International Journal of Public Health Science (IJPHS)

Vol. x, No. x, March 2020, pp. xx ~ xx

ISSN: 2252-8806, DOI: 10.11591 / ijphs.vxix.id  101

Food Handlers Knowledge, Attitudes and Practice in

Maintaining Food Quality: Systematic Review

Kholis Ernawati2, Qatrrunnada Nadhifah1, Anis Muslikha1, Muhammad Hidayat1, Rizki Maulana1,
Tia Aprilia Anjarnegara1, Dini Widianti2, Yusnita2, Zwasta Pribadi Mahardika2
1
Student Registrar, Faculty of Medicine, YARSI University
2
Lecturer at the Department of Public Health, YARSI University

Article Info ABSTRACT

Article history: Diseases caused through foodis still a public health problem in some
countries. Food handlers' knowledge, attitude and Practice (PSP) is one of the
aspects that is a risk factor for the incidence of disease caused by food. The
research objective was to assess the level of knowledge, attitudes and
Practice of food handlers in maintaining food quality using a systematic
review approach. The research method used a systematic review approach
Keywords: based on the PRISMA (Preffered Reporting Items for Systematic Review and
Meta Analyses) protocol. The research variables were sociodemography and
Food Handler PSP of food handlers. The article search process was accessed on three
Knowledge Attitude Practice electronic databases. The keywords used in the search for articles were food
Food Hygiene safety, food handler, KAP and hygiene. The article inclusion criteria were
quantitative research, primary data, publication year (11 September 2015 - 11
September 2020), in English, has gone through the peer review stage, and the
article is full text. Descriptive analysis was carried out on each research
variable. The results obtained 8 articles (100% sociodemography, 100%
knowledge, 62.5% attitude, and 87.5% Practice. The mean of significant
articles on sociodemographic variables was 18.5%, knowledge was 59.38%,
attitudes were 16.66%, and Practice was 30.61%.
In the majority of studies, the three aspects of PSP have a positive
relationship / correlation, thus indicating that knowledgefood handlers who
receive safety training have a higher chance than those who do not.
This is an open access article under the CC BY-SA license.

Corresponding Author:
,Name of Corresponding Author
,Department of Electrical and Computer Engineering
,National Chung Cheng University
.University Road, Minhsiung Township, Chiayi County 62102, Taiwan, ROC 168
Email: [email protected]

1. INTRODUCTION
Unclean and healthy Practice is one of the causes of various diseases in society [1]. One of the
impacts of unsanitary Practice is the emergence of food borne disease and it can cause death. Food that is
unsafe and contains bacteria, viruses, parasites, or chemicals, can cause 200 diseases ranging from diarrhea to
cancer[2].
World Health Organization estimates that around 600 million people worldwide have fallen ill
caused by food in 2015. This means that one in 10 people is affected, and 420 thousand and 33 million lose
their lives each month and every year [3]. WHO reports that there are about 2 million fatal cases of food

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102  ISSN: 2252-8806
poisoning occurring each year globally, especially in developing countries due to poor food safety and
general hygiene in these countries. In 2014, Malaysia recorded 49.79 cases of food poisoning per 100,000
population. More than 50% of the total cases of food poisoning are associated with improper handling of
food by food handlers. Outbreaks in academic institutions account for 43% of the total incidents of food
poisoning in Malaysia[4]. The Malaysian Ministry of Health has identified training ineffective food handlers,
their deliberate use of unsalted water and poor hygiene as major risk factors for food poisoning in the
country. Food handlers play an important role in ensuring food safety and prevention of food poisoning[5].
Infected food handlers can transmit gastrointestinal infectious disease agents through poor personal hygiene
practices. A previous study was successful. Salmonella is isolated from seafood but Salmonella is not a
common carrier. This is considered to be the result of cross-contamination by an infected food handler[6].
In 2007-2016 the Brazilian health ministry reported 6848 incidents of foodborne disease outbreaks
according to data from the National Notifiable Diseases Information System. Among the 610,465 people
exposed to danger, 121,283 people fell ill and 111 people died[7]. In Ethiopia there is little documentation for
the incidence of food born disease but in reality in Ethiopia many foods are not guaranteed health. In a study
conducted by Metadel Adane et al, only about 53% of foods were safe for consumption in samples taken
from roadside food colonizers. Another study showed that in Ethiopia, 2.5% of samples tested positive for
Escherechia Coli in food taken from meat sold by food colonizers.[8]. Bangladesh National Hygiene
Baseline Survey makes research as traders only know about 37% of cleanliness, this can have the potential to
trigger food born disease[9]. In Saudi Arabia, the food born disease outbreak has infected catering food
vendors, amounting to 1.26% of the 1000 catering food sellers[10].
In addition, many reports have shown that in Indonesia foodborne illness is still a public health
problem, based on data from the POM (2010) during the 2001-2009 period, 1,101 Extraordinary Events
(KLB) of food poisoning occurred. In 2015 data on extraordinary events (KLB), the types of food that caused
outbreaks of food poisoning in 2015 were household cooking as many as 25 incidents (40.98%), snack food
as many as 14 events (22.95%), food and food services as many as 13 incidence (21.31%), and processed
food as many as 9 events (14.75%)[11].
Lifestyle and human consumption Practice have changed, the tendency to prepare meals at home has
decreased and the consumption of food outside the home has increased. Increased consumption of food
outside of homes, restaurants and other eating establishments plays a role in increasing the risk of food-borne
diseases[12]. Foods that are cooked on a large scale have a higher chance of being contaminated. Food-borne
disease outbreaks due to contamination by food handlers are estimated to be 10 to 20%. Not paying attention
to food hygiene allows pathogens to come into contact with food, survive and increase in sufficient numbers
and further impact disease on consumers[3].
HygieneFood sanitation is an effort to maintain or control food factors, people, places and their
equipment which may or may cause illness or health problems. In good food management, there are several
factors of sanitation hygiene that must be considered as an effort to maintain good food quality, including
washing hands before contact with food and washing food with clean water. These Practice certainly have an
effect and can contribute to the occurrence of diarrhea disease.[13]. In addition, all food processing activities
must be protected from direct contact with the body. Protection of direct food contact with the body can be
done by wearing disposable gloves, using food tongs. To avoid contaminating food, clean clothes can be
used[14]. Another effort to maintain the quality of food remains good by storing foodstuffs in an appropriate
place because contamination can occur during the food processing process or through containers and or food
handlers that leave food at room temperature. While several studies have concluded that the risk factors for
the incidence of foodborne disease occur when cleaning cutlery, incompatibility with storage time
temperatures and low personal hygiene.[15]. In addition, other factors in an effort to maintain the quality of
food to stay good are certainly influenced by training and education for food handlers because it can be an
effective means of increasing knowledge and practice of food safety among food handlers to prevent
foodborne diseases, food handlers who receive training will have better understanding of safe food handling
practices as they may receive professional advice during training[16].
Several studies have proven the relationship between the level of knowledge, attitudes and Practice
of hygiene in food handlers which have an impact on food hygiene. According to Maywati, there is a
significant relationship between the level of knowledge and the hygiene practices of street food handlers[17].
Another researcher from Hiskia K et al, stated that there is a relationship between knowledge, attitudes, and
Practice with the personal hygiene of the food snack players around the snack market in Kotamobagu city.
[18].
Based on this, it is necessary to study the level of knowledge, attitudes and practice of food handlers
in maintaining food quality using a systematic review approach.

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2. METHOD
The research method uses a systematic review approach based on the PRISMA protocol (Preffered
Reporting Items for Systematic Review and Meta Analyzes). [19]. PRISMA protocol is used to identify
relevant research articles and includes sociodemographic, knowledge, attitude and practice (PSP) variables of
food handlers in maintaining food quality. The article search process was accessed on three electronic
databases, namely PLOS ONE, Pro Quest and Google Scholar. The keywords used in the search for journal
articles are food safety, food handler, KAP and hygiene.
The feasibility study was conducted using inclusion and exclusion criteria. The inclusion criteria set
are quantitative research, primary data, year of publication (11 September 2015 - 11 September 2020), in
English, have gone through the peer review stage, and are full text articles. The exclusions of this review are
qualitative research, literature other than articles, and literature review. Data extraction was carried out
through the Identification stage by searching for articles from the database, screening to determine the time
range, eligibility, and included screening to determine the title of the articles to be selected based on the
inclusion criteria. The results of the literature search were then analyzed descriptively narrative. Descriptive
analysis includes, (a) analysis based on sociodemographic factors consisting of age, gender,

3. RESULTS
The selection results based on keywords and following the PRISMA protocol obtained a total of
4,260 articles, and eliminated duplication of articles. Furthermore, in the screening based on the year of
publication (11 September 2015 - 11 September 2020), there were 1,8884 articles. Screening of English
journals, full text and having gone through the peer review stage obtained from PLOS ONE, ProQuest and
Google Schoolar, obtained 278 articles. An eligibility study was conducted to eliminate articles that did not
match the problem variables and did not match the established inclusion criteria. In the last stage, there were
8 articles that match the inclusion criteria.
Identification

Search results from the database with the keywords food safety, food handler, KAP
and hygiene, eliminating duplicate articles: Google Scholar (n = 2.978), ProQuest (n =
1.183), Plos One (n = 99). Total number of articles (n = 4,260)

11 September 2015 - Record Exclude

September 11, 2020 (n = 1,884) (n = 2,376)
Screening

(n = 693)
Record Exclude
(n = 1.606)
English articles, full text, quantitative, peer review
(n = 278)
Eligibility

Record Exclude
(n = 270)
Screening on titles and appropriate variables
(n = 8)
Included

Result: (n = 8)

Figure 1. Literature search results based on the PRISMA protocol

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Table 1. The distribution of articles is based on sociodemographic factors, knowledge, attitudes and
practice of food handlers in maintaining food quality
Variable Frequency Percentage (%)
(article)
Sociodemography of knowledge, 5 62.5%
attitudes and practice
Sociodemography of knowledge 2 25%
and practice
Sociodemography of knowledge 1 12.5%
total 8 100%

Based on table 1, it can be seen that articles discussing sociodemographic variables on knowledge,
attitudes and practice were found in 5 studies (62.5%). Meanwhile, articles discussing sociodemographic
variables on knowledge and practice were discussed in 2 studies (25%). As well as articles discussing
sociodemographic variables to knowledge were only discussed in 1 study (12.5%).

Table 2. Researcher Data, Research Location, Number of Samples and Number of Questions in the
Questionnaire on the Assessment of Sociodemographic Research Variables and KAP Food Handlers
Questionnaire Items on
Variables
Number
No Research Sociode-
Research of Attitud
(code) sites mograph Knowledg Practice
samples e
y e (item) (item)
(item)
(item)
D. Suryani et al., Yogyakarta,
1 Indonesia 109 5 11 22 11
2019 [20]
Al Madinah,
NA. Alqurashi et
2 Saudi Arabia 163 5 7 NA 8
al., 2019[21]
LI.Auad et al., Asa Norte and
3 2019 [22] Sao Paolo, 40 9 10 10 10
Brazil
AL. Doraliyana et Selangor and
al., 2018[23] Kuala
4 134 7 21 10 6
Lumpur,
Malaysia
J. Azanaw et al., Gondar,
5 Ethiopia 98 6 8 NA NA
2019 [24]
MK. Alam et al., Mymensingh
6 and Gazipur, 116 4 14 NA 14
2020[25]
Bangladesh
F. Ncube et al., Bindura,
7 Zimbabwe 101 6 20 15 20
2020 [26]
HK. Lee et al., Kuala
8 Lumpur, 111 7 60 14 12
2017[6] Malaysia
NA: Non Available (Not Available)

The number of research samples used and the number of item categories on the aspects assessed by
each factor are described in table 2 above. Table 2 illustrates the number of various research samples. The
assessment aspect items on the factors used in this community participation research vary, only 5 use these

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four factors (codes 1, 3, 4, 7, 8), then sociodemographic factors, knowledge and practice in 2 studies (code 2,
6), the last is sociodemographic and practice factors in 1 study (code 5).
Table 2 illustrates the distribution of samples and the factors used in the research of participating
food handlers. These articles link a variety of different factors, as inJ. Azanaw et al ,. 2019[24] linking the
sociodemographic aspects with knowledgein the form of basic knowledge about personal hygiene to prevent
the transmission of pathogens from food handlers to customers.[24]In the NA study. Alqurashi et al ,.
2019[21]and MK. Alam et al., 2020[25] linking sociodemographic aspects with knowledge and practice to
ensure food handlers have the skills and knowledge for food safety. [21], [25] Sociodemographic aspects
associated with the three KAP factors on D. Suryani et al ,. 2019[20] LI.Auad et al,. 2019[22] AL.
Doraliyana et al ,. 2018[23], F. NCube et al ,. 2020[26] and HK. Lee et al ,. 2017[6] evaluate understanding,
attitude and the practice of food handlers regarding the impact on food hygiene so as to produce good quality
food. [6], [22], [23], [26] Research with the four factors (sociodemography and KAP) will be very helpful to
provide better insights for the development of good food handling.

3.1. Sociodemographic Factors

Table 3. The distribution of articles is meaningful to determine the relationship between influencing
sociodemographic variables on food handlers on food quality
Research result
Factor
Category Code Frequency % Articles
Age Significant - 0 0%
No sign. (1,2,3,4,7) 5 62.5%
NA (5,6,8) 3 37.5%
Total 8 100%
Gender Significant (4) 1 12.5%
No sign. (1,3,5,7) 4 50%
NA (2,6,8) 3 37.5%
Total 8 100%
Education Significant (7) 1 12.5%
No sign. (1,4,8) 3 37.5%
NA (2,3,5,6) 4 50%
Total 8 100%
Experience Significant (2.8) 2 25%
No sign. (1,3,4,5,7) 5 62.5%
NA (6) 1 12.5%
Total 8 100%
Marital status Significant (3.5) 2 25%
No sign. - 0 0%
NA (1,2,4,6,7,8) 5 62.5%
Total 8 100%
Income per Significant (3) 1 12.5%
month No sign. (5) 1 12.5%
NA (1,2,4,6,7,8) 6 75%
Total 8 100%
The study mean is significant 18.5%
Information :
Sign: Significant NA: Non Available (Not Available)
Table 3 shows some of the sociodemographic aspects examined on community participation. Many
aspects can be included in this factor, but only 4 aspects that were studied the most in almost all studies,
namely age, gender, education, experience, marital status and monthly income. Then all variables are
categorized based on p value if <0.05 means significant and p> 0.05 is not significant. After that, the
sociodemographic variables were described one by one, namely starting from age, which did not affect the
quality of the food handlers in each article, it was found that p age> 0.05 was 5 articles with a percentage of
62.5% which indicated insignificant. For p gender more than 0.05, there are 4 articles with a percentage of
55% which indicates insignificance and there is 1 article with a percentage of 12.5%, significant value p
<0.05. On the p value of education, there is 1 article per month with a percentage of 12.5% which shows a p
value of 0.05 which means a significant value. Whereas for p experience and p marital status there are 2
articles with a percentage of 25%, p value <0.05, which indicates a significant result.
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Table 3 describes the sociodemographic factors. In terms of age, it does not provide significant
results or as much as 0%. On gender significant at 12.5% in articles with code (4) in article J, Azanaw et al ,.
2019[24]explained that the most food handlers are women 88%. In the education aspect, it is significant that
12.5% code (7) is in the NA article. Alqurashi et al ,. 2019[21] explained that as many as 48.5% of the
handlers knew the importance of cleanliness when preparing food serving such as washing hands, wearing
gloves before preparing food, cleaning knives, cutting boards and various other equipment. This research is
in line with the research of Kurniawan et al. 2019[27]which shows that there is a significant relationship
between the level of education and the actions of food handlers in handling food. This was also stated
according to Ramadani et al., 2017[28]The basic principle of sanitation needs to be done so that consumers
can be protected from harmful microorganisms and infectious diseases. This is regulated in the handling of
street food, namely food handlers, equipment, water, ingredients, food, food additives, serving and serving
facilities. Some of these aspects greatly affect the quality of food. In the aspect of experience, 25% of the
code is significant (2,8). In the article Metadel Adane et al., Explained that the inexperience of food handlers
is due to the lack of knowledge possessed by food handlers. Whereas in the article D. Suryani et al ,.
2019[20]. actually experience has no effect on food quality and safety. In the MK article. Alam et al.,
2020[25]85% of respondents did not have training on food safety and meat hygiene, although a large
proportion of slaughterhouses and meat handling center workers (90%) expressed willingness to attend food
safety or meat hygiene training. In the article J. Azanaw et al ,. 2019[24]., training can improve the overall
performance of food handlers in safe food handling practices. In this study, food handlers who received
safety training had a higher chance of good food safety practice because trained food handlers gained good
awareness through training, this morning was supported by other similar studies. An essential training
program to increase knowledge about food handlers. On the aspect of marital status it is significant 25% with
code (3.5). In the article J. Azanaw et al ,. 2019[24]., declaring marital status is another factor that is
significantly related to food safety practices and according to LI.Auad et al,. 2019[22], The survey results
showed a significant difference in attitude scores regarding marriage (p = 0.029), monthly income (p =
0.018), and food safety training (p = 0.033). There are no studies in the literature that link marital status or
monthly income with higher attitudes. On the aspect of significant monthly income, 12.5% with code (3). In
the MK article. Alam et al., 2020[25]., worker practice is related to various socio-economic factors such as
educational background, status and enthusiasm of workers (related to their income and social status).

3.2. Attitude and Practice Knowledge Factor

Food handlers PSP question patterns are usually divided into several question points, namely
personal hygiene, prevention of cross-contamination and sanitation, food handling, and health problems that
affect food.The following are some of the results of article assessments based on the main points of the food
handler PSP questionnaire in tabular form.

Table 4. The knowledge factor of food handlers on food quality

Research result
Factor
Category Code Freq. % Articles
personal hygiene Significant (2,4,5,6,7,8) 6 75%
No sign. (3) 1 12.5%
NA (1) 1 12.5%
Total 8 100%
Cross- Significant (2,4,5,6,7) 5 62.5%
contamination No sign. (3.8) 2 25%
prevention and NA (1) 1 12.5%
sanitation Total 8 100%
Food handling Significant (2,4,5,6,7,8) 6 75%
No sign. (3) 1 12.5%
NA (1) 1 12.5%
Total 8 100%
Health problems Significant (5.8) 2 25%
that affect food No sign. (1) 1 12.5%
NA (2,3,4,6,7) 5 62.5%
Total 8 100%
The study mean is significant 59.38%
Information :
Sign: Significant NA: Non Available (Not Available)

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Based on the data from table 4, it shows the distribution of aspects of the food handlers knowledge
factor. In this test analysis, what is shown is the most significant value of all existing aspects, it is said to be
significant if the P-Value <0.05.The aspects that were studied and had the highest significant value were
personal hygiene and food handling in 75% of the articles. This shows that personal hygiene and food
handling are the most significant aspects among other aspects. This was followed by the aspects of cross-
contamination prevention and sanitation in 62.5% of the articles and aspects of health problems that had an
effect on food in 25% of the articles. The average number of significant research articles on this factor was
59.38% of the articles. Significant results were obtained in all studies that discussed this aspect. Research that
does not address this aspect is categorized as non-available (NA).
According to Siswati ,. 2017[29]knowledge is everything that is known that is obtained from
sensory contact with a particular object. Knowledge is basically the result of the process of seeing, hearing,
feeling, and thinking which is the basis of humans and of behaving and acting. So it can be said that
knowledge about maintaining food quality should be a very influential factor for food handlers in an effort to
maintain food quality. The results of research J, Azanaw et al ,. 2019[24].,F. NCube et al ,. 2020[26]., and
MK. Alam et al., 2020[25].,the level of knowledge of food handlers related to the practice of maintaining
good food quality. Research from NA. Alqurashi et al ,. 2019[21], AL. Doraliyana et al ,. 2018[23]., and HK.
Lee et al ,. 2017[6].,shows that personal hygiene is the most influential factor in food handlers regarding food
quality. This is also supported by Miranti and Adi's research. 2018[30]and Assidiqi et al ,. 2019[31] which
shows that there is a relationship between knowledge and food handling hygiene. [30] [31] Research HK. Lee
et al ,. 2017[6]demonstrated that food handlers have good knowledge of personal hygiene but not cross-
contamination and sanitation because in Malaysia food handler training focuses more on personal hygiene
than prevention of the risk of cross-contamination of pathogens. However, Siti Makhampang's research
shows that there is no relationship between knowledge of health problems in food handlers. Research
LI.Auad et al,. 2019[22] stated that there was no significant relationship between knowledge, attitudes and
Practice towards food handlers. This is in line with Indriany's research. 2019[32] Rahmayani ,. [33]and
Amalia et al ,. 2015[34]which shows that there is no relationship between knowledge and food hygiene and
sanitation practices. The knowledge factor holds the highest percentage, namely 59.38% compared to the
attitude and practice factors from the systematical review results in this study.

Table 5. Attitude factors in food handlers on food quality

Research result
Factor
Category Code Frequency % Articles
View of knowledge about Significant (4.7) 2 40%
proper food handling No sign. - 0 0%
NA (1,3,8) 3 60%
Total 5 100%
View on maintaining Significant (4) 1 20%
personal hygiene No sign. - 0 0%
NA (1,3,7,8) 4 80%
Total 5 100%
A view of the separation Significant - 0 0%
between raw and cooked No sign. (4) 1 20%
foods NA (1,3,7,8) 4 80%
Total 5 100%
View of a safe place for Significant (4) 1 20%
food storage No sign. - 0 0%
NA (1,3,7,8) 4 80%
Total 5 100%
View on tool cleanliness Significant - 0 0%
No sign. (4) 1 20%
NA (1,3,7,8) 4 80%
Total 5 100%
View of work experience Significant (8) 1 20%
No sign. (7) 1 20%
NA (1,3,4) 3 60%
Total 5 100%
The study mean is significant 16.66%

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Information :
Sign: Significant NA: Non Available (Not Available)

Based on the data from table 5 shows the distribution of the food handlers attitude factor. It seems
that most of the aspects give the same value. . In this test analysis, what is shown is the most significant value
of all existing aspects, it is said to be significant if the P-Value <0.05. The aspect that has been researched
and has the highest significant value is the aspect of view of knowledge about proper food handling which
holds the highest percentage, namely 40%, this shows that this aspect is the most significant aspect from
other aspects. on the aspect of a view of maintaining personal hygiene 20%, a view of a safe place for food
storage 20% and a view of work experience 20%. View of the separation between raw food and cooked food
0% and 0% view of appliance cleanliness. The average research article that has a significant value on the
attitude factor based on the assessed aspects is 16.66% of the articles.
Based on data from table 5, in 5 articles that discuss aspects for attitude factors in the participation
of food handlers on the quality of food produced, the most significant results were obtained in one aspect,
namely the view of knowledge about correct food handling, amounting to 2 articles (40%) with different
articles. An insight into knowledge about proper food handling is contained in AL research. Doraliyana et
al ,. 2018[23]in the form of the importance of food handlers to have good knowledge in food safety, food
safety knowledge is mostly obtained through food safety training. This includes attending a certified training
course where participants are exposed to the importance of controlling temperature and time, personal
hygiene, safe food handling, and knowing the causes of foodborne disease spread. Other sources of food
safety knowledge are from printed educational materials and the use of new media where food safety
information can be found at fingertips.[23]About 95.5% of respondents rated that maintaining personal
hygiene while working was good. Keeping nails short, covering hair with a hair cap and washing hands
effectively are important habits to prevent cross-contamination. About 94.7% of food handlers agree on the
importance of food hygiene training to reduce the risk of contamination. Abdullah Sani and Siow found that
the attitude score of trained food handlers was higher than those who had never attended food safety training.
[35] However, it has been reported that, although food hygiene training can increase knowledge of food
safety, it is not the main factor affecting food handling practice and changing practices. [36]Approximately
89.6% agreed that cleaning hands effectively can prevent disease transmission through food. Regarding the
use of gloves, 91.9% of food handlers agreed or strongly agreed that washing hands is necessary before
wearing gloves. As many as 97.0% of respondents are positive that they must wear gloves when touching
ready-to-eat food to reduce contamination. A high percentage 96.3% of food handlers responded positively
that a person should take time off if they have a congenital disease that puts them at risk of contracting them
through food. Foodborne diseases are contagious diseases because they are easily transmitted if preventive
practice is not followed. Therefore,[37]About 90.3% agree that it is important to check the fridge or freezer
periodically to make sure it is working properly. Abdullah Sani and Siow, stated that 56.9% of respondents
also agreed that not monitoring refrigerator and freezer temperatures could harm health.[35]Food safety
attitudes have a significant positive relationship with overall food safety knowledge and personal hygiene
knowledge. This shows that the attitude of food handlers towards food safety increases with increasing
knowledge about food safety.[23] Based on other studies views on knowledge about proper food handling are
also found in the research of F. Ncube et al ,. 2020[26]that is, obtained a significant positive correlation
observed between food safety knowledge and attitudes. Good knowledge of food processing appears to
contribute to positive food safety attitudes. Positive correlations regarding food handlers' knowledge,
attitudes and practices of food safety are also reported in the literature (Abdul-Mutalib et al .; Abdullah Sani
& Siow; Al-Shabib, Mosilhey, & Husain.)[4], [35], [38]. In Brazil, de Souza, de Azevedo, & Seabra (2018)
also reported a positive correlation between food safety knowledge and self-reported food handling practices.
[26]. Overall, the attitude factor gives an average value of 16.66% which holds a lower percentage than the
average value of knowledge and practice.

Table 6. Practice factors in food handlers on food quality

Research result
Factor
Category Code Frequency % Articles
Wash hands before contact Significant (6.7) 2 28.57%
with food No sign. (1,2,3,4) 4 57.14%
NA (8) 1 14.29%
Total 7 100%
Wear a clean mask and Significant (6) 1 14.29%
uniform while working No sign. (1,2,4) 3 42.86%
NA (3,7,8) 3 42.86%

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Total 7 100%
Washing food items or Significant (6.7) 2 28.57%
utensils with clean water No sign. - 0 0%
NA (1,2,3,4,8) 5 71.43%
Total 7 100%
Wear gloves when in Significant (6.8) 2 28.57%
contact with food No sign. - 0 0%
NA (1,3,4,7,8) 5 71.43%
Total 7 100%
Store food ingredients in a Significant (6.7) 2 28.57%
suitable place No sign. (3,4) 2 28.57%
NA (1,2,8) 3 42.86%
Total 7 100%
Not smoking or coughing Significant (7) 1 14.29%
and sneezing while No sign. (1) 1 14.29%
preparing food NA (2,3,4,6,8) 5 71.43%
Total 7 100%
Food handlers doing the Significant (2,3,4,5,6) 5 71.42%
training No sign (1) 1 14.29%
NA (7) 1 14.29%
Total 100%
The study mean is significant 30.61%
Information :
Sign: Significant NA: Non Available (Not Available)

Based on the data from table 6, it shows the distribution of aspects of the food handler practice
factors.In this test analysis, what is shown is the most significant value of all existing aspects, it is said to be
significant if the P-Value <0.05.The aspect that is widely researched and has the highest significant value is
the food handlers who have conducted training on 71.42% of the articles. This shows that the food handlers
who carry out training are the most significant aspect among other aspects. this was followed by the aspect of
washing hands before contact with food, washing food ingredients or tools with clean water, wearing gloves
when in contact with food and storing food items in an appropriate place in 28.57% of the articles. Then
followed by the aspect of wearing a clean mask and uniform while working and not smoking or coughing and
sneezing when preparing food in 14.29% of the articles. The average research article was significant on this
factor of 30.61% of the articles. Significant results were obtained in all studies that discussed this aspect.
Research that does not address this aspect is categorized as non-available (NA). Research that does not have
a p value is also categorized as non-available (NA).
Table 6 discusses practicel factors in maintaining food quality for food handlers or food managers,
the expected practice is a form of practice in maintaining food quality. According to S. Notoatmodjo, health
practice is basically a person's (organism) response to stimuli related to illness and disease, the health service
system, food and the environment. Health practice includes health prevention practice which is a response to
prevent disease[39]. Food handlers who did the previous training gave significant results in 5 of the 7
articles. According to research by Al Shabib et al ,. 2016[38]training and education can be effective means of
increasing knowledge and practices of food safety among food handlers to prevent foodborne diseases. This
finding is supported by the research of J. Azanaw et al ,. 2019[24]The number of food handlers who received
food safety training in this study was higher than the findings of Bahir Dar (21.8%), and Mekelle (5.4%).
Food handlers who receive training will have a better understanding of safe food handling practices because
they may receive professional advice during the training. Training can improve the overall performance of
the food handler in safe food handling practices. According to ResearchNA. Alqurashi et al ,. 2019[21],
indicating that 68.1% of all staff have received food safety training and 63.8% of respondents understand
HACCP as a system for ensuring safe food by identifying and controlling certain hazards, indicating an
emphasis on food safety training in hospitals in Madinah. It is said that training universally reduces the
incidence of food-based diseases caused by food handlers in food companies. The study also emphasizes that
food safety training can effectively increase food safety knowledge.Washing hands before contact with food
and washing food items or tools cleanly gave the same significant results in 2 out of 7 articles (28.57%).
According to research by Retno at al ,. 2013[13] the act of washing hands is the most important basic
technique in preventing and controlling the transmission of infection, this is in line with the research of

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110  ISSN: 2252-8806
Purwandari et al. that the relationship between hand washing practice and the incidence of infectious diseases
shows a significant relationship. [13]. Washing hands is often considered a trivial thing in society, even
though washing hands can contribute to improving the community's health status. While wearing a mask
andclean uniform while working gave significant results in 1 in 7 articles (14.29%). In the research of K.
Putri et al ,. Based on the results of statistical tests, the relationship between personal hygiene practices of
food handlers in maintaining personal hygiene and clothing with E. coli bacterial contamination in food was
obtained P value = 0.372. This proves that there is no relationship between personal hygiene practices of food
handlers in maintaining personal hygiene and clothes with bacterial contamination in food[40]. Wearing
gloves when in contact with food gave significant results in 2 out of 7 articles (28.57%). In the NA study.
Alqurashi et al ,. 2019[21] the majority of staff (81%) wear gloves when handling food during preparation
[21]. There was a slight difference between respondents who reported that they felt uncomfortable wearing
gloves during food preparation and those who never used gloves (3.7% and 3.1%). Storing food ingredients
in an appropriate place when preparing meals gave the same significant results 1 in 7 articles (14.29%). The
application of food storage is needed to improve the quality of the food itself, based on the research of
Gultom et al. 2019[15]. that the storage of foodstuffs on food quality from the results of the correlation test
and determination of 63.2%, there is a strong relationship between the effect of food storage on food quality
with a value of 0.795.

3.3. Relationship of Knowledge and Attitude with Food Handlers Practice in Maintaining Food Quality

Table 7. The relationship between knowledge and attitude with food handler practice maintains food quality
Variable Article Code p
Knowledge & attitude with practice 4 0.005 & 0.015
8 <0.05 & <0.05
Knowledge with practice 7 0.001
Attitude with practice 1 0.031

Based on data from table 7, it shows the relationship between knowledge and practice and the
relationship between attitude and practice. Onknowledge and attitude variables when associated with practice
obtained a significant relationship in 2 articles, namely AL. Doraliyana et al ,. 2018[23] and HK. Lee et al ,.
2017[6] which shows that there is a significant relationship with p value <0.05. While the relationship
between knowledge and practice obtained a significant relationship in 1 article, namelyF. NCube et al ,.
2020[26] which shows that there is a significant relationship with a p value of 0.001. ThenThe relationship
between attitude and practice has a significant relationship in 1 article, namely D. Suryani et al ,. 2019[20]
which shows that there is a significant relationship with a p value of 0.031.
Based on data from table 7, there are 6 articles that discuss the relationship between knowledge and
attitudes with practice,knowledge with practice and the relationship between attitudes and practice in food
handlers in maintaining food quality. In the AL research. Doraliyana et al ,. 2018[23] F. NCube et al ,.
2020[26]and HK. Lee et al ,. 2017[6] The results show that there is a relationship between knowledge and
practice of food handlers in maintaining food quality, implied that the higher the knowledge of food safety,
the better the food safety practice [16]. This is supported by previous research by Abdullah Sani & Siow ,.
2014[35]that is, obtained a significant positive correlation between knowledge and practice of food handlers
in maintaining food quality. On researchD. Suryani et al ,. 2019[20], AL. Doraliyana et al ,. 2018[23] and
HK. Lee et al ,. 2017[6] The results show that there is a relationship between attitudes and practice of food
handlers in maintaining food quality, demonstrated that food handlers' food hygiene practices will improve
with better food safety knowledge and translated from positive food safety attitudes [19]. This is also
supported by previous research by Shabib NA et al ,. 2016[38]and Amalia IS et al ,. 2015[34] that is,
obtained a significant positive correlation between attitudes and practices of food handlers in maintaining
food quality.

4. CONCLUSION
In the majority of studies, the three aspects of KAP have a positive relationship / correlation, thus
indicating that knowledgefood handlers who receive safety training have a higher chance than those who do
not receive training because food handlers are trained and have good awareness to maintain food quality.
The results of a good KAP aspect can provide direct output, namely increase the use of safe food
handling practices. Therefore, it is necessary to prioritize increasing the knowledge and attitudes of food
safety from food handlers, through measures such as the provision of basic and advanced food safety training
programs.This study also provides findings from each article that can be used as a reference for further
research. The author hopes that further research can reduce the limitations of this study.

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WRITER BIOGRAPHY

Name: Qatrunnada Nadhifah

Email: [email protected]
Institution: YARSI University
Address of the Institution: Jalan Letjen Suprapto No. 13, RT10 / RW5, Cempaka Putih, Central
Jakarta, 10510, Indonesia.
Field: Public Health

Name: Anis Muslikha

Email: [email protected]
Institution: YARSI University
Address of the Institution: Jalan Letjen Suprapto No. 13, RT10 / RW5, Cempaka Putih, Central
Jakarta, 10510, Indonesia.
Field: Public Health

Name: Muhammad Hidayat

Email: [email protected]
Institution: YARSI University
Address of the Institution: Jalan Letjen Suprapto No. 13, RT10 / RW5, Cempaka Putih, Central
Jakarta, 10510, Indonesia.
Field: Public Health

Title of manuscript is short and clear, implies research results (First Author)
114  ISSN: 2252-8806

Name: Rizki Maulana

Email: [email protected]
Institution: YARSI University
Address of the Institution: Jalan Letjen Suprapto No. 13, RT10 / RW5, Cempaka Putih, Central
Jakarta, 10510, Indonesia.
Field: Public Health

Name: Tia Aprilia Anjarnegara

Email: [email protected]
Institution: YARSI University
Address of the Institution: Jalan Letjen Suprapto No. 13, RT10 / RW5, Cempaka Putih, Central
Jakarta, 10510, Indonesia.
Field: Public Health

Int. J. Public Health Sci, Vol. x, No. x, March 2020: xx - xx