Determinants of Safe Food Handling Behavior: A Case Study Integrating Sociodemographic and KAP Factors in Hospital Nutrition Installation

Eksanti Kusuma Wardani; Enny Suswati; Farida Wahyu Ningtyias

doi:10.55927/t953sc59

Authors

Eksanti Kusuma Wardani Department of Public Health, University of Jember Author
Enny Suswati Department of Public Health, University of Jember Author
Farida Wahyu Ningtyias Department of Public Health, University of Jember Author

DOI:

https://doi.org/10.55927/t953sc59

Keywords:

Food Handlers, Safe Food Handling, Sociodemographic, Knowledge Attitude Practice (KAP)

Abstract

This study aims to analyze the determinants of food safety behavior among food handlers by integrating sociodemographic factors and the Knowledge–Attitude–Practice (KAP) framework in the context of hospital nutrition facilities. This research used a qualitative case study design, data were collected through in-depth interviews, direct observation, and documentation review of food handlers, heads of nutrition facilities, nutritionists, and internal quality control officers. The results showed that the level of education and involvement in training greatly influenced food handlers' understanding of food safety principles, as well as shaping their attitudes and practices in implementing safe work procedures. Knowledge plays an important role in increasing awareness of contamination risks, while attitudes determine the level of motivation and commitment to complying with operational standards. Food safety practices are reflected in the consistency of food handlers in implementing hygienic procedures, although variations in behavior were found to be influenced by differences in educational background and access to training. These findings emphasize the need for ongoing training programs, strengthened supervision, and systematic managerial support to ensure compliance with food safety standards

References

Abdelhakeem, A. A., Feyza, B., & Hekmat, A.-A. (2021). Food Safety Knowledge among Food Handlers in Hospitals of Jordan. Food Science and Technology, 9(2), 17–30. https://doi.org/10.13189/fst.2021.090201

Abdel-Rahman, A. (2021). Food Safety Culture in Institutional Food Services: Determinants and Implications. Journal of Food Protection, 84(9), 1502–1513.

Adebola, O., & Adeyemi, T. (2022). Training Interventions and Behavioral Change in Food Handlers: A Public Health Review. International Journal of Nutrition and Food Safety, 14(1), 22–35.

Ahmed, S. (2020). Sociodemographic Predictors of Food Handling Compliance in Health Facilities. Public Health Perspectives, 18(2), 89–101.

Akabanda, F., Hlortsi, E. H., & Owusu-Kwarteng, J. (2017). Food safety knowledge, attitudes and practices of institutional food-handlers in Ghana. BMC Public Health, 17(1), 40. https://doi.org/10.1186/s12889-016-3986-9

Akinyemi, A. (2023). Organizational Moderators of Food Safety Practices in Institutional Settings. International Journal of Health Systems Research, 12(3), 144–159.

Al Banna, M. H., Masud, M. S., & Kundu, S. (2022). Food safety knowledge, attitudes, and practices among food handlers in hospitals: A cross-sectional study in Bangladesh. BMC Public Health, 22(1), 1–12. https://doi.org/10.1186/s12889-022-13446-4

Anwar, M., & Roslan, N. (2019). Knowledge and Hygiene Behavior among Hospital Food Handlers: Insights from Qualitative Studies. Asia Pacific Journal of Public Health, 31(4), 321–334.

Assefa, T., Kumie, A., & Wubshet, M. (2020). Food safety knowledge, attitude, and practices among food handlers in public hospitals in Ethiopia: A cross-sectional study. Journal of Environmental and Public Health, 2020, 1–9. https://doi.org/10.1155/2020/4576781

Avifah, S., & Fitria, L. (2025). Determinants of personal hygiene behavior amongst food handlers in fast food restaurants in South Jakarta, Indonesia. BKM Public Health and Community Medicine, e17121. https://doi.org/10.22146/bkm.v41i03.17121

Bello, R., & Yusuf, H. (2021). Compliance Patterns in Food Handling: The Role of Work Systems and Environmental Support. Journal of Environmental Health Research, 11(2), 73–87.

BMC Public Health. (2020). Food safety knowledge and practices among hospital food handlers in South Africa. BMC Public Health, 20, 1–12.

Castillo, J., & Mora, L. (2021). Knowledge-to-Action Gaps in Food Safety Compliance among Institutional Food Handlers. Public Health Nutrition, 24(6), 1125–1136.

Cheng, W., & Yuen, K. (2020). Organizational Safety Climate as a Determinant of Hygiene Behavior. Journal of Safety Research, 75, 142–150.

Cruz, M., & Santos, A. (2023). Food Safety Behavior in Healthcare Food Services: A Sociodemographic Lens. Journal of Hospital Infection Control, 45(1), 55–68.

Da Silva, M., & Vieira, A. (2022). Risk Perception and Attitudinal Formation in Health-Care Food Handlers. International Journal of Environmental Health, 29(1), 100–115.

Dlamini, S., & Chari, T. (2023). Behavioral Predictors of Safe Food Handling: A Systems Perspective. African Journal of Food Science, 17(2), 41–56.

Endeshaw, M., & Habte, T. (2021). Training Exposure and Hygiene Competency among Food Handlers in Hospitals. BMC Public Health, 21, 1334.

Fekadu, A., Getachew, B., & Teshome, F. (2019). Food safety practices and associated factors among food handlers in food and drinking establishments: A community-based cross-sectional study. Environmental Health Insights, 13, 1–8. https://doi.org/10.1177/1178630219863200

Fonseca, D., & Machado, R. (2019). Food Safety Knowledge and Behavioral Determinants in Institutional Kitchens. Journal of Culinary Science & Technology, 17(5), 403–420.

Gupta, R. K. (2017). Chapter 2—Foodborne infectious diseases.

Haddad, L., & Jaber, S. (2022). Cognitive Determinants of Hygiene Compliance in Clinical Food Preparation Units. International Journal of Food Microbiology, 373, 109–118.

Hailu, B., & Bayeh, A. (2021). Effectiveness of food safety training on knowledge and practices among institutional food handlers: A quasi-experimental study. Journal of Food Protection, 84(6), 987–995.

Hasan, A., & Abdullah, F. (2023). Sociodemographic and Behavioral Patterns of Food Handlers in Healthcare Facilities: A Mixed-Methods Review. Journal of Public Health and Hygiene, 19(3), 200–217.

Hassen, K., Gizaw, Z., & Beyene, A. (2020). Food handling practices and associated factors among food handlers in food service establishments. BMC Research Notes, 13(1), 1–7.

Ibrahim, Z., & Rahim, S. (2020). Structured Training Programs and Their Effects on Food Safety Behaviors. Malaysian Journal of Public Health Medicine, 20(3), 172–181.

Joseph, R., & Patel, S. (2021). Food Safety Practices in Hospital Settings: A Qualitative Exploration. International Journal of Healthcare Management, 14(1), 10–18.

Khairuzzaman, Md., Chowdhury, F. M., Zaman, S., et al. (2020). Food safety challenges and public health: A Bangladesh perspective. Journal of Food Science and Safety, 5(2), 55–67.

Khan, M., & Babu, R. (2019). Institutional Food Service Safety: Behavioral and Structural Barriers. Journal of Food Safety, 39(4), e12664.

Lee, S., & Choi, H. (2022). Psychosocial Determinants of Attitudes Toward Food Safety Among Institutional Staff. Journal of Behavioral Health, 11(2), 65–79.

Lestantyo, D., Iravati, S., Wahyuningsih, A. S., & Pramono, D. (2017). Safe food handling knowledge, attitude, and practice among hospital food handlers in Indonesia. Kesmas: National Public Health Journal, 12(1), 30–36.

Li, J., Wang, Z., Karim, M. R., & Zhang, L. (2020). Detection of human intestinal protozoan parasites in vegetables and fruits: A review. Parasites & Vectors, 13(1), 380. https://doi.org/10.1186/s13071-020-04255-3

Lopez, V., & Garcia, P. (2023). Attitude and Compliance Interaction in Hospital Food Safety Systems. International Journal of Sanitary Engineering, 29(2), 150–167.

Mekonnen, H., & Aga, F. (2021). Knowledge, attitude, and practice of food handlers in health-care facilities: A case study. Journal of Food Safety, 41(5), 1–10.

Mendes, F., & Duarte, J. (2018). Observed Practices and Hygiene Performance in Food Service Units. Food Control, 95, 25–33.

Mizanur Rahman, M., Haque, M., Salam, A., & Ahmed, S. (2019). Food safety KAP among food handlers in institutional food services: A Malaysian context. International Journal of Food Safety, Nutrition and Public Health, 8(2), 101–115.

Mutalib, N.-A., Abdul-Rashid, M.-F., Mustafa, S., Amin-Nordin, S., Hamat, R. A., & Osman, M. (2012). Knowledge, attitude and practices regarding food hygiene and sanitation of food handlers in Kuala Pilah, Malaysia. Food Control, 27(2), 289–293. https://doi.org/10.1016/j.foodcont.2012.04.001

Nam, S.-J., & Pak, T.-Y. (2023). Predicting adherence to COVID-19 preventive measures among South Korean adults aged 40 to 69 Years using the expanded health empowerment model. SSM - Population Health, 22, 101411. https://doi.org/10.1016/j.ssmph.2023.101411

Nguyen, H., & Kim, E. (2021). Food Safety Behavior Among Hospital Workers: A Model-Based Evaluation. Journal of Hospital Administration, 8(3), 12–23.

Odeyemi, O. A. (2019). Food safety knowledge and practices among food handlers worldwide: A comprehensive review. Food Research International, 116, 1386–1397.

Okafor, C., & James, I. (2022). Personal and Organizational Predictors of Food Handling Behavior. International Journal of Occupational Safety, 16(4), 221–238.

Park, J., & Lim, S. (2020). Training Outcomes in Institutional Food Safety Management. Journal of Nutrition and Health Services, 36(5), 411–423.

Rahman, Md. S., Hossain, Md. S., & Pulok, Md. F. H. (2025). Analysis of Food Safety Knowledge and Practices Among Food Handlers in Restaurants and Street Food Markets in Dhaka, Bangladesh: A Cross‐Sectional Study. International Journal of Food Science, 2025(1), 5369920. https://doi.org/10.1155/ijfo/5369920

Rebelo, A., & Couto, S. (2019). Role of Workplace Environment in Supporting Food Safety Practices. Occupational Health Review, 27(4), 289–301.

Santos, E., & Pereira, R. (2023). Cognition and Compliance in Food Safety Protocols: Evidence from Hospital Settings. International Journal of Clinical Nutrition Services, 18(1), 112–129.

Singh, P., & Sharma, R. (2021). Behavioral Predictors of Hygiene Compliance in Institutional Settings. Environmental Research and Public Health, 65(2), 97–108.

Tesfaye, T., & Berhanu, A. (2019). Predictors of hygienic food handling practices among food handlers: A mixed-method study. Journal of Nutrition and Food Sciences, 9(3), 1–8.

Tessema, A. G., Gelaye, K. A., & Chercos, D. H. (2020). Factors associated with safe food handling practices among food handlers in food establishments: A systematic review. Environmental Health Reviews, 63(1), 12–25.

Torres, L., & Mendez, A. (2022). Educational Gaps and Performance in Food Handling Workforces. Journal of Workforce Development in Health, 9(2), 77–93.

Wang, M., Huang, L., Pan, C., & Bai, L. (2021). Adopt proper food-handling intention: An application of the health belief model. Food Control, 127, 108169. https://doi.org/10.1016/j.foodcont.2021.108169

Werthmann, D., Rabito, F. A., & Reed, C. (2021). Knowledge, attitudes, and practices concerning cockroach exposure among caregivers of children with asthma. BMC Public Health, 21(1), 1485. https://doi.org/10.1186/s12889-021-11497-y

Wolde, M., & Tadesse, G. (2021). Sociodemographic determinants of food safety practices among institutional food handlers: Evidence from hospitals in East Africa. BMC Nutrition, 7(1), 1–10.

World Health Organization. (2022). Food safety in health-care settings: Guidelines for safe food service management in hospitals. WHO Press.

Wu, Y., & Chen, L. (2020). Linking Training Attendance to Hygiene Performance in Food Service Workers. International Journal of Environmental Research and Public Health, 17(14), 5096.

Yi, N.-Y., & Choi, J.-H. (2025). Age differences in food safety knowledge, attitudes, and practices among consumers in Seoul. Nutrition Research and Practice, 19(3), 440. https://doi.org/10.4162/nrp.2025.19.3.440

Zamaniahari, S., Zareipour, M., Rezaei, Z. M., Saeed Jadgal, M., Rostampor, F., & Soltani, R. G. (2023). Evaluating Determinants of Food Hygiene Behavior Based on Health Belief Model in Health Workers of Urmia Health Center. Journal of Nutrition and Food Security. https://doi.org/10.18502/jnfs.v8i4.14009

Zulfiani, E., & Meilani, M. (2025). Mikroorganisme Patogen Penyebab Foodborne Disease dan Gejalanya terhadap Kesehatan Tubuh di Masyarakat (Studi pada Masyarakat di Kecamatan Cigugur Tengah). MASALIQ, 5(5), 2361–2372. https://doi.org/10.58578/masaliq.v5i5.7124