Food Control 21 (2010) 260263

Contents lists available at ScienceDirect

Food Control
journal homepage: www.elsevier.com/locate/foodcont

Knowledge, attitudes and practices of workers on food hygienic practices

in meat processing plants in Fars, Iran
Maryam Ansari-Lari *, Sahar Soodbakhsh, Leila Lakzadeh
Department of Food Hygiene and Public Health, School of Veterinary Medicine, Shiraz University, Shiraz 71345, Iran

a r t i c l e i n f o a b s t r a c t

Article history: This cross-sectional study was conducted to evaluate the knowledge, attitudes and practices of food
Received 30 January 2009 workers in four meat processing plants in the Fars province, southern Iran. A self-administered, struc-
Received in revised form 28 May 2009 tured questionnaire was designed and completed by 97 food workers during November 2006January
Accepted 2 June 2009
2007. Results indicated that the respondents had acceptable level of knowledge, excellent attitudes
and poor practices toward food hygiene measures. Almost all of the food workers (97.9%) were aware
of the critical role of general sanitary measures in the work place while there was lack of knowledge
Keywords:
about microbial food hazards in the majority (6778%) of them. A signicant negative correlation was
Attitudes
Food hygiene
observed between knowledge and practices (rs = 0.20, P = 0.04), and attitudes and practices
Iran (rs = 0.27, P = 0.009), revealing that increased knowledge and even attitudes toward food safety does
Knowledge not always result in positive change in food handling behaviors.
Meat plant 2009 Elsevier Ltd. All rights reserved.
Practices

1. Introduction
Food poisoning and diarrheal illnesses are among the leading
causes of morbidity and mortality worldwide (World Health Orga-
nization, 1998). Food safety was identied as a high priority area in
the 20012005 World Organisation for Animal Health (OIE) Strate-
gic Plan. Member countries of the OIE considered that the organi-
sation should be more active in issues of public health and
consumer protection and that this should include more involve-
ment in the area of diseases or pathogens transmissible through
food (Droppers, 2006). Meat and meat products are of particular
importance regarding foodborne illnesses. Foodborne pathogens
can be introduced to foods during processing, storage and prepara-
tion, from infected humans who handle the food or by cross con-
tamination from some other raw agricultural products (Hedberg,
MacDonald, & Osterholm, 1994).
Human handling errors have been responsible for most out-
breaks of food poisoning (Clayton, Grifth, Peters, & Price, 2002;
Ehriri & Morris, 1996; Greig, Todd, Bartleson, & Michaels, 2007;
Howes, McEwen, Grifths, & Harris, 1996), for example hepatitis
A virus can be introduced by unwashed hands of food handlers
who are themselves infected. Therefore, good personal hygiene
as well as sanitary handling practices at work are essential parts
of any prevention programs for food safety.
* Corresponding author. Tel.: +98 711 2286950; fax: +98 711 2286940.
E-mail addresses: ansari@shirazu.ac.ir, ansarim47@yahoo.com (M. Ansari-Lari).
Food handlers must have the skills and knowledge that they
need to handle food safely. Training programs are important for
increasing knowledge of food handlers; however, increased knowl-
edge of food safety does not always result in positive change in
food handling behaviors. There are several studies about the
knowledge and practices of food handlers conducted in various
parts of the world (Angelillo, Viggiani, Greco, & Rito, 2001; Bas,
Ersun, & Kivan, 2006; Gomes-Neves, Araujo, Ramos, & Cardoso,
2007; Jevnik, Valentina, & Raspor, 2008; Toku, Ekuklu,
Berberoglu, Bilge, & Dedeler, 2008; Walker, Pritchard, & Forsythe,
2003). To the best knowledge of the authors, there is no any formal
study concerning the knowledge, attitudes and practices of food
workers in meat processing plants in Iran. The objectives of the
present study were to determine food workers knowledge, atti-
tudes and practices about food hygiene in four meat plant indus-
tries in Fars province, southern Iran, also to investigate inter-
relationship between knowledge, attitudes and practices in the
study group.
2. Methods
This is a cross-sectional study which was conducted from
November 2006 to January 2007 in four meat processing plants
in Fars province, southern Iran. Except slaughtering of animals,
all other steps for preparation of meat and meat products are
undertaken in these plants. The HACCP system has been imple-
mented in these plants since few years ago. Overall, 254 workers
are employed in these plants and 180 of them are oor workers.

0956-7135/$ - see front matter 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.foodcont.2009.06.003
 M. Ansari-Lari et al. / Food Control 21 (2010) 260263
The monthly production level of these plants ranges from 90 to
250 tons of meat and various meat products. A self-administered,
structured questionnaire was designed and modied by the aid
of previous research (Angelillo et al., 2001). Questionnaires were
completed by a convenient sample of 97 oor workers out of 180
who directly involved in cutting, processing and packaging of meat
and meat products. Each questionnaire was comprised of four dis-
tinct parts; demographic characteristics of the participants, food
hygiene knowledge, attitudes and practices. Questions about sex,
age, education, duration of employment and whether they at-
tended a training course in food safety were included in the rst
part of the questionnaire.
In the knowledge part, there were 20 close-ended questions
emphasizing personal hygiene, cross contamination, microbiologi-
cal food hazards and specic foodborne diseases. Each question
was provided by three possible answers (true, false and do not
know). Additional questions about appropriate refrigerator tem-
perature and high-risk groups for food poisoning were also in-
cluded. The knowledge scores were assigned to respondents
according to their answers to questions. The score range was be-
tween 0 and 20 and the scores below 10 were considered as poor
knowledge.
Subsequent part of the questionnaire was dealing with the atti-
tudes of the responders about various hygienic measures for food
safety. Eleven questions were designed and food handlers were
asked to indicate their level of agreement to the statements using
a three-point rating scale (agree, uncertain, and disagree). The
score ranged between 0 and 22 and the scores below 11 were con-
sidered as poor attitudes.
Practices of food workers were assessed by their self-reported
hygienic behaviors in the last part of the questionnaire. In this part,
10 questions were provided with ve-point rating scale (never,
rarely, sometimes, often and always). The score ranged between
0 and 50 and the scores below 25 were considered as poor prac-
tices. Two additional questions concerning how often they con-
sume or recommend the products of their working plants were
also included in this part.
Statistical analysis was conducted using SPSS software for
windows, version 11.5. Descriptive statistics were provided and
Spearmans correlation coefcient was used to test the association
between knowledge, attitudes and practices scores. P-value less
than 0.05 was considered as statistically signicant.
3. Results
Of 97 food workers which were participated in this study, 92%
were male. The mean age of participants was 29 (SD = 6.5), ranging
between 19 and 54 years. About 54% of them had below high-
school education, 39% had high-school education and 7% had high-
er education but not necessarily related to food. The mean and
median for duration of employment were ve (SD = 4.7) and
2 years, respectively. Fifteen percent had worked for more than
10 years. Ninety four percent had attended food safety training
programs which are implemented by Food and Drug safety depart-
ment, Ministry of Health and Medical Education. Nearly 79.4% had
repeated training.
Tables 14 summarize the results regarding knowledge, atti-
tudes and practices of respondents. Considering food workers
knowledge, almost all of them were aware of the critical role of
general sanitary measures in the work place such as washing
hands, using gloves, caps and aprons and proper cleaning of the
instruments (97.9% correct answers, Table 1). Most of the respon-
dents (56%) failed to select the correct answer for the question
about high-risk groups for food poisoning. Their knowledge
regarding specic diseases which are transmitted via food and
261
microbiological food hazards are presented in Table 1. Diarrhea,
bloody diarrhea, brucellosis and typhoid were answered with cor-
rect options by 86.6%, 77.3%, 64.9% and 51.5% of respondents,
respectively. However, correct responses about jaundice and abor-
tion were generally low, ranging between 18.6% and 26.8% (Table
1). The knowledge of the study population about microbiological
food hazards was generally lower than their knowledge of diseases.
Their correct responses for Salmonella, Hepatitis A virus, Hepatitis
B virus, Staphylococcus and Clostridium were 39.2%, 21.6%, 35.1%,
33% and 33%, respectively. Approximately 49.5% of responses about
the proper temperature for refrigerator were incorrect. Two ques-
tions were about the knowledge of respondents for necessity to
take leave during infectious diseases of eye and skin. Their correct
responses were 64.9% and 87.6%, respectively (Table 1).
Almost all of the participants in the study (9299%) agreed with
various statements in the attitudes part of the questionnaire. Small
percentages were disagree (13%) or did not have any idea (15%)
about some of the statements (Table 2).
Good hygienic practices of food workers were evaluated using
12 questions. The results (Table 3) indicated that 96% of the
respondents always wear aprons, while corresponding measures
for using gloves and washing hands before it were 69.1% and
76.3%, respectively. Two to three percent reported that they never
use gloves or wash their hands. About 56.7% of the respondents re-
ported that they always use masks and 11% stated that they rarely
or never use masks during their work. Results showed that only
67% never eat or drink and 10% reported that they always eat or
drink in their work place. Considering smoking in the work place,
97% indicated that they never smoke. Approximately 85.6% of
respondents reported that they always or often recommend the
products of their plants, but only 50.5% reported that they always
or often consume their products by own.
According to rating scale, summary statistics for total knowl-
edge, attitudes and practices were calculated and presented in Ta-
ble 4. Mean score for knowledge was 11.7 (SD = 3.1) ranging
between 3 and 18 scores. Approximately 35% of respondents had
poor knowledge about food safety measures. Mean score for atti-
tudes was 21.8 (SD = 2.5) and about 98% had their total attitudes
score higher than 15. Mean score for practices was 13.5
(SD = 4.3), ranging between 9 and 34 points. Nearly 92% of respon-
dents had poor self-reported hygienic practices.
There was positive correlation between knowledge and attitude
(rs = 0.35, P < 0.001); however, knowledge and practices
(rs = 0.20, P = 0.04) as well as attitudes and practices (rs = 0.25,
P = 0.01) were negatively associated. There was also signicant
association between knowledge and level of education (rs = 0.27,
P = 0.009), practices with duration of employment (rs = 0.40,
P < 0.001), and knowledge of microbiological food hazards with le-
vel of education (rs = 0.27, P = 0.02).
4. Discussion
It has been shown that most outbreaks of food poisoning result
from improper food handling practices (Clayton et al., 2002; Ehriri
& Morris, 1996; Howes et al., 1996). Food workers in many settings
have been responsible for foodborne disease outbreaks for decades,
and there is no indication that this is diminishing (Greig et al.,
2007).
The results of the present study showed acceptable knowledge,
excellent attitudes and relatively poor practices of food workers in
the four meat processing plants in Fars province, south of Iran. Al-
most all respondents had high level of knowledge concerning the
general sanitary measures in the work place such as washing
hands, using gloves, caps and aprons, and proper cleaning of the
instruments, while majority of them failed in the identication of
262 M. Ansari-Lari et al. / Food Control 21 (2010) 260263

Table 1
Summary of questions and number of responses for assessment of respondents food safety knowledge of 97 food workers in four meat processing plants, Iran.

Statements Responses, n (%)

True False Do not knowa
Washing hands before work reduces the risk of food contamination 95 (97.9) 1 (1) 1 (1)
Using gloves during work reduces the risk of food contamination 95 (97.9) 1 (1) 1 (1)
Proper cleaning and handling of instruments reduces the risk of food contamination 95 (97.9) 1 (1) 1 (1)
Eating and drinking in the work place increases the risk of food contamination 79 (81.4) 14 (14.4) 4 (4.1)
All persons, including children, adults, pregnant women and old-ages are at equal risk for food poisoning 43 (44.3) 42 (43.3) 12 (12.3)
Typhoid can be transmitted by food 50 (51.5) 18 (18.6) 29 (29.9)
Jaundice can be transmitted by food 26 (26.8) 42 (43.3) 29 (29.9)
Diarrhea can be transmitted by food 84 (86.6) 6 (6.2) 7 (7.2)
AIDS can be transmitted by food 21 (21.6) 60 (61.9) 16 (16.5)
Brucellosis can be transmitted by food 63 (64.9) 15 (15.5) 19 (19.6)
Bloody diarrhea can be transmitted by food 75 (77.3) 9 (9.3) 13 (13.4)
Abortion in pregnant women may be induced by foodborne disease 18 (18.6) 43 (44.3) 36 (37.1)
Salmonella is among the foodborne pathogens 38 (39.2) 3 (3) 56 (57.7)
Hepatitis A virus is among the foodborne pathogens 21 (21.6) 30 (30.9) 46 (47.4)
Hepatitis B virus is among the foodborne pathogens 18 (18.6) 34 (35.1) 45 (46.4)
Staphylococcus is among the foodborne pathogens 32 (33) 11 (11.3) 54 (55.7)
Clostridium botulinum is among the foodborne pathogens 32 (33) 11 (11.3) 54 (55.7)
The correct temperature for refrigerator is 49 (50.5) 48 (49.5) 0 (0)
During infectious disease of skin, it is necessary to take leave from work 85 (87.6) 6 (6.2) 6 (6.2)
During infectious disease of eye, it is necessary to take leave from work 63 (64.9) 26 (26.8) 8 (8.2)
a
Occasional cases of missing responses were added to this column.

Table 2
Summary of questions and responses for assessment of respondents food safety attitudes of 97 food workers in four meat processing plants, Iran.

Statements Responses, n (%)

Agree Disagree No idea
One of the most important responsibilities of the food handlers is . . . to food safety measures 92 (94.8) 3 (3) 2 (2)
Using gloves is important in reducing risk of food contamination 96 (99) 1 (1) 0 (0)
Using apron is important in reducing risk of food contamination 94 (96.9) 2 (2) 1 (1)
Using masks is important in reducing risk of food contamination 91 (93.8) 2 (2) 4 (4.1)
Using caps is important in reducing risk of food contamination 93 (95.9) 3 (3) 1 (1)
Food handlers who have abrasions or cuts on hands should not touch foods without gloves 95 (97.9) 1 (1) 1 (1)
Raw and cooked foods should be stored separately to reduce risk of food contamination 92 (94.8) 1 (1) 4 (4.1)
Food hygiene training for workers is an important issue in reducing risk of food contamination 91 (93.8) 1 (1) 2 (2)
It is necessary to check the temperature of the refrigerator periodically to reduce risk of food contamination 91 (93.8) 2 (2) 4 (4.1)
Health status of the workers should be evaluated before employment 94 (96.9) 1 (1) 2 (2)
Foodborne illnesses can have deleterious health and economic effects on the society 89 (91.7) 3 (3) 5 (5.2)

Table 3
Summary of questions and responses for assessment of respondents food hygienic practices of 97 food workers in four meat processing plants, Iran.

Statements Responses, n (%)

Never Rarely Sometimes Often Always
Do you use gloves during work? 2 (2) 3 (3) 10 (10.3) 15 (15.5) 67 (69.1)
Do you wash your hands before using gloves? 3 (3) 0 (0) 11 (11.3) 8 (8.2) 74 (76.3)
Do you wear apron during work? 0 (0) 1 (1) 2 (2) 0 (0) 93 (95.9)
Do you use mask during work? 7 (7.2) 4 (4.1) 15 (15.5) 16 (16.5) 55 (56.5)
Do you use cap during work? 0 (0) 0 (0) 6 (6.2) 1 (1) 90 (92.8)
Do you wash your hands before you touch raw meat? 0 (0) 0 (0) 1 (1) 6 (6.2) 89 (91.7)
Do you wash your hands after you touch raw meat? 2 (2) 2 (2) 5 (5.2) 4 (4.1) 83 (85.6)
Do you wash your hands after rest time when you come back to work? 1 (1) 2 (2) 1 (1) 10 (10.3) 83 (85.6)
Do you eat or drink in your work place? 65 (70.7) 6 (6.1) 10 (10.3) 6 (6.1) 10 (10.3)
Do you smoke in your work place? 94 (96.8) 1 (1) 1 (1) 0 (0) 0 (0)
How often do you use the products of your working plant? 1 (1) 20 (20.6) 27 (27.8) 23 (23.7) 26 (26.8)
How often do you recommend the products of your working plant to others? 0 (0) 3 (3) 11 (11.3) 23 (23.7) 60 (61.9)

specic disease or pathogens which could be transmitted via foods.
Similar disappointing results were obtained for awareness of the
fact that children, pregnant women and old age groups are at
greatest risk for food poisoning and its adverse consequences (Ta-
ble 1). Lack of acceptable knowledge about foodborne pathogens
were reported by Toku et al. (2008) from Turkey and Gomes-
Neves et al. (2007) from Portugal.
In the present study, near half or more of the respondents did
not know whether Salmonella, Hepatitis A virus, Hepatitis B virus
and Staphylococcus are among foodborne pathogens or not (Table
1). This is in spite of this fact that majority of workers attended
educational programs in food safety. It seems that more specic
courses should be planned for food workers. The training courses
need an evaluation to ensure the effectiveness, too.
Awareness of the fact that some groups such as children and
pregnant women are at special risk for microbiological hazards in
foods was another question with low correct response rate. Similar
results were obtained for the possibility of food poisoning-induced
 M. Ansari-Lari et al. / Food Control 21 (2010) 260263
Table 4
Summary statistics for total knowledge, attitudes and practices scores of 97 food
workers in four meat processing plants, Iran.
Mean SD Median Min. Max.
Knowledge (20 questions) 11.7 3.1 12 3 18
Attitudes (11 questions) 21.3 2.5 22 0 22
Practices (10 questions) 13.5 4.3 13 9 34
abortion in pregnant women. We considered this question because
foods including all types of raw meat and ready-to-eat products
potentially contain Listeria monocytogenes which could lead to
spontaneous abortion or stillbirth in pregnant women (Jemmi &
Stephan, 2006).
There was signicant positive correlation between level of edu-
cation with general knowledge and knowledge of microbiological
food hazards, also between practices and length of employment.
This is in agreement with results obtained by Angelillo et al.
(2001) who reported that knowledge of foodborne pathogens
was signicantly higher among workers with a higher educational
level.
In agreement with almost all previous studies, the overall atti-
tudes of the respondents was very positive toward food safety
measures while they had relatively poor practices (Angelillo
et al., 2001; Bas et al., 2006; Gomes-Neves et al., 2007; Jevnik
et al., 2008; Toku et al., 2008; Walker et al., 2003). Results of
the present study showed that as self-reported hygienic practices,
only 69% and 76.3% always washed their hands and using gloves,
respectively. Furthermore, there was signicant negative associa-
tion between both, knowledge and attitudes with practices in the
present study. This means that training may bring about increased
knowledge, but this does not always result in a change in food han-
dling practices and behaviors.
In conclusion, the results of the present study indicated that de-
spite good knowledge and attitudes of food workers, their practices
toward food hygiene are not acceptable. Although food safety
training programs are essential, behavioral changes will not occur
merely as a result of training. Evaluation of the programs impact is
needed to show the worth of a program and possible area for
change and modication. It is also necessary to evaluate the proper
263
functioning of the HACCP system and managerial control in the
meat plants in the future researches.
Up to Acknowledgements
20
22 We appreciate the cooperation of staff of meat processing
50 plants for conducting of this study. This study was supported by
Shiraz University.
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