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Insfran-Rivarola A, Tlapa D, Limon-Romero J, Baez-Lopez Y, Miranda-Ackerman M, Arredondo-Soto K, Ontiveros S. A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers. Foods 2020; 9:E1169. [PMID: 32854221 PMCID: PMC7555000 DOI: 10.3390/foods9091169] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 12/02/2022] Open
Abstract
Foodborne diseases are a significant cause of morbidity and mortality worldwide. Studies have shown that the knowledge, attitude, and practices of food handlers are important factors in preventing foodborne illness. The purpose of this research is to assess the effects of training interventions on knowledge, attitude, and practice on food safety and hygiene among food handlers at different stages of the food supply chain. To this end, we conducted a systematic review and meta-analysis with close adherence to the PRISMA guidelines. We searched for training interventions among food handlers in five databases. Randomized control trials (RCT), quasi-RCTs, controlled before-after, and nonrandomized designs, including pre-post studies, were analyzed to allow a more comprehensive assessment. The meta-analysis was conducted using the random-effects model to calculate the effect sizes (Hedges's g) and 95% confidence interval (CI). Out of 1094 studies, 31 were included. Results showed an effect size of 1.24 (CI = 0.89-1.58) for knowledge, an attitude effect size of 0.28 (CI = 0.07-0.48), and an overall practice effect size of 0.65 (CI = 0.24-1.06). In addition, subgroups of self-reported practices and observed practices presented effect sizes of 0.80 (CI = 0.13-1.48) and 0.45 (CI = 0.15-0.76) respectively.
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Affiliation(s)
- Andrea Insfran-Rivarola
- Departamento de Ingeniería Industrial, Facultad de Ingeniería, Universidad Nacional de Asunción, Paraguay, San Lorenzo 2160, Paraguay;
- Facultad de Ingeniería, Arquitectura y Diseño–Universidad Autónoma de Baja California, Ensenada 22870, Mexico;
| | - Diego Tlapa
- Facultad de Ingeniería, Arquitectura y Diseño–Universidad Autónoma de Baja California, Ensenada 22870, Mexico;
| | - Jorge Limon-Romero
- Facultad de Ingeniería, Arquitectura y Diseño–Universidad Autónoma de Baja California, Ensenada 22870, Mexico;
| | - Yolanda Baez-Lopez
- Facultad de Ingeniería, Arquitectura y Diseño–Universidad Autónoma de Baja California, Ensenada 22870, Mexico;
| | - Marco Miranda-Ackerman
- Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma de Baja California, Tijuana 22390, Mexico; (M.M.-A.); (K.A.-S.)
| | - Karina Arredondo-Soto
- Facultad de Ciencias Químicas e Ingeniería, Universidad Autónoma de Baja California, Tijuana 22390, Mexico; (M.M.-A.); (K.A.-S.)
| | - Sinue Ontiveros
- Facultad de Ciencias de la Ingeniería, Administrativas y Sociales, Universidad Autónoma de Baja California, Tecate 21460, Mexico;
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Young I, Greig J, Wilhelm BJ, Waddell LA. Effectiveness of Food Handler Training and Education Interventions: A Systematic Review and Meta-Analysis. J Food Prot 2019; 82:1714-1728. [PMID: 31536416 DOI: 10.4315/0362-028x.jfp-19-108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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; I2 = 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.
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Affiliation(s)
- Ian Young
- 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.])
| | - Judy Greig
- National Microbiology Laboratory, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, Ontario, Canada N1G 5B2
| | - Barbara J Wilhelm
- Big Sky Health Analytics, P.O. Box 3339, Vermilion, Alberta, Canada T9X 2B3
| | - Lisa A Waddell
- National Microbiology Laboratory, Public Health Agency of Canada, 160 Research Lane, Suite 206, Guelph, Ontario, Canada N1G 5B2
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Hanratty B, Craig D, Brittain K, Spilsbury K, Vines J, Wilson P. Innovation to enhance health in care homes and evaluation of tools for measuring outcomes of care: rapid evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BackgroundFlexible, integrated models of service delivery are being developed to meet the changing demands of an ageing population. To underpin the spread of innovative models of care across the NHS, summaries of the current research evidence are needed. This report focuses exclusively on care homes and reviews work in four specific areas, identified as key enablers for the NHS England vanguard programme.AimTo conduct a rapid synthesis of evidence relating to enhancing health in care homes across four key areas: technology, communication and engagement, workforce and evaluation.Objectives(1) To map the published literature on the uses, benefits and challenges of technology in care homes; flexible and innovative uses of the nursing and support workforce to benefit resident care; communication and engagement between care homes, communities and health-related organisations; and approaches to the evaluation of new models of care in care homes. (2) To conduct rapid, systematic syntheses of evidence to answer the following questions. Which technologies have a positive impact on resident health and well-being? How should care homes and the NHS communicate to enhance resident, family and staff outcomes and experiences? Which measurement tools have been validated for use in UK care homes? What is the evidence that staffing levels (i.e. ratio of registered nurses and support staff to residents or different levels of support staff) influence resident outcomes?Data sourcesSearches of MEDLINE, CINAHL, Science Citation Index, Cochrane Database of Systematic Reviews, DARE (Database of Abstracts of Reviews of Effects) and Index to Theses. Grey literature was sought via Google™ (Mountain View, CA, USA) and websites relevant to each individual search.DesignMapping review and rapid, systematic evidence syntheses.SettingCare homes with and without nursing in high-income countries.Review methodsPublished literature was mapped to a bespoke framework, and four linked rapid critical reviews of the available evidence were undertaken using systematic methods. Data were not suitable for meta-analysis, and are presented in narrative syntheses.ResultsSeven hundred and sixty-one studies were mapped across the four topic areas, and 65 studies were included in systematic rapid reviews. This work identified a paucity of large, high-quality research studies, particularly from the UK. The key findings include the following. (1) Technology: some of the most promising interventions appear to be games that promote physical activity and enhance mental health and well-being. (2) Communication and engagement: structured communication tools have been shown to enhance communication with health services and resident outcomes in US studies. No robust evidence was identified on care home engagement with communities. (3) Evaluation: 6 of the 65 measurement tools identified had been validated for use in UK care homes, two of which provide general assessments of care. The methodological quality of all six tools was assessed as poor. (4) Workforce: joint working within and beyond the care home and initiatives that focus on staff taking on new but specific care tasks appear to be associated with enhanced outcomes. Evidence for staff taking on traditional nursing tasks without qualification is limited, but promising.LimitationsThis review was restricted to English-language publications after the year 2000. The rapid methodology has facilitated a broad review in a short time period, but the possibility of omissions and errors cannot be excluded.ConclusionsThis review provides limited evidential support for some of the innovations in the NHS vanguard programme, and identifies key issues and gaps for future research and evaluation.Future workFuture work should provide high-quality evidence, in particular experimental studies, economic evaluations and research sensitive to the UK context.Study registrationThis study is registered as PROSPERO CRD42016052933, CRD42016052933, CRD42016052937 and CRD42016052938.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Katie Brittain
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - John Vines
- Northumbria School of Design, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, University of Manchester, Manchester, UK
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Spiva L, Johnson K, Robertson B, Barrett DT, Jarrell NM, Hunter D, Mendoza I. The Effectiveness of Nurses’ Ability to Interpret Basic Electrocardiogram Strips Accurately Using Different Learning Modalities. J Contin Educ Nurs 2012; 43:81-9. [DOI: 10.3928/00220124-20111011-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 08/11/2011] [Indexed: 11/20/2022]
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The Effects of Information Technology on Perioperative Nursing. AORN J 2010; 92:528-40; quiz 541-3. [DOI: 10.1016/j.aorn.2010.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2010] [Accepted: 02/22/2010] [Indexed: 11/22/2022]
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Chau JPC, Lam LW, Lui MHL, Ip WY, Chien WT, Lee IFK, Thompson DR. A survey of registered nurses’ perceptions of the code of professional conduct in Hong Kong. J Clin Nurs 2010; 19:3527-34. [DOI: 10.1111/j.1365-2702.2010.03349.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cox J, Roche S, Van Wynen E. The effects of various instructional methods on retention of knowledge about pressure ulcers among critical care and medical-surgical nurses. J Contin Educ Nurs 2010; 42:71-8. [PMID: 20704094 DOI: 10.3928/00220124-20100802-03] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 06/24/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND To determine whether there was a difference in retention of knowledge about pressure ulcers with a traditional lecture versus computer-based instruction. METHODS A quasi-experimental, pretest/posttest design was used. Medical-surgical and critical care nurses (N = 60) were randomly assigned to a lecture, to computer-based instruction, or to a control group. Study participants were given the pressure ulcer knowledge test before and immediately after the program and at 3-month and 6-month intervals. RESULTS Analysis of variance showed statistically significant differences in pretest and posttest scores [F(2, 57) = 35.784, p = .000] and in posttest to 3-month scores [F(2, 57) = 18.427, p = .000] among the three groups. CONCLUSION The most significant loss of pressure ulcer knowledge, regardless of educational method, occurred within the first 3 months. Based on these findings, quarterly education in pressure ulcer prevention is recommended to maintain knowledge. Computer-based instruction is a viable option for acquisition and retention of knowledge about pressure ulcer prevention.
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Affiliation(s)
- Jill Cox
- Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
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Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O'Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2009; 2009:CD003030. [PMID: 19370580 PMCID: PMC7138253 DOI: 10.1002/14651858.cd003030.pub2] [Citation(s) in RCA: 652] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not. OBJECTIVES To assess the effects of educational meetings on professional practice and healthcare outcomes. SEARCH STRATEGY We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006. SELECTION CRITERIA Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots. MAIN RESULTS In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes. AUTHORS' CONCLUSIONS Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.
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Affiliation(s)
- Louise Forsetlund
- Norwegian Knowledge Centre for the Health Services, PO Box 7004, St Olavs plass, Oslo, Norway, 0130.
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Harrington SS, Walker BL. The effects of computer-based fire safety training on the knowledge, attitudes, and practices of caregivers. J Contin Educ Nurs 2009; 40:79-86. [PMID: 19263929 DOI: 10.3928/00220124-20090201-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Older adults in small residential care facilities are at a high risk of fire death and injury because of their characteristics and environment. The authors investigated computer-based instruction as a way to teach fire emergency planning to caregivers from small residential care facilities. Study participants (N=59) who completed the training significantly improved their scores from pretest to posttest when compared to a control group. Participants indicated on the course evaluation that the computers were easy to use (97%) and that they would like to use computers for future training courses (97%).
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Affiliation(s)
- Susan S Harrington
- Harrington Software Associates, Inc, 7431 Wilson Road, Warrenton, VA 20186, USA
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