ws

510,

Food safety

tionticeuralided athr

with highest and lowest correct scores in, respectively, the food poisoning and good hygienic practices

e wide994),effec

8). Ta3 case

of food safety issues has increased government attention to theissue of controlling food-borne illnesses (FDA Taiwan, 2011).

Food safety management in Taiwan follows hazard analysis andcritical control point (HACCP) principles and good hygienic practice

facturers, with most of the former located in greater Taipei (FDATaiwan, 2011). The Taiwan government uses GHP and HACCPsystem standards to conduct sanitation evaluations in the hospi-tality industry. However, not all restaurants use HACCP. Even large,well-established food companies nd it a difcult challenge to copewith HACCPs many interrelated factors. Small and medium sizedenterprises often perceive the difculties associated with theHACCP system to be insurmountable (Gilling, Taylor, Kane, & Taylor,2001; Route, 2001; Taylor, 2001). In general, large hotels are more

* Tel.: 886 2 29053755.

Contents lists available at

Food Co

lse

Food Control 29 (2013) 192e197E-mail address: 073770@mail.fju.edu.tw.during 1981e2010 (FDA Taiwan, 2011), with case numbers ona generally upward trend. Cases occurred primarily in the homeduring 1981e1990 and at foodservice venues (e.g., restaurants andschools) during 1991e2010 (Sun, Wang, & Huang, 2012). Theprimary causes of food poisoning in Taiwan are cross-contamination between raw and cooked foods; insufcient heat-ing; keeping foods at room temperature for extended periods;contamination by infected food handlers; and contamination byinadequately cleaned equipment. The relationship between foodhandling and food poisoning together with rising public awareness

means used worldwide to control food safety. HACCP compliance isan increasingly important component of food safety in interna-tional trade. The HACCP system is a common-sense approach toidentifying, quantifying, and controlling food safety hazards. Itallows detailed examinations of processes to identify hazards anddetermine whether they can be controlled (Eves & Dervisi, 2005).As small and medium-scale restaurants typically lack sufcientfunds to set up an HACCP system, the government designated hoteland large restaurants as priority targets for HACCP certication.Taiwan now has 259 HACCP-certied restaurants and food manu-1. Introduction

Although food-borne illnesses ar(Notermans, Zwietering, & Mead, 1related infections have not beenStanwell-Smith, & Handysides, 199Administration (FDA) reported 4960956-7135/$ e see front matter 2012 Elsevier Ltd.http://dx.doi.org/10.1016/j.foodcont.2012.05.076knowledge and HACCP practices. The implications of these ndings are discussed. 2012 Elsevier Ltd. All rights reserved.

spread global problemsapproaches to controltive (OBrien, Rooney,iwans Food and Drugs of food-borne illness

(GHP) standards. Food processors and restaurants must complywith GHP rules. On September 7, 2000, the Department of Healthpublished its nal version of Food GHPs (Food GHP, 2000; Jeng &Fang, 2003). This publication states, food business operationsshall ensure that all stages of production, processing, and distri-bution of food under their control satisfy the relevant hygienerequirements laid down in the GHPs. HACCP is the most prevalentAttitudeHACCPself-improvement. With the exception of the food poisoning construct, this study found correlationsamong knowledge, attitude, and HACCP practices, with attitude mediating the relationship betweenKnowledge (GHP) constructs. The highest score in the attitude section was concern for food safety followed byThe relationship among food safety knoHACCP practices in restaurant employee

Wen-Hwa Ko*

Department of Restaurant, Hotel and Institutional Management, Fu-Jen University, No.

a r t i c l e i n f o

Article history:Received 4 January 2012Received in revised form22 May 2012Accepted 31 May 2012

Keywords:

a b s t r a c t

This study investigates relacontrol point (HACCP) pracquestionnaire to 542 restapractices. A total of 421 vasurvey item were calculatrelationships between the

journal homepage: www.eAll rights reserved.ledge, attitudes and self-reported

Zhongzheng Rd., Xinzhuang Dist., New Taipei City 24205, Taiwan

ships among food safety knowledge, attitudes and hazard analysis criticals in restaurant employees in Taiwan. The authors administered a baselinent employees to assess their food safety knowledge, attitude and HACCPquestionnaires were returned and used in analysis. Mean scores for eachnd used in a structural equation model (SEM) designed to assess inter-ee. Participants scored an average 84.7% correct in food safety knowledge,

SciVerse ScienceDirect

ntrol

vier .com/locate/ foodcont

using a ve-point Likert-type scale, ranging from 1 (stronglydisagree) to 5 (strongly agree).

We subjected our initial 10 indicators in section two to item andfactor analysis. Item analysis assessed individual test item perfor-mance, based on the assumption that overall test quality reectsthe quality of its component items. We evaluated the item analysisindex, i.e., mean, standard deviation, corrected item-total correla-tion, skewness, and item discrimination. We deleted 2 items thathad the poor results by using item analysis. Exploratory factoranalysis (EFA) explores relationships among observed indicators interms of their basic factors. This study used the varimax rotationEFA method, with a minimum eigenvalue of 1.0 used for factorextraction. The nal food safety attitude questionnaire included 8items across two constructs, including self-improvement (4 items),and food safety concern (4 items). Cronbachs a for the twoconstructs ranged from 0.760 to 0.809, showing good reliability.

trollikely to have a better HACCP quality team approach and do bet-ter monitoring of critical control points (Fletcher, Maharaj, andJames, 2009).

As the Taiwan government assigns producers primary respon-sibility to ensure food safety, producer staff must have an adequatelevel of food safety knowledge. The efcacy of training on staff foodsafety behaviors has yet to be fully evaluated. Typically, GHPsdesigned to ensure food hygiene are implemented rst, potentiallyfollowed by the HACCP regulations. Food safety is thus achievedusing GHPs and an operational program is distributed usingHACCP principles where possible by establishing CCPs (EU, 2004;ISO, 2005).

Training and education are essential to ensure workers haveadequate awareness and knowledge to comply with food hygienerequirements. However, such does not always result in a positivechange in food handling behavior (Seaman, 2010). The need fortraining of food handlers is an essential part of the HACCP concept,as recognized in EU legislation (EU, 2004). Knowledge alone doesnot alter attitudes toward food safety (Howes, McEwen, Grifths, &Harris, 1996). In food safety management, managers with a thor-ough knowledge of food safety issues and positive attitude towardfood safety have a competitive advantage over those who do not(Coleman, Grifth, & Botterill, 2000). Some studies have demon-strated that, although training may increase food safety knowledge,knowledge does not always result in positive changes in food-handling behaviors. This gap between knowledge and practiceexists because some food companies do not provide adequatetraining (Howes et al., 1996).

Schwartz (1975) identied a relationship between knowledge,attitude, and practice (KAP). Rennie (1995) demonstrated the KAPmodel assumes that an individuals behavior is dependent uponhis or her knowledge, and suggested that information will lead toattitude changes and then changes in practices. Although severalresearchers have identied numerous factors underlying food-handling practices, there is a general consensus that foodhandlers must have adequate food safety knowledge and theability to apply such knowledge in handling food (Mortlock,Peters, & Grifth, 1999). However, knowledge alone does notcause food handling practices to change. Social psychologistshave used behavioral models to further clarify other factors. Someof these attempts have been criticized for their not fullyacknowledging the inuence on behavior of attitude, a particu-larly difcult factor to change (Rennie, 1995). Ajzens (1991)theory of reasoned action model suggests it necessary to specif-ically investigate attitudinal components, especially intention toact due to its role as a best indicator of behavior. It has beensuggested that this model is awed in assuming knowledge as themain precursor of behavioral change (Ehiri, Morris, & McEwen,1997). It is clear that much more must be elicited aboutemployee attitudes toward food safety issues and legislation aswell as their potential to inuence practice.

Most studies of KAP in food safety have targeted schools (Yallow,Remig, & Higgins, 2009); Only a few have targeted large-scalecommercial restaurants. The Taiwan government has promotedHACCP certication for large-scale foodservice providers during thepast two years. This study investigates the relationships amongknowledge, attitudes, and intentions related to HACCP amongrestaurants employees. Findings can offer suggestions to foodser-vice industry executives and government ofcials regarding how toimprove food safety enforcement under HACCP. Structural equationmodeling (SEM) is used primarily as a conrmatory technique todetermine model validity. Fig. 1 shows the hypothesized interre-lationships in this study. Therefore, we hope to verify a correlationconrmatory between factors inuencing food safety knowledge,

W.-H. Ko / Food Conattitude, and HACCP practices using the method of SEM.2. Methodology

2.1. The sample and data collection

Participant selection used a quota sampling method. Partici-pants were full- and part-time employees working at restaurants inTaipei City, Taiwan. All restaurants targeted by the study werecurrently HACCP certied. One hundred participants pilot testedthe questionnaire in November 2009 to assess question clarity,identify response options, and gauge likely interview timerequirements. We used pilot test results, item analysis, factoranalysis and other recommendations to revise the questionnaire.We distributed 542 questionnaires for the formal survey. A total of421 (77.7%) were returned between January and February, 2010 inthe pre-addressed, postpaid envelopes provided.

2.2. Measures

The questionnaire included four sections. Section one included20 yes/no questions assessing food safety knowledge. Questionsfocused on three central themes related to food poisoning issues,GHP standards, and the HACCP standard. A panel of Taiwan foodsafety experts developed these questions using food-borne illnesscase data (FDATaiwan, 2011), GHP and HACCP standards (Food GHP,2000; Jeng & Fang, 2003), discussions with research teammembers. Each correct answer was assigned 1 point, with no pointsassigned for wrong answers. Participant knowledge correlatedpositively with his/her score. The reliability of KR 20 was 0.72 forfood safety knowledge.

Sections two and three addressed food safety attitudes andHACCP practices, respectively, derived from Coleman et al. (2000)and GHP and HACCP standards. Items in all scales were scored

Food Safety Attitude

Food Safety Knowledge

HACCP Practice

Fig. 1. Model development.

29 (2013) 192e197 193The 5 items in the HACCP practices section drafted by the research

teamwere all retained following item analysis. Only one factor wasanalyzed by EFA. Cronbachs a for all scales was 0.815.

The nal section of the questionnaire collected data on partici-pant gender, age, years of work experience and education, theemployees department, and whether the participant wassupervised.

2.3. Statistical analysis

SPSS 17.0 software was used for data analysis, which includeddescriptive analysis, reliability analysis, and Pearsons correlationanalysis. We tested the research construct properties of theproposed model using SEM, a LISREL procedure (Joreskog &Sorbom, 1993) and then used correlation matrices and standarddeviations to test the hypothesized model in terms of SEM. Allpaths in the proposed model were interpreted as reecting causalrelationships among variables and latent constructs. We usedseveral measures to estimate model t. As the conventional c2 ttest is used to test exact t, we rejected it as inappropriate for thisstudy. We chose instead to use root mean square error of approx-imation (RMSEA), and recognized a value

Table 4HACCP practice for the employees.

Item Mean S.D.

I have a plan to achievemy HACCP goal.

4.15 0.640

I respect HACCP plan goals. 4.24 0.572I usually follow the HACCP

plan to maintain food safety.4.18 0.634

Knowledge of food sanitationhelps to perform my jobcorrectly.

4.23 0.602

I try hard to maintain foodsanitation standards.

4.22 0.626

Total 4.20 0.471

Table 6Goodness-of-t indices for the measurement model.

CFA results c2 df CFIa GFIb IFIc RMSEAd NFIe NNFIf

Measurement 12.71 7 0.99 0.99 0.99 0.044 0.97 0.97

N 421.a CFI comparative t index.b GFI goodness of t index.c IFI incremental t index.d RMSEA root mean square error of approximation.e NFI normed t index.f NNFI non-normed t index.

W.-H. Ko / Food Control 29 (2013) 192e197 195restaurants, with those working in Chinese restaurants (24.2%) andbanquet halls (16.6%) the next most numerous (Table 1). Please seethe line 176e182.

Food poisoning, GHPs, and HACCP practices were the threeconstructs in the food safety knowledge section. The average scorein this sectionwas 84.7%, with the food poisoning construct earningthe highest average score and the GHPs construct earning thelowest average score. Proper holding and refrigeration tempera-tures earned the lowest average scores of all items in the food safetyknowledge section (Table 2).

Self-improvement and food safety concern were the twoconstructs in the food safety attitude section. The food safetyconcern construct earned the highest average score (4.44) followedby the self-improvement aspect (4.16) (Table 3). The mean HACCPpractice score was 4.20 (Table 4). Results indicate that participants,while paying close attention to food safety, are less concerned withself-improvement. Food safety knowledge, attitude, and HACCPpractice constructs were strongly inter-correlated (Table 5). Weidentied no relationship between food safety attitudes and HACCPpractices in the food poisoning construct.

The model of food safety knowledge, attitude and HACCPpractices was to verify by SEM. In Table 6, the c2 for the measure-ment model was 12.71 (p 0.000), with 7 degrees of freedom (df).Technically, when assumptions are met, c2 may be statisticallyinsignicant. Although an c2/df ratio

g kn

trolbetween food poisoning knowledge and food safety attitude andHACCP practices, which were unrelated. We also found that foodsafety attitudes mediate the relationship between knowledge andHACCP practices.

Legislative governance of food sanitation guidelines canimprove the sanitation practices of catering employees (Worsfold,1996). Consumers can then choose restaurants with safe,hygienic, practical, and well-presented facilities that use packagedfoods before their expiration dates and havewell designed kitchens(Lin, 1997). Grifth and Clayton (2005) reported that knowledgeimproves practices, and suggested that factors such as staff atti-tudes can limit or prevent improvements in staff practices.

0.65

0.75*

0.23

B2 0.78

B1

Food Safety Attitude

0.31*

0.08

0.55

Food Safety Knowledge

0.59 A3

A2A1

Fig. 2. Model of food safety knowledge, attitude, and HACCP practice. A1: food poisoninB2: food safety concern attitude; C1: HACCP implementation (*P < 0.05).

W.-H. Ko / Food Con196Employee training has been shown to improve food safety knowl-edge and hygienic awareness (Worsfold, 1993) and potentiallyimprove food safety practices (Thompson, de Burger, & Kadri,2005). However, considerable evidence exists that improvedknowledge does not automatically translate into improved food-handling behaviors (Kassa, 2001). Attitude, an important supple-mentary factor to knowledge and enforcement, is necessary toreduce food-borne illness risk. A combination of positive behaviors,positive attitudes, and food handler education is necessary toimprove food-handling safety (Howes et al., 1996).

Managers, supervisors, and operators all have important roles toplay in HACCP system implementation. Fletcher et al. (2009) indi-cated staff in large hotels to be more knowledgeable about HACCPplans, HACCP principles, and related standard operating proce-dures. Such knowledge enhances knowledge transfer, feedback,self-control, and individual commitment to HACCP (Eves & Dervisi,2005). Managers blamed improper HACCP implementation oninadequate employee knowledge, time constraints, and the largeamount of required documentation. Application of HACCP has beendemonstrated as more consistent and smooth in companies thatalready followed good manufacturing practices (Eves & Dervisi,2005). We thus expect training on GHPs and HACCP to positivelyaffect staff attitude and behavior.

Training food handlers has been identied as one of the mosteffective interventions to increase the safety of food served bystreet (Hanashiro, Morita, Matt, Matt & Torres, 2005) andencourage the adoption of hygienic practices (Egan et al., 2007).However, research results obtained by this study found a negligibleimpact of knowledge on HACCP practices. Instead, we found thatattitude mediated these two variables. Government evaluations ofthe HACCP system should be codied as part of national strategiesto prevent and control of food-borne illnesses in the food andhospitality industry. Improving employee knowledge throughtraining is extremely important in terms of fostering positive atti-tudes supportive of desirable food sanitation behaviors. Foodser-vice companies can also establish committees to monitor foodsanitation and maintain food safety. Although food safety trainingprograms are essential, they do not necessarily result in desiredbehavioral changes. Program impact evaluations are necessary to

owledge; A2: GHP knowledge; A3: HACCP knowledge; B1: self-improvement attitude,1.00 C1HACCP Practice

29 (2013) 192e197demonstrate program effectiveness and recommend improve-ments. Evaluating HACCP system functions and managerial controlin the hospitality industry are two recommended areas of futureresearch.

5. Limitations

This study enrolled employees of restaurants located in TaipeiCity. Thus, analytical results cannot be generalized to all hospitalityindustry employees in Taiwan. Expanding the recruitment scopewould help improve result generalizability. Also, self-reported dataused in this study may reect participant biases.

References

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and HumanDecision Processes, 50, 179e211.

Angelillo, I. F., Foresta, M. R., Scozzafava, C., & Pavia, M. (2001). Consumers andfoodborne diseases: knowledge, attitudes and reported behavior in one regionof Italy. International Journal of Food Microbiology, 64, 161e166.

Bolton, D. J., Meally, A., Blair, I. S., McDowell, C. A., & Cowan, C. (2008). Food safetyknowledge of head chefs and catering managers in Ireland. Food Control, 19,291e300.

Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model t.Sociological Methods and Research, 21, 230e258.

Clayton, D. A., & Grifth, C. J. (2004). Observation of food safety practices in cateringusing notational analysis. British Food Journal, 106, 221e227.

Coleman, P., Grifth, C. J., & Botterill, D. (2000). Welsh caterers: food safety beliefsand attitudes. International Journal of Hospitality Management, 19, 145e157.

DOH. (2001). Food safety control system for ready-to-eat food factories. Hsinchu,Taiwan, Republic of China: Food Industry Research and Development Institute.

Egan, M. B., Raats, M. M., Grubb, S. M., Eves, A., Lumbers, M. L., Dean, M. S., et al.(2007). A review of food safety and food hygiene training studies in thecommercial sector. Food Control, 18, 1180e1190.

Ehiri, J. E., Morris, G. P., & McEwen, J. (1997). Evaluation of a food hygiene trainingcourse in Scotland. Food Control, 8, 137e147.

European Union. (2004). Corrigendum to regulation (EC) 852/2004 of the Europeanparliament and of the council of 29 April 2004 on the hygiene of foodstuffs.Ofcial Journal of the European Union, .

Eves, A., & Dervisi, P. (2005). Experiences of the implementation and operation ofhazard analysis critical control points in the food service sector. InternationalJournal of Hospitality Management, 24, 3e19.

FDA Taiwan. (2011). 1981e2010 Foodborne illness reported in Taiwan. Retrieved 12.11.11,from. http://www.fda.gov.tw/content.aspx%3fsite_content_sn%3d%20323.

Fletcher, S. M., Maharaj, S. R., & James, K. (2009). Description of the food safetysystem in hotel and how it compares with HACCP standards. Journal of TravelMedicine, 16, 35e41.

Food GHP. (2000). Food good hygienic practice (GHP). Retrieved 25.10.11, from. http://www.fda.gov.tw/les/people_laws/%20Food%20good%20hygienic%20practice%20(GHP)%20-20000907.doc.

Gilling, S., Taylor, E. A., Kane, K., & Taylor, J. Z. (2001). Successful HACCP imple-mentation in the UK: understanding the barriers through the use of a behav-ioral adherence model. Journal of Food Protection, 64, 710e715.

Grifth, C. J., & Clayton, D. (2005). Food safety knowledge, attitudes and practices ofcaterers in the UK. In B. Maunsell, & D. J. Bolton (Eds.), Restaurant and cateringfood safety. Dublin, Ireland: Teagasc.

Hanashiro, A., Morita, M., Matt, G. R., Matt, M. H., & Torres, E. A. F. S. (2005).Microbiological quality of selected street foods from a restricted area of SoPaulo city, Brazil. Food Control, 16, 439e444.

Howes, M., McEwen, S., Grifths, M., & Harris, L. (1996). Food handler certicationby home study: measuring changes in knowledge and behavior. Dairy, Food andEnvironmental Sanitation, 16, 737e744.

ISO. (2005). Food safety management systems e Requirements for any organization inthe food chain. Geneva (Switzerland): International Standardization Organization.

Jeng, H. Y. J., & Fang, T. J. (2003). Food safety control system in Taiwanethe exampleof food service sector. Food Control, 14, 317e322.

Joreskog, K. G., & Sorbom, D. (1993). LISREL 8: Users reference guide. Chicago, I.L:Scientic Software International.

Kassa, H. (2001). An outbreak of Norwalk-like viral gastroenteritis in a frequentlypenalized food service operation. Journal of Environmental Health, 64(10), 9e33.

Lin, M. R. (1997). The study of food sanitation and environment in school restaurant.Environment Education Quarterly, 32, 74e87.

Mortlock, M. P., Peters, A. C., & Grifth, C. (1999). Food hygiene and HACCP in the UKfood industry, practices, perceptions and attitudes. Journal of Food Protection, 62,786e792.

Notermans, S., Zwietering, M. H., & Mead, G. C. (1994). The HACCP concept: iden-tications of potentially hazardous micro organisms. Food Microbiology, 11,203e214.

OBrien, S., Rooney, R., Stanwell-Smith, R., & Handysides, S. (1998). Taking control ofinfectious intestinal disease. Communicable Disease and Public Health, 1,144e145.

Rennie, D. M. (1995). Health education models and food hygiene education. Journalof Royal Social Health, 115, 75e79.

Route, N. (2001). HACCP and SMEs: a case study. In T. Mayes, & S. Mortimore (Eds.),Making the most of HACCP. Cambridge: Woodhead Publishing Ltd.

Schwartz, N. E. (1975). Nutrition knowledge, attitude, and practices of high schoolgraduates. Journal of American Dietary Association, 66, 28e31.

Seaman, P. (2010). Food hygiene training: introducing the food hygiene trainingmodel. Food Control, 21, 381e387.

Sun, Y. M., Wang, S. T., & Huang, K. W. (2012). Hygiene knowledge and practices ofnight market food vendors in Tainan city, Taiwan. Food Control, 23, 159e164.

Taylor, E. (2001). HACCP in small companies: benet or burden? Food Control, 2,217e222.

Thompson, S., de Burger, R., & Kadri, O. (2005). The Toronto food inspection anddisclosure system: a case study. British Food Journal, 107, 140e149.

Worsfold, D. (1993). Food safety, an appraisal of a training program. Journal RoyalSocial Health, 113, 317e319.

Worsfold, D. (1996). Training caterers for the new hygiene regulations. British FoodJournal, 98, 27e32.

Yallow, L., Remig, V. M., & Higgins, M. M. (2009). Food safety educational inter-vention positively inuences college students food safety attitudes, beliefs,knowledge, and self-reported practices. Journal of Environmental Health, 71,30e35.

W.-H. Ko / Food Control 29 (2013) 192e197 197

The relationship among food safety knowledge, attitudes and self-reported HACCP practices in restaurant employees1. Introduction2. Methodology2.1. The sample and data collection2.2. Measures2.3. Statistical analysis

3. Results4. Discussion and recommendations5. LimitationsReferences