve hand washing practices in reducing the outbreak of
foodborne diseases. This chapter also describes the problem statement, the objectives
of this study and significance of study. Thesis organization is presented at the end of
this chapter.
1.2 Background of Study
The foodborne diseases are the results of ingesting contaminated food, which
adversely affect both health and economic aspects. A substantial number of the
population is diagnosed with foodborne diseases every year. The World Health
Organization (WHO) estimated that one in every 10 people in an estimated
population of 600 million experiences illness with 420,000 death cases due to the
foodborne diseases annually. The foodborne diseases affect children (under the age
of five years) the most with almost one-third (30%) of the total death cases (WHO,
2015). Besides that, the African region demonstrates the highest susceptibility
towards foodborne diseases, which is followed by the Southeast Asia region;
meanwhile, the American and European regions have the lowest susceptibility
towards foodborne diseases (WHO, 2015).
There are various economic implications of foodborne diseases, which include health
treatment cost and the cost of food industry loss. In the US alone, approximately
USD 7 billion are expended annually to manage the outbreak of foodborne diseases
in the foodservice industry, which involves lawsuit or legal fees, notifying the
consumers, food recall, and compensating for the related damages (Hussain &
Dawson, 2013). The cost of the outbreak of foodborne diseases outweighs the cost of
preventive and control measures for the foodservice industry (Bartsch et al., 2018).
Despite the substantial economic and health implications, the foodservice operations
are accountable for the majority of the outbreak cases of foodborne diseases globally.
For example, the Centers for Disease Control and Prevention [CDC] (2017), reported
that 467 outbreak cases of foodborne diseases occurred in the US were associated
with restaurants.
With that, all food producers and foodservice operators are responsible to ensure that
the prepared food is safe for public consumption. The institutional foodservice (i.e.,
school, hospital childcare, and community service), which typically serves a large
group of vulnerable people (e.g., children, patients, and elders), has greater
responsibility in the food preparation for safe consumption. Moreover, most of the
© COPYRIG
HT UPM
2
cases of foodborne diseases in Malaysia occur in the education institutions. The
Ministry of Health (MOH) Malaysia reported 60 episodes of food positioning in
schools between 2015 and 2016 (April). In particular, 78.3% of the total episodes
occurred in the public schools and institutions under the Ministry of Education
(MOE) Malaysia, which increased from 30 cases in 2015 to 47 cases in 2016. There
are various ongoing efforts to address the outbreak of foodborne diseases, such as the
mandatory training for food handlers, the implementation of Guidebook for Safe
Food “(Buku Garis Panduan Makanan Selamat) and the enforcement of Food Act
1983 (Akta Makanan 1983), Food Regulations 1985 (Peraturan-Peraturan Makanan
1985), and Food Hygiene Regulations 2009 (Peraturan-peraturan Kebersihan
Makanan 2009) (Food Act 1983, 2016; MOE, 2019). Despite these various efforts,
the cases of food poisoning remain reported. For instance, three recent cases of food
poisoning, which involved 155 students from primary and secondary schools, were
reported in May, July, and August 2018 (Astro Awani, 2018; Bernama, 2018;
MyMetro, 2018).
Accordingly, the WHO (2006) identified five factors that contribute to the outbreak
of foodborne diseases, which included (1) inadequate cooking, (2) temperature
abuse, (3) contaminated utensils or equipment, (4) unsafe food sources, and (5) poor
personal hygiene. Meanwhile, prior studies identified poor personal hygiene as one
of the primary factors that contribute to foodborne diseases in the foodservice
industry (Chapman, Eversley, Fillion, Maclaurin, & Powell, 2010; Egan et al., 2007;
NDSC, 2004; Pellegrino, Crandall, O’Bryan, & Seo, 2015; Rajagopal & Strohbehn,
2013; Thaivalappil, Waddell, Greig, Meldrum, & Young, 2018; Yu, 2015).
Accordingly, the food handler in the foodservice industry who is directly involved in
the food preparation plays a key role in preventing the outbreak of foodborne
diseases given the potential risk of being the main carrier in the transmission of
pathogens, toxins, or chemicals to the prepared food. Therefore, the food handler’s
personal hygiene, especially their hand hygiene practice, is significantly important in
the foodservice industry—any hand hygiene malpractices can be a source of
infection that leads to the outbreak of foodborne diseases (Smigic et al., 2016).
The hand washing practices is essentially part of the hand hygiene practice.
Basically, the hand washing practices refers to the act of washing hands with water
and regular soap or antibacterial soap (WHO, 2009b). The hand washing practices is
an essential practice in the foodservice industry because hands are the primary
pathway of transmitting pathogens, toxins, or chemicals to the prepared food.
Despite that, prior studies highlighted that most food handlers do not apply proper
hand washing practices (Allwood et al., 2004; Pellegrino, Crandall, O’Bryan, et al.,
2015; Pellegrino, Crandall, & Seo, 2015). Besides that, Pragle et al. (2007) revealed
that majority of food handlers (68%) did not wash their hands and there were also
several food handlers that did not properly wash the soap residue off their hands
before preparing food. Strohbehn et al. (2008) also revealed that the retail
foodservice, such as assisted living (33%), restaurant (7%), childcare, and school,
also demonstrated similar trend of low compliance rate of hand washing practices
among the food handlers. Similarly, majority of the food handlers (88%) in Malaysia
failed to describe the proper procedure of hand washing practices despite being the
© COPYRIG
HT UPM
3
most familiar and widely recognized practice among these food handlers (Tan,
Cheng, Soon, Ghazali, & Mahyudin, 2013).
Most studies on food safety identified education through training, specifically the
dissemination of knowledge on food safety, as the key element to enhance the food
safety practices in the foodservice industry. Apart from attitude and behavior, studies
on improving the food safety practices in Malaysia also focused on the training
aspect (Siow & Sani, 2011; Lee et al., 2012; Aziz & Dahan, 2013; Saad et al., 2013;
Tan, Bakar, et al., 2013; Tan, Cheng, et al., 2013; Abdullah Sani & Siow, 2014;
Rosmawati et al., 2015; Siau, 2015; Nik Husain et al., 2016; Woh et al., 2016).
However, the findings on the effects of training on food safety remain inconclusive
despite substantially explored in prior studies. Clayton, Griffith, Price, and Peters
(2002) revealed that 95% of the total participants (N = 137), specifically the
foodservice employees, received training on food safety, but 63% admitted to not
practicing safe food handling procedure. Besides that, Soon et al. (2012) conducted a
meta-analysis on the effectiveness of training on food safety and intervention on
hand hygiene practice, which revealed that the knowledge score on hand hygiene
practice increased following the completion of training, but the motivation to
practice good hand hygiene practice was not warranted. In other words, the
knowledge gained through training on food safety does not necessarily translate to
the actual practice (Arendt & Sneed, 2008), which was also supported by prior
studies (Green et al., 2007; Pragle et al., 2007). With respect to the factors that
influence the food handlers’ hand hygiene practice or hand washing practices, Green
et al. (2007) identified the type of activity at the workplace, the number and location
of sinks, and the availability of supplies and, Pragle et al., (2007), identified time
pressure and, inadequate facilities and supplies. Accordingly, both studies (Green et
al., 2007; Pragle et al., 2007) propounded the need for multidimensional or multiple-
components intervention to address various factors that influence the food handlers’
hand hygiene practice to improve the overall food safety practice. In addition,
Mitchell et al. (2007) emphasized the need to address both individual and contextual
factors that influence food safety practice in order to effectively transform the food
handlers’ behavior.
With that, prior studies applied various social cognition models, such as health belief
model (HBM) (Clayton & Griffith, 2008) and health action process approach
(HAPA) (Reyes, Lippke, Knoll, Blanca Moya, & Schwarzer, 2015), to identify these
factors that influence the hand hygiene practice. Accordingly, there are also other
studies that applied the theory of planned behavior (TPB) as the underlying
theoretical framework to predict the intention of performing food safety practice
(Clayton, 2004; Roberts & Barrett, 2011; Bai et al., 2014; Mullan et al., 2015).
(York, Brannon, Shanklin, Roberts, Barrett, et al., 2009) revealed that the single
application of either the theory of planned behavior (TPB) intervention or training on
food safety improves the food handlers’ food safety practices, but a combined
strategy of both the theory of planned behavior (TPB) intervention and training was
found to be the most effective intervention to address the barriers and improve the
food handlers’ food safety practices (i.e., hand washing practices and the use of
thermometer). The study generally demonstrated the potential of the theory of
planned behavior (TPB) in the prediction and intervention of food safety practices.
© COPYRIG
HT UPM
4
1.3 Problem Statement
The foodborne diseases are of major public health concern globally and Malaysia is
of no exception. The transmission of pathogens, toxins, or chemicals to the prepared
food can be drastically minimized when the food handlers apply proper food safety
practices, especially hand washing practices. Moreover, the foodservice industry,
especially the institutional foodservice, serves vulnerable people, such as children,
patients, and elders. It is essential that the food handlers in the institutional
foodservice perform proper hand washing practices prior to preparing food for these
individuals with weaker immune system. These food handlers are responsible to
ensure that the prepared food is safe for consumption, and their hand washing
practices plays a key role in preventing the outbreak of foodborne diseases.
The reported cases of food poisoning in Malaysia mostly occur in schools (of both
primary and secondary schools). Addressing that, the Malaysian government has
implemented various strategies to address the outbreak of food poisoning, such as
regular inspection of the school canteens and kitchens at boarding schools, the
implementation of mandatory training for food handlers, the introduction of
regulatory guidelines (e.g., Guidebook for Safe Food [Buku Garis Panduan Makanan
Selamat] and Self Examination Program [Program Pemeriksaan Sendiri KENDIRI],
and the enforcement of legislations and regulations (e.g., Food Act 1983 (Akta
Makanan 1983), Food Regulations 1985 (Peraturan-peraturan Makanan 1985), and
Food Hygiene Regulations 2009 (Peraturan-peraturan Kebersihan Makanan 2009))
(Food Act 1983, 2016; MOE, 2019). However, the cases of food poisoning in
schools remain reported, such as the recent case that involved 103 MARA students in
August 2018 (MyMetro, 2018). The hand washing practices is an integral aspect that
should be critically addressed to prevent such outbreak. Unfortunately, the food
handlers in Malaysia do not perform proper hand washing practices (Tan, Bakar, et
al., 2013; Tan, Cheng, et al., 2013).
Therefore, it is pivotal to address potential factors beyond the food safety
knowledge, such as environmental, motivational, personal, and social factors, in
order to prevent the outbreak of foodborne diseases and to induce proper hand
washing practices among food handlers. As highlighted in prior studies, solely
depending on food safety training does not effectively improve or sustain the food
handlers’ hand washing practices. This study expected to identify significant factors
that improve hand washing practices as the basis for strategic intervention
development. Furthermore, most studies on food safety in Malaysia focused on
knowledge, attitude, and behavior as well as the microbial assessment. To date,
studies on identification of multifaceted factors that influence food handlers’ hand
washing practices remain scarce.This suggests that there are even fewer interventions
that are developed based on the multifaceted factors that influence hand washing
practices, especially among food handlers at the school canteens in Malaysia.
© COPYRIG
HT UPM
5
1.4 Research Objectives
This study generally aimed to develop an intervention to improve hand washing
practices among food handlers at the public school canteens in Malaysia. The
specific objectives of this study are presented in the following:
1) To elicit the beliefs on the hand washing practices among food handlers at the
school canteen;
2) To identify the specific factors that influence hand washing practices among food
handlers;
3) To develop the intervention to improve hand washing practices among food
handlers at the school canteen;
4) To evaluate the effectiveness of the developed intervention on hand washing
practices among food handlers.
1.5 Significance of Study
With respect to the objectives of this study, this study focused on the public school
canteens across three states in Malaysia. This study extended the existing knowledge
base on food safety within the Malaysian context. The identified factors that
influence hand washing practices in this study established the basis for the
development of an effective intervention to improve the hand washing practices
among food handlers at public school canteens in Malaysia. Besides that, this study
extended the research prospects of hand washing practices given the
multidimensionality of the identified factors in this study. Adding to that, the
findings of this study contributed to the development of future interventions for the
management of school canteen (especially for the canteen manager or canteen
owner), school administration, and the public health authorities. After all, the
management of the school canteen is legally responsible for the health and safety of
students by preparing food that are safe for consumption. Thus, it is imperative that
the canteen managers or canteen owners fully comprehend the challenges and factors
that influence the food safety practices among food handlers. The findings of this
study were also expected to assist the management of the school canteen in their
efforts to enhance their strategies to promote food safety practices. Moreover, this
study was also expected to facilitate the school administration in advancing their
inspection programs and other strategies to monitor the management of the school
canteen. In addition, this study also contributed significant findings for the
management of public health authorities in their efforts to improve their existing
programs, policies, and other regulations on food safety among food handlers at the
school canteens.
1.6 Thesis Organization
Overall, this thesis consists of five chapters, which is organized as follows:
Chapter One presented the background of this study on the outbreak of foodborne
diseases globally, including Malaysia. This chapter also described the problem
statement, which addressed the existing cases of food poisoning, low compliance rate
of hand washing practices among food handlers, and limited studies on the factors
that influence food safety practices, especially in Malaysia.
© COPYRIG
HT UPM
6
Chapter Two reviews related literature on the definitions of foodservice industry
and food safety in the foodservice industry. This chapter also subsequently discusses
the hand hygiene practice and hand washing practices. Besides that, this chapter also
reviews various factors and interventions that influence food safety practice,
including hand washing practices. Additionally, this chapter also reviews the adopted
theories in prior studies on food safety.
Chapter Three describes the methodology of this study. This study specifically
employed a mixed-methods approach. This chapter proceeds to describe the two
phases of data collection in this study. This chapter also discusses how this study
analyzes the obtained data in Phase One and Phase Two.
Chapter Four discusses the obtained results of Phase One and Phase Two, namely
the results of focus group discussion and questionnaire survey, with respect to the
objectives of this study.
Chapter Five summarizes the major findings of this study. This chapter also
presents the limitations of study and recommendations for future research.
© COPYRIG
HT UPM
87
REFERENCES
Abdul-Mutalib, N. A., Mohammad Faid, A.-R., Shuhaimi, M., Syafinaz, A.-N.,
Rukman Awang, H., & Malina, O. (2012). Knowledge, attitude and practices
regarding food hygiene and sanitation of food handlers in Kuala Pilah,
Malaysia. Food Control, 27, 289–293.
http://doi.org/10.1016/j.foodcont.2012.04.001
Abdullah Sani, N., & Siow, O. N. (2014). Knowledge, attitudes and practices of food
handlers on food safety in food service operations at the Universiti Kebangsaan
Malaysia. Food Control, 37(1), 210–217.
http://doi.org/10.1016/j.foodcont.2013.09.036
Acocella, I. (2012). The focus groups in social research: Advantages and
disadvantages. Quality and Quantity, 46(4), 1125–1136.
http://doi.org/10.1007/s11135-011-9600-4
Aguinis, H., Gottfredson, R. K., & Joo, H. (2012). Delivering effective performance
feedback: The strengths-based approach. Business Horizons, 55(2), 105–111.
http://doi.org/10.1016/j.bushor.2011.10.004
Ajzen, I. (1985). From Intentions to Actions: A Theory of Planned Behavior. In
Action Control (pp. 11–39). Berlin, Heidelberg: Springer Berlin Heidelberg.
http://doi.org/10.1007/978-3-642-69746-3_2
Ajzen, I. (1991). The theory of planned behavior. Orgnizational Behavior and
Human Decision Processes, 50, 179–211. http://doi.org/10.1016/0749-
5978(91)90020-T
Ajzen, I. (2010). Constructing a theory of planned behavior questionnaire.
Biofeedback and Selfregulation, 17, 1–7. http://doi.org/10.1016/0749-
5978(91)90020-T
Ajzen, I., & Fishbein, M. (2004). Questions Raised by a Reasoned Action Approach:
Comment on Ogden (2003). Health Psychology, 23(4), 431–434.
http://doi.org/10.1037/0278-6133.23.4.431
Akta Makanan 1983 (Akta 281) & Peraturan-Peraturan (Hingga 10hb Mei 2016).
(2016). Kuala Lumpur: International Law Book Services.
Allwood, P. B., Jenkins, T., Paulus, C., Johnson, L., & Hedberg, C. W. (2004). Hand
washing compliance among retail food establishment workers in Minnesota.
Journal of Food Protection, 67(12), 2825–8. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/15633696
Almanza, B. A., & Ghiselli, R. (2016). Food safety : researching the hazard in
hazardous foods. Retrieved from
https://books.google.com.my/books/about/Food_Safety.html?id=MhAyAwAA
QBAJ&redir_esc=y
Alonso, A. D., & O’Neill, M. A. (2010). Exploring consumers images of open
restaurant kitchen design. Journal of Retail and Leisure Property, 9(3), 247–
259. http://doi.org/10.1057/rlp.2010.5
Andrew, S., & Halcomb, E. (2009). Mixed methods research for nursing and the
health sciences. Wiley-Blackwell Pub. Retrieved from
https://www.wiley.com/en-
my/Mixed+Methods+Research+for+Nursing+and+the+Health+Sciences-p-
9781405167772
Arendt, S. W., Ellis, J. D., Strohbehn, C., & Paez, P. (2011). Development and use of
an instrument to measure retail foodservice employees’ motivation for
following food safety practices. Journal of Foodservice Business Research,
© COPYRIG
HT UPM
88
14(1), 68–85. http://doi.org/10.1080/15378020.2011.548227
Arendt, S. W., & Sneed, J. (2008). Employee motivators for following food safety
practices: Pivotal role of supervision. Food Protection Trends.
Arendt, S. W., Strohbehn, C., & Jun, J. (2015). Motivators and barriers to safe food
practices: Observation and interview. Food Protection Trends, 35(5), 365–376.
Astro Awani. (2018). 31 pelajar MRSM Taiping keracunan makanan, dipercayai
lepas jamah soto. Retrieved from http://www.astroawani.com/berita-
malaysia/31-pelajar-mrsm-taiping-keracunan-makanan-dipercayai-lepas-jamah-
soto-180318
Aziz, S. A. A., & Dahan, H. M. (2013). Food Handlers’ Attitude towards Safe Food
Handling in School Canteens. Procedia - Social and Behavioral Sciences, 105,
220–228. http://doi.org/10.1016/j.sbspro.2013.11.023
Azjen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social
behavior. Englewood Cliffs, NJ: Prentice-Hall.
Bai, L., Tang, J., Yang, Y., & Gong, S. (2014). Hygienic food handling intention. An
application of the Theory of Planned Behavior in the Chinese cultural context.
Food Control, 42, 172–180. http://doi.org/10.1016/j.foodcont.2014.02.008
Barjaktarović-Labović, S., Mugoša, B., Andrejević, V., Banjari, I., Jovićević, L.,
Djurović, D., … Radojlović, J. (2017). Food hygiene awareness and practices
before and after intervention in food services in Montenegro. Food Control, 85,
466–471. http://doi.org/10.1016/j.foodcont.2017.10.032
Bartsch, S. M., Asti, L., Nyathi, S., Spiker, M. L., & Lee, B. Y. (2018). Estimated
cost to a restaurant of a foodborne illness outbreak. Public Health Reports,
XX(X), 1–13. http://doi.org/10.1177/0033354917751129
Berg, B. L., & Lune, H. (2012). Qualitative research methods for the social sciences.
N.J: Pearson Upper Saddle River.
Bernama. (2018). 21 pelajar SK Jabi keracunan makanan. Retrieved from
http://www.bernama.com/state-news/beritabm.php?id=1590382
Besieux, T. (2017). Why I hate feedback: Anchoring effective feedback within
organizations. Business Horizons, 60(4), 435–439.
http://doi.org/10.1016/j.bushor.2017.03.001
Birnbach, D. J., Rosen, L. F., Fitzpatrick, M., Everett-Thomas, R., & Arheart, K. L.
(2017). A ubiquitous but ineffective intervention: Signs do not increase hand
hygiene compliance. Journal of Infection and Public Health, 10(3), 295–298.
http://doi.org/10.1016/j.jiph.2016.05.015
Borges, J. A. R., Tauer, L. W., & Lansink, A. G. J. M. O. (2016). Using the theory of
planned behavior to identify key beliefs underlying Brazilian cattle farmers’
intention to use improved natural grassland: A MIMIC modelling approach.
Land Use Policy, 55, 193–203. http://doi.org/10.1016/j.landusepol.2016.04.004
Boyce, J. M., & Pittet, D. (2002). Guideline for Hand Hygiene in Health-Care
Settings: Recommendations of the Healthcare Infection Control Practices
Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task
Force. Infection Control & Hospital Epidemiology, 23(S12), S3–S40.
http://doi.org/10.1086/503164
Brannon, L. A., York, V. K., Roberts, K. R., Shanklin, C. W., & Howells, A. D.
(2009). Appreciation of food safety practices based on level of experience.
Journal of Foodservice Business Research, 12(2), 134–154.
http://doi.org/10.1080/15378020902910462
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative
Research in Psychology. Qualitative Research in Psychology, 3(2), 77–101.
© COPYRIG
HT UPM
89
http://doi.org/10.1191/1478088706qp063oa
Brehaut, J. C., Colquhoun, H. L., Eva, K. W., Carroll, K., Sales, A., Michie, S., …
Grimshaw, J. M. (2016). Practice feedback interventions: 15 suggestions for
optimizing effectiveness. Annals of Internal Medicine, 164(6), 435.
http://doi.org/10.7326/M15-2248
Burusnukul, P. (2011). Extending the theory of planned behaviour: Factors
predicting intentions to perform handwashing protocol in cross-cultural
foodservice settings. Texas Tech University. Retrieved from
https://repositories.tdl.org/ttu-ir/handle/2346/ETD-TTU-2011-05-1347
CDC, C. for D. C. and P. (2016). Hand hygiene through years: Posters. Retrieved
from https://www.cdc.gov/handhygiene/download/Hand_Hygiene_poster.pdf
CDC, C. for D. C. and P. (2017). Surveillance for foodborne disease outbreaks
United States, 2015 : Annual report. Atlanta Georgia.
CDC, C. for D. C. and P. (2018). Food safety. Retrieved from
https://www.cdc.gov/foodsafety/foodborne-germs.html
Chapman, B. J., Eversley, T., Fillion, K., Maclaurin, T., & Powell, D. (2010).
Assessment of food safety practices of food service food handlers (risk
assessment data): testing a communication intervention (evaluation of tools).
Journal of Food Protection, 73, 1101–1107.
Chapman, B. J., Maclaurin, T., & Powell, D. (2011). Food Safety Infosheets. British
Food Journal, 113(2), 160–186. http://doi.org/10.1108/00070701111105286
Chapman, B. J., Maclaurin, T., & Powell, D. A. (2013). Video observation and data
coding methods to assess food handling practices at food service. Food
Protection Trends, 33(3), 146–156.
Chittleborough, C. R., Nicholson, A. L., Basker, E., Bell, S., & Campbell, R. (2013).
Europe PMC Funders Group Factors influencing hand washing behaviour in
primary schools : process evaluation within a randomised controlled trial, 27(6),
1055–1068. http://doi.org/10.1093/her/cys061.Factors
Cho, S., Hertzman, J., Erdem, M., & Garriott, P. O. (2013). A food safety belief
model for Latino (A) employees in foodservice. Journal of Hospitality and
Tourism Research, 37(3), 330–348. http://doi.org/10.1177/1096348012436378
Choudhury, M., Mahanta, L. B., Goswami, J. S., & Mazumder, M. D. (2011). Will
capacity building training interventions given to street food vendors give us
safer food?: A cross-sectional study from India. Food Control, 22(8), 1233–
1239. http://doi.org/10.1016/j.foodcont.2011.01.023
Chow, S., & Mullan, B. (2010). Predicting food hygiene. An investigation of social
factors and past behaviour in an extended model of the Health Action Process
Approach. Appetite, 54(1), 126–133. http://doi.org/10.1016/j.appet.2009.09.018
Clayton, D. A. (2004). Understanding and predicting food handlers’ implementation
of specific food safety practices using social cognition models.
Clayton, D. A., & Griffith, C. J. (2008). Efficacy of an extended theory of planned
behaviour model for predicting caterers’ hand hygiene practices. International
Journal of Environmental Health Research, 18(2), 83–98.
http://doi.org/10.1080/09603120701358424
Clayton, D. A., Griffith, C. J., Price, P., & Peters, A. C. (2002). Food handlers’
beliefs and self- reported practices. International Journal of Environmental
Health Research, 12(1), 25–39. http://doi.org/10.1080/09603120120110031
Clayton, M., Smith, K., Neff, R., Pollack, K., & Ensminger, M. (2015). Listening to
food workers: Factors that impact proper health and hygiene practice in food
service. International Journal of Occupational and Environmental Health,
© COPYRIG
HT UPM
90
21(4), 314–327.
Conner, M., & Norman, P. (Eds.). (2015). Predicting and changing health
behaviour: Research and practice with social cognition models (Third).
England: Open Press University.
Conover, D. M., & Gibson, K. E. (2016a). A review of methods for the evaluation of
handwashing efficacy. Food Control, 63, 53–64.
http://doi.org/10.1016/j.foodcont.2015.11.020
Conover, D. M., & Gibson, K. E. (2016b). Comparison of two plain soap types for
removal of bacteria and viruses from hands with specific focus on food service
environments. Food Control, 69, 141–146.
http://doi.org/10.1016/j.foodcont.2016.04.047
Cormier, R. J., Mallet, M., Chiasson, S., Magnússon, H., & Valdimarsson, G. (2007).
Effectiveness and performance of HACCP-based programs. Food Control,
18(6), 665–671. http://doi.org/10.1016/J.FOODCONT.2006.02.019
Crandall, P., & Reynolds, J. (2018). International Journal of Hospitality Management
Exploring the in fl uence of food safety climate indicators on handwashing
practices of restaurant food handlers, (April).
http://doi.org/10.1016/j.ijhm.2018.06.029
Curtis, V. A., Danquah, L. O., & Aunger, R. V. (2009). Planned, motivated and
habitual hygiene behaviour: an eleven country review. Health Education
Research, 24(4), 655–673. http://doi.org/10.1093/her/cyp002
da Cunha, D. T., Fiorotti, R. M., Baldasso, J. G., de Sousa, M., Fontanezi, N. M.,
Caivano, S., … Camargo, M. C. R. (2013). Improvement of food safety in
school meal service during a long-term intervention period: a strategy based on
the knowledge, attitude and practice triad. Food Control, 34(2), 662–667.
http://doi.org/10.1016/j.foodcont.2013.06.003
da Cunha, D. T., Stedefeldt, E., & de Rosso, V. V. (2014). The role of theoretical
food safety training on Brazilian food handlers’ knowledge, attitude and
practice. Food Control, 43, 167–174.
http://doi.org/10.1016/j.foodcont.2014.03.012
de Leeuw, A., Valois, P., Ajzen, I., & Schmidt, P. (2015). Using the theory of
planned behavior to identify key beliefs underlying pro-environmental behavior
in high-school students: Implications for educational interventions. Journal of
Environmental Psychology, 42(June), 128–138.
http://doi.org/10.1016/j.jenvp.2015.03.005
Dharod, J. M., Pérez-Escamilla, R., Paciello, S., Bermúdez-Millán, A.,
Venkitanarayanan, K., & Damio, G. (2007). Comparison between self-reported
and observed food handling behaviors among Latinas. Journal of Food
Protection, 70(8), 1927–1932. http://doi.org/10.4315/0362-028X-70.8.1927
DiClemente, C. ., Prochaska, J. ., Fairhurst, S. ., Velicer, W. ., Velasquez, M. ., &
Rossi, J. . (1991). he process of smoking cessation: an analysis of
precontemplation, contemplation and preparation stages of change. Ournal of
Consulting and Clinical Psychology, 59, 295–304.
do Prado, D. B., Bettoni, A. P., Correa, V. A., de Abreu Filho, B. A., Garcia, L. B.,
Tognim, M. C. B., & Cardoso, C. L. (2015). Practice of hand hygiene in a
university dining facility. Food Control, 57, 35–40.
http://doi.org/10.1016/j.foodcont.2015.03.024
Doronina, O., Jones, D., Martello, M., Biron, A., & Lavoie-Tremblay, M. (2017). A
systematic review on the effectiveness of interventions to improve hand hygiene
compliance of nurses in the hospital setting. Journal of Nursing Scholarship,
© COPYRIG
HT UPM
91
49(2), 143–152. http://doi.org/10.1111/jnu.12274
DOSM, D. of S. M. (2010). Population & Demography. Retrieved from
https://www.dosm.gov.my/v1/index.php?r=column/ctwoByCat&parent_id=115
&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09
Edwards, J. S. A., Causa, H., & Overstreet, K. (2009). What is food service? Journal
of Foodservice, 20(1), 1–3. http://doi.org/10.1111/j.1748-0159.2008.00122.x
EFSA, & ECDC. (2015). The European Union summary report on trends and sources
of 374 zoonoses, zoonotic agents and food-borne outbreaks in 2013 European
Food Safety Authority 375 and European Centre for Disease Prevention and
Control. EFSA Journal, 13(12), 1–191.
Egan, M. B., Raats, M. M., Grubb, S. M., Eves, A., Lumbers, M. L., Dean, M. S., &
Adams, M. R. (2007). A review of food safety and food hygiene training studies
in the commercial sector. Food Control, 18(10), 1180–1190.
http://doi.org/10.1016/j.foodcont.2006.08.001
Ellis, J. D., Arendt, S. W., Strohbehn, C. H., Meyer, J., & Paez, P. (2010). Varying
influences of motivation factors on employees’ likelihood to perform safe food
handling practices because of demographic differences. Journal of Food
Protection, 73, 2065–2071.
EPRD, M. of E. (2017). Quick facts 2017: Malaysia educational statistics.
Etikan, I., Musa, S. A., & Kasim, R. S. Al. (2016). Comparison of convenience
sampling and purposive sampling. American Journal of Theoretical and Applied
Statistics, 5(1), 1. http://doi.org/10.11648/j.ajtas.20160501.11
Falk, R. F., & Miller, N. B. (1992). A primer for soft modeling. Akron, OH:
University of Akron Press.
FDA. (2009). FDA Report on the Occurrence of Foodborne Illness Risk Factors in
Selected Institutional Foodservice, Restaurant, and Retail Food Store Facility
Types 2009. The Food and Drug Administration. Retrieved from
http://www.fda.gov/Food/GuidanceRegulation/RetailFoodProtection/Foodborne
IllnessRiskFactorReduction/ucm224321.htm
FDA, U. S. (2013). Food Code 2013, 1–768.
http://doi.org/10.1016/j.parint.2011.08.011
Finch, C., & Daniel, E. (2005). Food Safety Knowledge and Behavior of Emergency
Food Relief Organization Workers: Effect of Food Safety Training Intervention.
Journal of Environmental Health, 67(9), 30–34.
Fornell, C., & Larcker, D. F. (1981). Evaluating Structural Equation Models with
Unobservable Variables and Measurement Error. Journal of Marketing
Research, 18(1), 39. http://doi.org/10.2307/3151312
Free Malaysia Today, F. (2018). 71 murid di Kedah keracunan makanan. Retrieved
from http://www.freemalaysiatoday.com/category/bahasa/2018/02/12/71-murid-
di-kedah-keracunan-makanan/
Fulham, E., & Mullan, B. (2011). Hygienic food handling behaviors: attempting to
bridge the intention-behavior gap using aspects from temporal self-regulation
theory. Journal of Food Protection, 74(6), 925–32. http://doi.org/10.4315/0362-
028X.JFP-10-558
Garcia, P. P. C., Akutsu, R. de C., Savio, K. E., Camargo, E. B., & Silva, I. C. R.
(2015). The efficacy of food handler training:the transtheoretical model in
focus, Brazil, 2013. Journal of Safety Studies, 1(2), 11.
http://doi.org/10.5296/jss.v1i2.8618
Götz, O., Liehr-Gobbers, K., & Krafft, M. (2010). Evaluation of Structural Equation
Models Using the Partial Least Squares (PLS) Approach. In Handbook of
© COPYRIG
HT UPM
92
Partial Least Squares (pp. 691–711). Berlin, Heidelberg: Springer Berlin
Heidelberg. http://doi.org/10.1007/978-3-540-32827-8_30
Gould DJ, Moralejo, D., Drey, N., & Chudleigh, J. (2011). Interventions to improve
hand hygiene compliance in patient care. Cochrane Database of Systematic
Reviews, (9). http://doi.org/10.1002/14651858.CD005186.pub3.Copyright
Green, L. R. (2008). Behavioral Science of Food Safety. Journal Environmental
Health, 71(2), 47–49.
Green, L. R., Radke, V., Mason, R., Bushnell, L., Reimann, D. W., Mack, J. C., …
Selman, C. A. (2007). Factors related to food worker hand hygiene practices.
Journal of Food Protection, 70(3), 661–666.
Green, L. R., & Selman, C. (2005). Factors impacting food workers ’ and managers ’
safe food preparation practices : A qualitative study. Food Protection Trends,
25(12), 981–990.
Green, L. R., Selman, C. A., Radke, V., Ripley, D., Mack, J. C., Reimann, D. W., …
Bushnell, L. (2006). Food worker hand washing practices : An observation
study. Journal of Food Protection, 69(10), 2417–2423.
Griffith, C. J., Livesey, K. M., & Clayton, D. A. (2010). The assessment of food
safety culture. British Food Journal, 112(4), 439–456.
http://doi.org/10.1108/00070701011034448
Guetterman, T. C., & Creswell, J. W. (2015). Integrating Quantitative and
Qualitative Results in Health Science Mixed Methods Research Through Joint
Displays. Annals Family of Medicine, 554–561.
http://doi.org/10.1370/afm.1865.INTRODUCTION
Gupta, R. K., Dudeja, P., & Minhas, A. S. (2017). Food safety in the 21st
century :Public health perspective. http://doi.org/10.1016/B978-0-12-801773-
9/00048-0
Guzewich, J., Guzewich, J., & Ross, M. P. (1999). Evaluation of risk related to
microbiological contamination of ready-to-eat foods by food preparation
workers and the effectiveness of interventions to minimize those risks. Silver
Spring, MD: Food and Drug Administration, Center for Food Safety and Appli.
Retrieved from
http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.410.843
Gwet, K. L. (2014). Handbook of inter-rater reliability : the definitive guide to
measuring the extent of agreement among raters. Retrieved from
https://books.google.com.my/books/about/Handbook_of_Inter_Rater_Reliabilit
y_4th.html?id=fac9BQAAQBAJ&redir_esc=y
Hair, J. F. J., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2017). A primer on
partial least squares structural equation modeling (PLS-SEM) (2nd ed.). Los
Angeles: SAGE.
Hair, J. F. J., Hult, G. T. M., Ringle, C., & Sarstedt, M. (2014). A Primer on Partial
Least Squares Structural Equation Modeling (PLS-SEM). Long Range Planning
(Vol. 46). Los Angeles: SAGE. http://doi.org/10.1016/j.lrp.2013.01.002
Henroid, D., & Sneed, J. (2004). Readiness to implement Hazard Analysis and
Critical Control Point (HACCP) systems in Iowa schools. Journal of the
American Dietetic Association, 104(2), 180–5.
http://doi.org/10.1016/j.jada.2003.11.009
Henseler, J., Ringle, C. M., & Sarstedt, M. (2015). A new criterion for assessing
discriminant validity in variance-based structural equation modeling. Journal of
the Academy of Marketing Science, 43(1), 115–135.
http://doi.org/10.1007/s11747-014-0403-8
© COPYRIG
HT UPM
93
Henseler, J., Ringle, C. M., & Sinkovics, R. R. (2009). The use of partial least
squares path modeling in international marketing. Advances in International
Marketing. http://doi.org/10.1108/S1474-7979(2009)0000020014
Ho, M., Seto, W., Wong, L., & Wong, T. (2012). Effectiveness of multifaceted hand
hygiene interventions in long-term care facilities in Hong Kong: A cluster-
randomized controlled trial. Infection Control & Hospital Epidemiology, 33(08),
761–767. http://doi.org/10.1086/666740
Howells, A. D., Roberts, K. R., Shanklin, C. W., Pilling, V. K., Brannon, L. a., &
Barrett, B. B. (2008). Restaurant employees’ perceptions of barriers to three
food safety practices. Journal of the American Dietetic Association, 108, 1345–
1349. http://doi.org/10.1016/j.jada.2008.05.010
Hussain, M., & Dawson, C. (2013). Economic impact of food safety outbreaks on
food businesses. Foods, 2(4), 585–589. http://doi.org/10.3390/foods2040585
Insight, H. (2018). What about Malaysia?
Jeong, S. Y., & Kim, K. M. (2016). Influencing factors on hand hygiene behavior of
nursing students based on theory of planned behavior: A descriptive survey
study. Nurse Education Today, 36, 159–164.
http://doi.org/10.1016/j.nedt.2015.09.014
Lee, H. K., Halim, H. A., Thong, K. L., & Cha, L. C. (2017). Assessment of food
safety knowledge, attitude, self-reported practices, and microbiological hand
hygiene of food handlers. International Journal of Environmental Research and
Public Health, 14(12), 55. http://doi.org/10.3390/ijerph14010055
Lee, H. Y., Chik, W. N. W., Bakar, F. A., Saari, N., & Mahyudin, N. A. (2012).
Sanitation practices among food handlers in a military food service institution,
Malaysia. Food and Nutrition Sciences, 03(11), 1561–1566.
http://doi.org/10.4236/fns.2012.311204
Lee, S. S., Park, S. J., Chung, M. J., Lee, J. H., Kang, H. J., Lee, J., & Kim, Y. K.
(2014). Improved hand hygiene compliance is associated with the change of
perception toward hand hygiene among medical personnel. Infection &
Chemotherapy, 46(3), 165. http://doi.org/10.3947/ic.2014.46.3.165
Lelieveld, H., Mostert, T., & Holah, J. (2005). Handbook of hygiene control in the
food industry. Handbook of Hygiene Control in the Food Industry.
http://doi.org/10.1533/9781845690533
Lin, C.-M., Wu, F.-M., Kim, H.-K., Doyle, M. P., Michael, B. S., & Williams, L. K.
(2003). A comparison of hand washing techniques to remove Escherichia coli
and caliciviruses under natural or artificial fingernails. Journal of Food
Protection, 66(12), 2296–2301. http://doi.org/10.4315/0362-028X-66.12.2296
Lydon, S., Power, M., McSharry, J., Byrne, M., Madden, C., Squires, J. E., &
O’Connor, P. (2017). Interventions to improve hand hygiene compliance in the
ICU: A systematic review. Critical Care Medicine, 45(11), e1165–e1172.
http://doi.org/10.1097/CCM.0000000000002691
Machado, M. G., Monego, E. T., & Campos, M. R. H. (2014). Risk perception of
food safety by school food-handlers. Journal of Health, Population, and
Nutrition, 32(1), 19–27. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/24847589
MacPhail, C., Khoza, N., Abler, L., & Ranganathan, M. (2016). Process guidelines
for establishing intercoder reliability in qualitative studies. Qualitative
Research, 16(2), 198–212. http://doi.org/10.1177/1468794115577012
Marks, D. F., & Yardley, L. (Eds.). (2011). Research methods for clinical and health
psychology. In Journal of US-China Public Administration (Vol. 8, pp. 968–
© COPYRIG
HT UPM
94
977). http://doi.org/10.5430/jnep.v6n5p100
McArthur, L. H., Holbert, D., & Forsythe, W. A. (2006). Compliance with food
safety recommendations among university undergraduates: application of the
health belief model. Family and Consumer Sciences Research Journal, 35(2),
160–170. http://doi.org/10.1177/1077727X06292932
McCambridge, J., Witton, J., & Elbourne, D. R. (2014). . Systematic review of the
Hawthorne effect: New concepts are needed to study research participation
effects. Journal of Clinical Epidemiology.
Mchugh, M. L. (2012). Lessons in biostatistics Interrater reliability : the kappa
statistic, 276–282.
McIntyre, L., Peng, D., & Henderson, S. B. (2014). Retraining effectiveness in
FOODSAFE trained food handlers in British Columbia, Canada. Food Control,
35(1), 137–141. http://doi.org/10.1016/j.foodcont.2013.06.028
Meftahuddin, T. (2002). Review of trand and cause of food borne outbreak in
Malaysia from 1988 to 1997. Med. Journal Malaysia, (57), 70 – 79.
Ministry of Education, M. (2019). Garis panduan penyediaan makanan bersih dan
selamat di kantin dapur asrama. Retrieved from
https://www.moe.gov.my/index.php/my/kesihatan/garis-panduan-makanan-
selamat-kantin-dan-dapur-asrama
Mitchell, R., Fraser, A., & Bearon, L. (2007). Preventing food-borne illness in food
service establishments: Broadening the framework for intervention and research
on safe food handling behaviors. International Journal of Environmental Health
Research, 17(1), 9–24. http://doi.org/10.1080/09603120601124371
MOE, M. of E. (2018). Number of Primary And Secondary Schools by States (31
January 2018). Retrieved February 25, 2019, from
https://www.moe.gov.my/index.php/en/korporat/statistik/bilangan-sekolah-
mengikut-kumpulan-jenis-dan-negeri
MOH. (2017). Health Facts 2017. Ministry of Health Malaysia, Planning Division
Health Informatics Centre, 2016–2017.
Moore, C. (2015). A qualitative case study of nurse , physician , and allied clinicians
perceptions on hand hygiene compliance. University of Phoenix.
Mullan, B., Allom, V., Fayn, K., & Johnston, I. (2014). Building habit strength : A
pilot intervention designed to improve food-safety behavior. Food Research
International, 66, 274–278. http://doi.org/10.1016/j.foodres.2014.09.027
Mullan, B., Allom, V., Sainsbury, K., & Monds, L. (2015). Examining the predictive
utility of an extended theory of planned behaviour model in the context of
specific individual safe food-handling. Appetite, 90, 91–8.
http://doi.org/10.1016/j.appet.2015.02.033
Mullan, B., & Wong, C. (2009). Hygienic food handling behaviours. An application
of the Theory of Planned Behaviour. Appetite, 52, 757–761.
http://doi.org/10.1016/j.appet.2009.01.007
Mullan, B., & Wong, C. (2010). Using the Theory of Planned Behaviour to design a
food hygiene intervention. Food Control, 21(11), 1524–1529.
http://doi.org/10.1016/j.foodcont.2010.04.026
MyMetro. (2018). 103 pelajar MRSM Taiping alami keracunan makanan.
Naikoba, S., & Hayward, A. (2001). The effectiveness of interventions aimed at
increasing handwashing in healthcare workers - a systematic review. Journal of
Hospital Infection, 47(3), 173–180. http://doi.org/10.1053/jhin.2000.0882
NDSC, N. D. S. C. (2004). Preventing foodborne disease: A focus on the infected
food handler. Retrieved from
© COPYRIG
HT UPM
95
https://www.hpsc.ie/AboutHPSC/ScientificCommittees/Publications/File,871,en
Neo, J. R. J., Sagha-Zadeh, R., Vielemeyer, O., & Franklin, E. (2016). Evidence-
based practices to increase hand hygiene compliance in health care facilities: An
integrated review. American Journal of Infection Control, 44(6), 691–704.
http://doi.org/10.1016/j.ajic.2015.11.034
Nik Husain, N. R., Wan Muda, W. M., Noor Jamil, N. I., Nik Hanafi, N. N., & Abdul
Rahman, R. (2016). Effect of food safety training on food handlers’ knowledge
and practices. British Food Journal, 118(4), 795–808.
http://doi.org/10.1108/BFJ-08-2015-0294
Niode, O., Bruhn, C., & Simonne, A. H. (2011). Insight into Asian and hispanic
restaurant manager needs for safe food handling. Food Control, 22(1), 34–42.
http://doi.org/10.1016/j.foodcont.2010.06.006
Nørrung, B., & Buncic, S. (2008). Microbial safety of meat in the European Union.
Meat Science, 78(1–2), 14–24. http://doi.org/10.1016/J.MEATSCI.2007.07.032
Nunally, J. C., & Bernstein, I. (1994). Psychometric theory. New York: McGraw-
Hill.
Paez, P., & Strohbehn, C. (2007). (2007). Handwashing frequencies and methods
used in deli-type foodservice operations. In Proceedings of Twelve Annual
Graduate Education and Graduate Student Research Conference in Hospitality
and Tourism.
Palinkas, L. A., Aarons, G., Horwitz, S., Chamberlain, P., Hurlburt, M., &
Landsverk, J. (2011). Mixed method designs in implementation research. Adm.
Policy Ment. Health, 38(1), 44–53.
Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., &
Hoagwood, K. (2015). Purposeful Sampling for Qualitative Data Collection and
Analysis in Mixed Method Implementation Research. Adm. Policy Ment.
Health, 42(5), 533–544. http://doi.org/10.1007/s10488-013-0528-y.Purposeful
Park, S.-H., Kwak, T.-K., & Chang, H.-J. (2010). Evaluation of the food safety
training for food handlers in restaurant operations. Nutrition Research and
Practice, 4(1), 58–68. http://doi.org/10.4162/nrp.2010.4.1.58
Patton, M. Q. (2002). Qualitative research and evaluation methods. Nurse Education
Today (3rd ed.). UK: London, England: SAGE Publications.
Pellegrino, R., Crandall, P. G., O’Bryan, C. A., & Seo, H.-S. (2015). A review of
motivational models for improving hand hygiene among an increasingly diverse
food service workforce. Food Control, 50, 446–456.
http://doi.org/10.1016/j.foodcont.2014.09.015
Pellegrino, R., Crandall, P. G., & Seo, H.-S. (2015). Hand washing and disgust
response to handling different food stimuli between two different cultures. Food
Research International, 76(P2), 301–308. Retrieved from
http://dx.doi.org/10.1016/j.foodres.2014.12.027
Petty, R. E., & Krosnick, J. A. (1995). Attitude strength : antecedents and
consequences. Lawrence Erlbaum Associates.
Philip, A. (2015). Food safety in Malaysia. Japan Medical Association Journal,
58(4), 180–184.
Phillip, S., & Anita, E. (2010). Efficacy of the theory of planned behaviour model in
predicting safe food handling practices. Food Control, 21(7), 983–987.
http://doi.org/10.1016/j.foodcont.2009.12.012
Pilling, V. K., Brannon, L. A., Shanklin, C. W., Howells, A. D., & Roberts, K. R.
(2008). Identifying specific beliefs to target to improve restaurant employees’
© COPYRIG
HT UPM
96
intentions for performing three important food safety behaviors. Journal of the
American Dietetic Association, 108(6), 991–997.
http://doi.org/10.1016/j.jada.2008.03.014
Pittet, D. (2001). Improving adherence to hand hygiene practice: A multidisciplinary
approach. Emerging Infectious Diseases, 7(2), 234–240.
http://doi.org/10.3201/eid0702.700234
Pragle, A., Harding, A. K., & Mack, J. C. (2007). Food Workers ’ Perspectives on
Handwashing Behaviors and Barriers in the Restaurant Environment. J Environ
Health, 69(7), 27–32.
Price, L., Melone, L., McLarnon, N., Bunyan, D., Kilpatrick, C., Flowers, P., &
Reilly, J. (2018). A systematic review to evaluate the evidence base for the
World Health Organization’s adopted hand hygiene technique for reducing the
microbial load on the hands of healthcare workers. American Journal of
Infection Control, 46(7), 814–823. http://doi.org/10.1016/j.ajic.2018.01.020
Puckett, R. P. (2003). Institutional food service operations. In R. H. Schmidt & G. E.
Rodrick (Eds.), Food Safety Handbook. John Wiley & Sons, Inc.
http://doi.org/10.1002/047172159X
Rajagopal, L., & Strohbehn, C. H. (2013). Observational assessment of glove use
behaviors among foodservice workers in a university dining setting: Testing a
visual intervention tool. Food Protection Trends, 33(5), 315–324.
Ray, P. S., Bishop, P. A., & Wang, M. Q. (1997). Efficacy of the components of a
behavioral safety program. International Journal of Industrial Ergonomics,
19(1), 19–29. http://doi.org/10.1016/0169-8141(95)00067-4
Reilly, J. S., Price, L., Lang, S., Robertson, C., Cheater, F., Skinner, K., & Chow, A.
(2016). A Pragmatic Randomized Controlled Trial of 6-Step vs 3-Step Hand
Hygiene Technique in Acute Hospital Care in the United Kingdom. Infection
Control and Hospital Epidemiology, 37(6), 661–666.
http://doi.org/10.1017/ice.2016.51
Reyes, F. B., Lippke, S., Knoll, N., Blanca Moya, E., & Schwarzer, R. (2015).
Promoting action control and coping planning to improve hand hygiene. BMC
Public Health, 15(1), 964. http://doi.org/10.1186/s12889-015-2295-z
Reynolds, J., Rajagopal, L., & Reynolds, J. (2017). Childcare food handling
employees’ erceived barriers and motivators to follow food safety practices.
Early Childhood Education Journal. http://doi.org/10.1007/s10643-017-0885-3
Ritchie, J., & Lewis, J. (2003). The foundations of qualitative research. In J. Ritchie
& J. Lewis (Eds.), Qualitative research practice: A guide for social science
students and researchers (pp. 2–10). http://doi.org/10.4135/9781452230108
Roberts, K. R. (2008). Using the theory of planned behavior to explore restaurant
managers support for employee food safety training. Kansas State University.
Roberts, K. R., Arendt, S. W., Strohbehn, C., Ellis, J. D., & Paez, P. (2012).
Educating future managers to motivate employees to follow food safety
practices. Journal of Management & Education, 6(1), 1–8.
http://doi.org/10.1108/eb017384
Roberts, K. R., & Barrett, B. B. (2011). Restaurant managers’ beliefs about food
safety training: An application of the Theory of Planned Behavior. Journal of
Foodservice Business Research, 14(3), 206–225.
http://doi.org/10.1080/15378020.2011.594379
Robertson, L. A., Boyer, R. R., Chapman, B. J., Eifert, J. D., & Franz, N. K. (2013).
Educational needs assessment and practices of grocery store food handlers
through survey and observational data collection. Food Control, 34(2), 707–
© COPYRIG
HT UPM
97
713. http://doi.org/10.1016/J.FOODCONT.2013.06.004
Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory
and the health belief model. Health Education Quarterly, 15(2), 175–183.
http://doi.org/10.1177/109019818801500203
Rosmawati, N. N., Manan, W. W., Izani, N. N., & Nurain, N. N. (2015). Validity and
reliability of food safety knowledge and practices questionnaire among food
handlers. Health and the Environment Journal, 6(1), 11–30.
Saad, M., Toh, P. S., & Adil, M. A. M. (2013). Hygiene practices of food handlers at
Malaysian Government Institutions Training Centers. Procedia - Social and
Behavioral Sciences, 85, 118–127. http://doi.org/10.1016/j.sbspro.2013.08.344
SAGE. (2016). Pretesting and pilot testing. Sage, 101–119. Retrieved from
http://www.sagepub.com/sites/.../68507_Ruel_Chapter_6.pdf
Schafer, R. B., Schafer, E., Bultena, G. L., & Hoiberg, E. O. (1993). Food safety: An
application of the health belief model. Journal of Nutrition Education, 25(1),
17–24. http://doi.org/10.1016/S0022-3182(12)80183-X
Schroeder, M., Yang, L., Eifert, J., Boyer, R., Chase, M., & Nieto-Montenegro, S.
(2016). Evaluation of how different signs affect poultry processing employees’
hand washing practices. Food Control, 68, 1–6.
http://doi.org/10.1016/j.foodcont.2016.03.019
Seaman, P. (2010). Food hygiene training: Introducing the Food Hygiene Training
Model. Food Control, 21(4), 381–387.
http://doi.org/10.1016/j.foodcont.2009.08.005
Seaman, P., & Eves, A. (2006). The management of food safety—the role of food
hygiene training in the UK service sector. International Journal of Hospitality
Management, 25(2), 278–296. http://doi.org/10.1016/j.ijhm.2005.04.004
Seaman, P., & Eves, A. (2010). Perceptions of hygiene training amongst food
handlers, managers and training providers – A qualitative study. Food Control,
21(7), 1037–1041. http://doi.org/10.1016/j.foodcont.2009.12.024
Sharif, L., Obaidat, M. M., & Al-Dalalah, M.-R. (2013). Food Hygiene Knowledge,
Attitudes and Practices of the Food Handlers in the Military Hospitals. Food
and Nutrition Sciences, 04(03), 245–251. http://doi.org/10.4236/fns.2013.43033
Siau, M. F. (2015). Food court hygiene assessment and food safety knowledge ,
attitudes and practices of food handlers in Putrajaya, 22(5), 1843–1854.
Siow, O. N., & Sani, N. A. (2011). Assessment of knowledge, attitudes and practices
(KAP) Among food handlers at residential colleges and canteen regarding food
safety. Sains Malaysiana, 40(4), 403–410.
Smigic, N., Djekic, I., Martins, M. L., Rocha, A., Sidiropoulou, N., & Kalogianni, E.
P. (2016). The level of food safety knowledge in food establishments in three
European countries. Food Control, 63, 187–194.
http://doi.org/10.1016/j.foodcont.2015.11.017
Sneed, J., & Henroid, D. (2007). Impact of educational interventions on hazard
analysis critical control point ( HACCP ) program implementation in Iowa
schools. The Journal of Child Nutrition & Management, (1).
Soon, J. M., Richard Baines, & Seaman, P. (2012). Meta-analysis of food safety
training on hand hygiene knowledge and attitudes among food handlers. Journal
of Food Protection, 75(4), 793–804. http://doi.org/10.4315/0362-028X.JFP-11-
502
Soon, J. M., Singh, H., & Baines, R. (2011). Foodborne diseases in Malaysia: A
review. Food Control, 22(6), 823–830.
http://doi.org/10.1016/j.foodcont.2010.12.011
© COPYRIG
HT UPM
98
Stewardson, A. J., Sax, H., Gayet-Ageron, A., Touveneau, S., Longtin, Y., Zingg,
W., & Pittet, D. (2016). Enhanced performance feedback and patient
participation to improve hand hygiene compliance of health-care workers in the
setting of established multimodal promotion: a single-centre, cluster randomised
controlled trial. The Lancet Infectious Diseases, 16(12), 1345–1355.
http://doi.org/10.1016/S1473-3099(16)30256-0
Strohbehn, C., Jun, J., & Arendt, S. W. (2014). School foodservice employees ’
perceptions of practice : Differences by generational age and hours worked. The
Journal of Child Nutrition & Management, 38(1), 1–22.
Strohbehn, C., Paez, P., Sneed, J., & Meyer, J. (2011). Mitigating cross
contamination in four retail foodservice sectors. Food Protection Trends,
31(10), 620–630.
Strohbehn, C., Shelley, M., Arendt, S. W., Correia, A. P., Meyer, J., Abidin, U. F. U.
Z., & Jun, J. (2014). Retail foodservice employees perceptions of barriers and
motivational factors that influence performance of safe food behaviors. Food
Protection Trends, 34(3), 139–150.
Strohbehn, C., Sneed, J., Paez, P., & Meyer, J. (2008). Hand washing frequencies
and procedures used in retail food services. Journal of Food Protection, 71(8),
1641–1650. http://doi.org/10.1016/j.jada.2009.06.370
Sutton, S. (2004). Determinants of health-related behaviours: Theoretical and
methodological issues. The Sage Handbook of Health Psychology, 94–126.
http://doi.org/10.4135/9781848608153.n4
Sutton, S., French, D. P., Hennings, S. J., Mitchell, J., Wareham, N. J., Griffin, S., …
Kinmonth, A. L. (2003). Eliciting salient beliefs in research on the theory of
planned behaviour: The effect of question wording. Current Psychology, 22(3),
234–251. http://doi.org/10.1007/s12144-003-1019-1
Tan, S. L., Bakar, F. A., Karim, M. S. A., Lee, H. Y., & Mahyudin, N. A. (2013).
Hand hygiene knowledge, attitudes and practices among food handlers at
primary schools in Hulu Langat district, Selangor (Malaysia). Food Control,
34(2), 428–435. http://doi.org/10.1016/j.foodcont.2013.04.045
Tan, S. L., Cheng, P. L., Soon, H. K., Ghazali, H., & Mahyudin, N. A. (2013). A
qualitative study on personal hygiene knowledge and practices among food
handlers at selected primary schools in Klang valley area, Selangor, Malaysia.
International Food Research Journal, 20(1), 71–76.
Tariq, S., & Woodman, J. (2013). Using mixed methods in health research. JRSM
Short Reports, 4(6), 204253331347919.
http://doi.org/10.1177/2042533313479197
Taylor, R. E. (2015). The role of message strategy in improving hand hygiene
compliance rates. American Journal of Infection Control, 43(11), 1166–1170.
http://doi.org/10.1016/j.ajic.2015.06.015
Teddlie, C., & Yu, F. (2007). Mixed Methods Sampling. Journal of Mixed Methods
Research, 1(1), 77–100. http://doi.org/10.1177/2345678906292430
Thaivalappil, A., Waddell, L., Greig, J., Meldrum, R., & Young, I. (2018). A
systematic review and thematic synthesis of qualitative research studies on
factors affecting safe food handling at retail and food service. Food Control, 89,
97–107. http://doi.org/10.1016/j.foodcont.2018.01.028
Toney-Butler, T. J., & Carver, N. (2018). Hand, washing (hand hygiene). StatPearls.
StatPearls Publishing. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/29262113
Tóth, A. J., Koller, Z., Illés, C. B., & Bittsánszky, A. (2017). Development of
© COPYRIG
HT UPM
99
conscious food handling in Hungarian school cafeterias. Food Control, 73, 644–
649. http://doi.org/10.1016/j.foodcont.2016.09.011
Tschudin-Sutter, S., Rotter, M. L., Frei, R., Nogarth, D., Häusermann, P., Stranden,
A., … Widmer, A. F. (2017). Simplifying the WHO ‘how to hand rub’
technique: three steps are as effective as six—results from an experimental
randomized crossover trial. Clinical Microbiology and Infection, 23(6), 409.e1-
409.e4. http://doi.org/10.1016/j.cmi.2016.12.030
Ungku Fatimah, U. Z. A., Strohbehn, C. H., & Arendt, S. W. (2014). An empirical
investigation of food safety culture in onsite foodservice operations. Food
Control, 46, 255–263. http://doi.org/10.1016/j.foodcont.2014.05.029
Ungku Zainal Abidin, U. F. (2014). Measuring food safety culture: Insights from
onsite foodservice operations. Dissertation Abstracts International Section A:
Humanities and Social Sciences. Retrieved from
http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2014-
99071-032&site=ehost-live
Webb, M., & Morancie, A. (2015). Food safety knowledge of foodservice workers at
a university campus by education level, experience, and food safety training.
Food Control, 50(April), 259–264.
http://doi.org/10.1016/j.foodcont.2014.09.002
White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W.,
… Paterson, D. (2015). Using a theory of planned behaviour framework to
explore hand hygiene beliefs at the ‘5 critical moments’ among Australian
hospital-based nurses. BMC Health Services Research, 15(1), 59.
http://doi.org/10.1186/s12913-015-0718-2
WHO, W. H. O. (2009a). Hand Hygiene: Why, How and When? World Health
Organization, (August), 1–7. Retrieved from
http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochu
re.pdf?ua=1
WHO, W. H. O. (2009b). WHO guidelines on hand hygiene in health care: First
global patient safety challenge clean care is safer care. World Health
Organization (Vol. 52). http://doi.org/10.1111/j.1365-2648.2005.03625.x
WHO, W. H. O. (2015). WHO estimates of the global burden of foodborne diseases:
Foodborne disease burden epidemiology reference group 2007-2015. World
Health Organization.
Wilcock, A., Ball, B., & Fajumo, A. (2011). Effective implementation of food safety
initiatives: Managers’, food safety coordinators’ and production workers’
perspectives. Food Control, 22(1), 27–33.
http://doi.org/10.1016/j.foodcont.2010.06.005
Woh, P. Y., Thong, K. L., Behnke, J. M., Lewis, J. W., & Mohd Zain, S. N. (2016).
Evaluation of basic knowledge on food safety and food handling practices
amongst migrant food handlers in Peninsular Malaysia. Food Control, 70, 64–
73. http://doi.org/10.1016/j.foodcont.2016.05.033
Woh, P. Y., Thong, K. L., Lim, Y. A. L., Behnke, J. M., Lewis, J. W., & Mohd Zain,
S. N. (2017). Microorganisms as an indicator of hygiene status among migrant
food handlers in peninsular Malaysia. Asia Pacific Journal of Public Health,
29(7), 599–607. http://doi.org/10.1177/1010539517735856
York, V. K., Brannon, L. a., Roberts, K. R., Shanklin, C. W., & Howells, A. D.
(2009). Using the theory of planned behavior to elicit restaurant employee
beliefs about food safety: using surveys versus focus groups. Journal of
Foodservice Business Research, 12(2), 180–
© COPYRIG
HT UPM
100
197.http://doi.org/10.1080/15378020902910777
York, V. K., Brannon, L. A., Shanklin, C. W., Roberts, K. R., Barrett, B. B., &
Howells, A. D. (2009). Intervention improves restaurant employees’ food safety
compliance rates. International Journal of Contemporary Hospitality
Management, 21(4), 459–478. http://doi.org/10.1108/09596110910955703
York, V. K., Brannon, L., Shanklin, C., Roberts, K. R., Howells, A. D., & Barrett, E.
(2009). Foodservice employees benefit from interventions targeting barriers to
food safety. Journal of the American Dietetic Association, 109(9), 1576–1581.
http://doi.org/10.1016/j.jada.2009.06.370
Youn, S., & Sneed, J. (2002). Training and perceived barriers to implementing food
safety practices in school foodservice. The Journal of Child Nutrition &
Management, (2).
Yu, H. (2015). Improved Handwashing through Behavior-Based Training.
University of Houston.
Yu, H., Neal, J., Dawson, M., & Madera, J. M. (2018). Implementation of behavior-
based training can improve food service employees’ handwashing frequencies,
duration, and effectiveness. Cornell Hospitality Quarterly, 59(1), 70–77.
http://doi.org/10.1177/1938965517704370
Zhang, W. (2014). Mixed methods application in health intervention research: A
multiple case study. International Journal of Multiple Research Approaches,
8(1), 24–35. http://doi.org/10.5172/mra.2014.8.1.24
© COPYRIG
HT UPM