School of Occupational and Public Health, Ryerson University, 350 Victoria Street, POD 249, Toronto, Ontario, Canada M5B 2K3 (ORCID: https://orcid.org/0000-0002-5575-5174 [I.Y.]).
National Microbiology Laboratory, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, Ontario, Canada N1G 5B2.
J Food Prot. 2019 Oct;82(10):1714-1728. doi: 10.4315/0362-028X.JFP-19-108.
Improper food handling among those working in retail and food service settings is a frequent contributor to foodborne illness outbreaks. Food safety training and education interventions are important strategies to improve the behaviors and behavioral precursors (e.g., knowledge and attitudes) of food handlers in these settings. We conducted a comprehensive systematic review to identify, characterize, and synthesize global studies in this area to determine the overall effectiveness of these interventions. The review focused on experimental studies with an independent control group. Review methods included structured search strategy, relevance screening of identified abstracts, characterization of relevant articles, risk of bias assessment, data extraction, meta-analysis of intervention effectiveness for four outcome categories (attitudes, knowledge, behavior, and food premise inspection scores), and a quality of evidence assessment. We identified 18 relevant randomized controlled trials (RCTs) and 29 nonrandomized trials. Among RCTs, 25 (64%) unique outcomes were rated as high risk of bias, primarily owing to concerns about outcome measurement methods, while 45 (98%) nonrandomized trial outcomes were rated as serious risk of bias, primarily because of concerns about confounding bias. High confidence was identified for the effect of training and education interventions to improve food handler knowledge outcomes in eight RCT studies (standardized mean difference = 0.92; 95% confidence interval: 0.03, 1.81; = 86%). For all other outcomes, no significant effect was identified. In contrast, nonrandomized trials identified a statistically significant positive intervention effect for all outcome types, but confidence in these findings was very low due to possible confounding and other biases. Results indicate that food safety training and education interventions are effective to improve food handler knowledge, but more evidence is needed on strategies to improve behavior change.
在零售和食品服务场所工作的人员，如果食品处理不当，往往会导致食源性疾病爆发。食品安全培训和教育干预是改善这些场所食品处理人员行为和行为前体（例如，知识和态度）的重要策略。我们进行了一项全面的系统评价，以确定、描述和综合全球在这一领域的研究，以确定这些干预措施的总体效果。该综述侧重于具有独立对照组的实验研究。综述方法包括结构化搜索策略、对已确定摘要的相关性筛选、相关文章的特征描述、偏倚风险评估、数据提取、对四类干预效果进行荟萃分析（态度、知识、行为和食品前提检验分数），以及证据质量评估。我们确定了 18 项相关的随机对照试验（RCT）和 29 项非随机试验。在 RCT 中，25 项（64%）独特的结果被评为高偏倚风险，主要是由于对结果测量方法的担忧，而 45 项（98%）非随机试验结果被评为严重偏倚风险，主要是由于对混杂偏倚的担忧。在八项 RCT 研究中（标准化均数差=0.92；95%置信区间：0.03，1.81； = 86%），培训和教育干预对提高食品处理人员知识结果的效果被确定为高度置信。对于所有其他结果，没有发现显著效果。相比之下，非随机试验确定了所有结果类型的干预效果均具有统计学意义，但由于可能存在混杂和其他偏倚，对这些发现的信心非常低。结果表明，食品安全培训和教育干预措施可以有效提高食品处理人员的知识水平，但需要更多关于改善行为改变策略的证据。
