Extending the theory of planned behavior: Factors predicting intentions to perform handwashing protocol in cross-cultural foodservice settings

Annually billions of consumers worldwide experience foodborne illnesses attributed to sub-standard hygienic practices. A contributing issue often cited is inadequate and improper handwashing by foodservice workers. Handwashing compliance in the foodservice industry has been reported to be sub-optimal and in critical need of improvement. In order to achieve successful behavioral change, a range of personal, social, and environmental factors as well as barriers to performing food safety practices in retail foodservice establishments need to be addressed. Research shows relying on educational training alone is ineffective and likely to produce limited results. Therefore, a comprehensive intervention program that incorporates an educational component and addresses the ecological factors influential to the performance of handwashing behavior in the organizational infrastructure is needed to ensure optimal results. In-depth understanding of the relationships among factors influencing handwashing intention, handwashing behavior, and knowledge about handwashing performance would be useful to foodservice providers for the development and implementation of effective handwashing intervention programs.

The purpose of this research was two-fold: (a) to develop a theoretical framework for the investigation of handwashing behavior in the foodservice context and (b) to validate the foodservice handwashing theoretical framework in a cross-cultural context. A research-based model incorporating the psychology-based Theory of Planned Behavior (TpB) was proposed to explain the relationships among ecological variables and to better understand the motivational factors underlying foodservice workers’ handwashing performance in two cultures, the United States (US) and Taiwan, Republic of China (ROC).

Data were collected in the Fall of 2009 in the US and in the Fall of 2010 in Taiwan, ROC from a convenience sample comprised of undergraduate university students majoring in Hospitality Management and Culinary Arts programs who had foodservice work experience. For each cultural context, data were analyzed to assess the validity and reliability of the self-administered handwashing survey instrument and to evaluate the utility of the hypothesized TpB based model in examining handwashing behavior in foodservice settings. Further, data analysis was performed to examine the relationships among the multi-item variables including: (a) handwashing behavior, (b) intention, (c) attitude, (d) subjective norm, (e) perceived behavioral control, (f) subjective knowledge, (g) behavioral beliefs, (h) normative beliefs, and (i) control beliefs.

The results of the confirmatory factor analysis indicated the handwashing assessment instrument (FS/HB-76) was successfully developed, having validity and reliability in measuring the constructs of the extended TpB to examine handwashing behavior in the foodservice context. Structural equation modeling (SEM) analyses showed acceptable model fit to the observed data from self-administered surveys suggesting the capability of utilizing the extended TpB in explaining and predicting foodservice workers’ handwashing behavior in both the US and Taiwan, ROC foodservice contexts. However, these findings should be accepted with caution in light of the revealed relationships among various influential factors and handwashing intention and behavior.

For US foodservice workers (N = 265), SEM results revealed a non-significant relationship between handwashing intention and previous handwashing performance. Of the basic TpB motivational factors (i.e., attitude, subjective norm, perceived behavioral control), only attitude influenced handwashing intention. Subjective knowledge, as an extension to the TpB, was found to have significant impact and direct influence on handwashing intention, subjective norm, and perceived behavioral control.

For Taiwan, ROC foodservice workers (N = 297), no significant relationship between handwashing intention and previous handwashing performance was found. However, handwashing performance was directly influenced by perceived behavioral control. Of the basic TpB motivational factors, subjective norm and perceived behavioral control influenced handwashing intention. The proposed subjective knowledge was found to have direct influence on intention as well as indirect influence on intention through subjective norm and perceived behavioral control. While not initially hypothesized, control beliefs were found to have direct influence on subjective norm.

For researchers, findings contribute to the body of knowledge pertaining to food safety in the epidemiological literature and provide a replicable theoretical framework for empirical research. For academicians and foodservice practitioners, this research offers practical information that can be (a) incorporated into the development of more effective food safety intervention programs and (b) used in managerial applications for improving handwashing compliance in the foodservice industry.

Data for this research were acquired from convenience samples of undergraduate students with foodservice work experience enrolled at two universities in each cultural context. Therefore, caution needs to be taken when generalizing the findings to other foodservice workers. Future research should replicate the study with a sample drawn from the general population of foodservice workers in diverse foodservice formats (e.g., casual and fast-food restaurants; independent, chain, franchised restaurants; and institutional foodservices) to increase demographic diversity in the sample (e.g., educational background, age, ethnic identification, geographic location) and generalizability of research results. Further, pre-intervention and post-intervention assessments should be conducted to establish cause and effect of intervention on foodservice workers’ psychological characteristics regarding motivational factors toward handwashing behavior. In addition, consideration should be given to conducting direct observation in acquiring data on handwashing performance to avoid the effects of social desirability bias and temporal difference of measurement (i.e., between intention and behavioral performance).