EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
An Educational Intervention to Improve Raw Chicken Handling Practices in Restaurants:
The Campy Training Kit
Emmy S. Myszka, MPH, REHS1*
1
San Mateo County Environmental Health, 2000 Alameda de las Pulgas, Suite 100, San Mateo,
California 94403
Key words: raw chicken, Campylobacter, training tools, active managerial control, intervention,
food facilities, restaurants
*Author for correspondence. Tel: (650) 372-6211; Fax: (650) 627-8244
Email: emyszka@smcgov.org
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Abstract
Campylobacter species infections contribute to a large burden of foodborne illness infections and
almost half are linked to food facilities. Campylobacter-contaminated poultry burdens public
health as the most common pathogen-food combination. A case control study conducted by the
County of San Mateo sought to measure the change in chicken handling practices following
implementation of an educational invention with two delivery methods: the Campy Training Kit
alone and supplemented by in-person training with the food facility manager. A repeated
measures logistic regression model was used to analyze food safety before and after intervention.
Both intervention groups showed increased use of thermometers to verify chicken cooking
temperatures relative to a wait list control group. Furthermore, the two intervention groups did
not differ from the wait list control group on other cross contamination risk factors, with the
exception of the intervention-lite group having slightly better storage practices than the wait list
control group. Additional research is needed to develop an intervention to prevent crosscontamination with raw chicken with ready-to-eat foods and food contact surfaces during
preparation.
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Introduction
Campylobacter spp. are microbes responsible for a large burden of acute bacterial
gastroenteritis throughout the world. In the United States, the species is one of six key pathogens
that contribute to over 50% of food-related illnesses (Centers for Disease Control and Prevention
[CDC], 2011). Campylobacter spp. is frequently found in poultry and Campylobactercontaminated poultry is the most common pathogen-food combination burdening public health
(Batz, Hoffman, & Morris, 2011).
In 2012, an average of 14.2 cases of laboratory-confirmed Campylobacter species
infections per 100,000 persons annually were reported in the United States (CDC, 2014). The
incidence of campylobacteriosis in San Mateo County in 2012 was 35.2 per 100,000 persons,
more than twice the national incidence (California Department of Public Health, 2015). These
numbers clearly indicate that Campylobacter infections are a significant public health problem in
San Mateo County.
National surveillance data indicate that during 1998 through 2008, almost half (45%) of
Campylobacter spp. foodborne illness outbreaks were linked with restaurants or delicatessens
(CDC, 2013). These data suggest that food facilities are improperly handling and cooking
poultry, the primary source of Campylobacter. Foodborne illness can be caused through crosscontamination from raw poultry to ready-to-eat (RTE) foods or the environment, such as food
contact surfaces and equipment. Contaminated chicken can also cause foodborne illness when
the chicken is not cooked to a temperature high enough to kill foodborne pathogens on or in the
chicken. It is important to use a thermometer to check the internal temperature of meat, including
chicken, because it is the only method to determine if meat is fully cooked (United States
Department of Health & Human Services, 2015).
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
The Centers for Disease Control and Prevention (CDC) has identified the top five risk
factors responsible for foodborne illness outbreaks as: improper hot/cold holding temperatures of
potentially hazardous food; improper cooking temperatures of food; contaminated utensils and
equipment; poor employee health and hygiene; and food from unsafe sources (Bryan, 1988).
Educational interventions for food facilities, therefore, should target these risk factors to protect
the health and safety of consumers.
Previous research has shown that educational interventions with food facilities are more
effective when directed at owners/managers. Researchers at Iowa State University’s Department
of Apparel, Educational Studies, and Hospitality Management found that “if the organizational
culture is not supportive [of safe handling practices], then intervention at the individual level
may not be sufficient.” They concluded that “the organization would benefit from providing the
needed resources to practice food safety and instill values attached to food safety” (Abidin,
Arendt & Strohbehn, 2011, p. 10). Since managers and owners have more direct influence over
the organizational culture, targeting them is more likely to improve food safety practices than an
educational intervention focused on food handlers.
Research has also shown that training with an active, hands-on component leads to
greater retention of the training concepts (Lillquist, McCabe, & Church, 2005). Specifically,
train-the-trainer programs can provide subject matter experts (the food facility managers) with
teaching skills in order to replicate a food safety program with food handlers. Through train-thetrainer programs, managers can increase their knowledge of food safety and learn how to teach
others (Centers for Public Health Preparedness, 2005). Train-the-trainer models have been found
successful in implementing public health preparedness programs (Orfaly et al., 2005).
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
In an effort to reduce campylobacteriosis in San Mateo County, San Mateo County
Environmental Health Services Division (SMC EH) developed a targeted educational
intervention for managers and food handlers for improving raw chicken handling practices in
food facilities. Specifically, we developed a “Campy Training Kit” that included materials
focused on safe storage, preparation, and cooking of raw chicken.
Methods
We provided the Campy Training Kit in two different delivery methods to groups of food
facilities in San Mateo County. We assessed raw chicken handling practices in these facilities
before and after implementation of the Campy Kit training. We measured the effectiveness of the
training kit, as well as the two delivery methods, by comparing observed chicken handling
practices in the two groups before and after the intervention as compared to a third group of food
facilities that did not get the training. We hypothesized that the Campy Training Kit delivered
with a train-the-trainer component (intervention-full: delivery of kit with an in-person training)
would improve raw chicken handling practices over the Campy Training Kit by itself
(intervention-lite: delivery of kit alone) and a wait list control group (receipt of training kit after
the study was completed).
Study Facilities. In 2011, San Mateo County (SMC) Environmental Health administered
a pilot survey to all food facilities in the county that handled raw chicken. A total of 1,276
surveys were collected. A power analysis indicated that 700 facilities would be needed to detect
a small to medium effect size (Cohen’s d≥.2) for an educational intervention. Thus, 700 facilities
were selected from the food facility population in San Mateo County using a stratified, fixed
allocation model, with simple random sampling within strata. The sampling was stratified by
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
language. More specifically, the initial pilot survey found that the three primary languages
spoken in food facilities in San Mateo County were English (32.7%), Spanish (39.9%) and
Chinese (17.9%: Cantonese 75.9% and Mandarin 24.1%). Thus, we stratified the sample such
that in 40% of the facilities, the primary language spoken amongst all food handlers was English,
in 40% of the facilities, the primary language spoke was Spanish, and in 20% of the facilities, the
primary language spoke was Chinese.
Study Groups and Procedure. From the 700 facilities selected for the study, 200
facilities were randomly assigned to a wait list control group (a group that would receive the
intervention at the completion of the study), 250 were assigned to an intervention-full group (a
group that received the training kit and an in-person training session with the manager), and 250
to the intervention-lite group (group that received the training kit alone). Facilities that cooked
raw chicken directly from the frozen state were excluded from the study because the risk of
cross-contamination in that procedure is minimal.
In SMC EH, the food facilities are divided into inventories in 14 districts. Each district is
assigned to an Environmental Health Specialist (EHS) who is responsible for routine inspections,
re-inspections, and complaint investigations. Fourteen EHS collected the data for facilities in
their districts and are herein called ‘data collectors.’ Data collectors were blind to the
intervention condition of the facility.
All 14 data collectors received training on how to administer the study measures that
were used to observe chicken handling practices in the facility. Data collectors were required to
attend two days of classroom standardization training and one day of field standardization
training to ensure consistency in data collection. For the classroom training, SMC contracted
with Vicky Everly, an EHS with extensive experience developing and implementing
6
EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
standardization programs. The study measures were reviewed in detail and various scenarios
were discussed to ensure data collectors would feel confident completing the measure in the
facilities.
Following classroom standardization training, all data collectors (14/14, 100%)
participated in field standardization training with an EHS Food Specialist or Food Program
Supervisor. The Food and Drug Administration’s Procedures for Standardization of Retail Food
Safety Inspection Officers was used as a model for the field standardization, specifically
Standard 2: Trained Regulatory Staff. A modified version of the Conference for Food
Protection’s Field Training Worksheet was created to assess the performance elements and
competencies necessary for the data collectors to collect the data independently. The trainer and
the data collector completed side-by-side surveys and compared their results. Data collectors
began collecting data independently once their survey and their EHS trainer’s survey were in
90% agreement at two facilities.
Data collectors completed the assessments in their regularly assigned districts. Data
collection replaced routine inspection for the facilities to reduce the burden of inspection time
and encourage participation in the study. Only two facilities declined participation due to
scheduling conflicts; two other facilities were subsequently added.
Intervention. The “Campy Training Kit” was the primary intervention. The kit was
developed by SMC EH and designed by Kuleana Design. Development of the materials for the
Campy Training Kit were discussed in one-on-one discussions with 14 food facility managers
and owners who provided feedback on what types of materials would be most useful in their
kitchens. These facilities were later excluded from the study population. The Campy Training
Kit consisted of a Raw Chicken Handling Training Manual for Owners and Managers, quick
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
reference cards, a video, a poster, and thermometer as well as refrigerator shelving labels. The
materials were produced in English, Spanish, and Chinese. The written Chinese language can be
understood by both Cantonese- and Mandarin-speakers.
Campy Training Kits were hand-delivered to each facility in the two intervention study
groups by an ‘EHS trainer,’ not the EHS data collector. In the intervention-lite group, the EHS
trainer made sure the owner/operator received the kit. In the intervention-full group, there was an
additional training component: the EHS trainer provided an individual training session to the
manager. Six EHS trainers delivered the intervention-full: three delivered the training in English,
two in Spanish and one in Chinese (Cantonese or Mandarin). The purpose of the training was to
“train-the-trainer” by having an EHS trainer instruct the manager on how to train food handlers
on safe chicken handling using the training manual and other materials in the Campy Training
Kit. The script for the in-person training component focused on the same basic principles that are
present in the training manual: safe handling of raw chicken in storage, preparation, and
cooking. The training was approximately 45 minutes long and was presented at a time
convenient for the manager/owner. The Campy Training Kits were mailed to the facilities in the
wait list control group upon completion of the study.
Measures. Two surveys were developed for the study. The surveys were modeled after
CDC Environmental Health Specialists Network’s (EHS-Net) Chicken Handling Study Protocol
(Centers for Disease Control and Prevention, 2007). The first survey, the Facility Assessment
Survey, captured environmental observations made by the data collector. This survey utilized a
binary (yes/no) response format to capture observations made about chicken storage, preparation
and cooking. Each data collector was also asked to observe the presence or absence of training
manuals, educational materials (e.g., posters, labels, checklists, and probe thermometers). For the
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
second round of Facility Assessment Surveys following implementation of the intervention, data
collectors were also asked about the presence or absence of materials specific to the Campy
Training Kit.
The second survey, the Food Handlers Survey, was a food handler interview conducted
by the data collector. Interview questions covered problems with training, management support,
and knowledge of food handling practices. The interview used a force-choice response format.
Data Analyses. Both the observation and the interview provided skip patterns for
inapplicable questions and allowed for item non-response as a function of an inability to observe
the behavior and/or the equipment in question. For some questions, the data collected did not
enough variability in their distribution to provide sufficient numbers in the response levels for a
stable statistical analysis. Due to the skip patterns, each facility’s survey would potentially have
different numbers of applicable questions so using a count of ‘yes’ responses would not take into
account the different number of total responses on the survey. To improve the stability of the
analysis and ability to interpret the results, some survey questions were combined to generate
new ‘domains’ to determine if the behaviors observed would increase the likelihood of
Campylobacter spread. The domains that were constructed by combining survey questions are
shown in Table 1. Specific questions composing each domain can be obtained from the author.
The present study was designed to test the hypothesis that two targeted educational
interventions (full and lite) would improve chicken handling practices in comparison to a wait
list control group. Since the answers to the survey questions were binary (yes/no responses), a
repeated measures logistic regression model was used for this analysis.
This regression model included terms to account for differences between the groups at
pre-assessment on the defined outcomes and to account for the change over time between pre-
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
and post-assessment. An interaction term between the three study groups group and the time
variable (pre vs. post) yielded the point estimates and confidence intervals for the assessment of
the intervention effects. All models used the wait list control group and pre-assessment as the
referent categories. As long as a facility had one data point for an outcome, it was retained in the
model (just pre-assessment or just post-assessment). Odds ratios and 95% confidence intervals
are presented for each study group comparison against the wait list control group for each
outcome.
Implementation of the intervention in the lite and full interventions was examined
descriptively. More specifically, we examined the presence/absence of Campy materials in
facilities provided with the lite or full intervention as compared to the wait list control group.
Results
Of the facilities included in this study, 15.9% were chains with 20 or more locations in
the United States while 83.0% were independent. In 26.3% of the facilities, the average amount
of chicken purchased weekly was less than 50 pounds, 19.0% of the facilities purchased 50-99
pounds of chicken weekly and 51.8% of the facilities purchased 100 pounds or more chicken
weekly. In 80.5% of the facilities, up to 50% of the meals served included chicken while 17.9%
of the facilities include chicken in over 50% of the meals served. Of the food facility managers,
86.2% had ever held food safety certification, while 77.1% of those managers held a current food
safety certification. Furthermore, 87% of respondents indicated that “all” or “most” of the food
handlers working their shift had valid food handler cards.
Facility Assessment by Intervention Group. Three surveys from the intervention-full
group, one record from the intervention-lite group and one record from the wait list control group
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
had to be removed from analyses because they were incomplete. Table 2 presents the results of
the Facility Assessment Surveys by intervention group. Overall, practices changed for all three
groups. Both the intervention-lite group and the intervention-full group showed a statistically
significant increase in thermometer use when compared to the wait list control group. In
addition, the intervention-lite group evidenced a statistically significant greater reduction in
problems with storage practices as compared to the wait list control group. Problems with
storage practices included storing chicken above ready-to-eat or cooked foods or above other raw
protein with lower cooking temperatures or storing raw chicken without a cover or in a leakproof container. No statistically significant differences were observed in cross-contamination in
storage or thawing, thawing practices, preparation practices, sanitizing food contact surfaces and
equipment, wiping cloth practices, or cross-contamination during cooking.
Food Handler Outcomes by Intervention Group. On the Food Handler Survey, there
was a statistically significant reduction in problems associated with training on safe handling
practices among those in the intervention-lite group compared to the wait list control group
(Table 3). Problems with training could include a manager failing to explain why the food
handler needed to do training on how to prepare raw chicken safely, the food handler failing to
understand the information given by the manager, or the food handler not learning new
information or not feeling more confident in his/her ability to prepare chicken safely. Table 3
also shows a reduction in problems with training in the intervention-full group, but it was not
statistically significant. The level of support was measured by asking how often the food handler
has enough support from the manager and if the food handler has enough time and proper
equipment to prepare food safely. On each of the questions, the food handlers reported a high
level of support so the overall ‘support’ domain was also high. Each group had an almost
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
uniform endorsement of ‘always’ being supported at pre and post assessment. There were no
significant differences between the intervention groups and the wait list control group. Finally,
there were modest increases in knowledge about safe chicken handling in all three study groups;
neither of the intervention groups had increases that surpassed those evidenced by the wait list
control group. Results for support and knowledge are presented in Table 4.
Intervention Fidelity. Given that all three groups evidenced improvement on the
outcome measures between the pre- and post-assessments and there appeared to be no/little
differential effect due to the intervention(s), examination of fidelity to the intervention was
warranted. Intervention fidelity was examined in two ways: 1) observation of “Campy” training
materials by intervention group and; 2) utilization of “Campy” materials for training by
intervention group.
As reflected in Table 5, of all the materials included in the Campy Kit, the training
manual, educational posters, and thermometers were the most frequently observed materials at
intervention facilities. The training manual was observed in 9.97% of the intervention-full and
9.13% of the intervention-lite facilities; the posters were observed in 21.36% of the interventionfull and 20.45% of the intervention-lite facilities; and the thermometer was observed in 19.05%
of the intervention-full and 17.90% of the intervention-lite facilities. It is worth noting that studyprovided materials were observed in very few facilities in the wait list control group. This
suggests that cross-over between the intervention groups and the wait list control group was low.
Despite receiving the materials, we found that only 54% of facilities in the intervention-full
group and 45% of facilities in the intervention-lite group reported having used the “Campy”
materials for training.
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Discussion
Although some food handling practices to prevent Campylobacter-contaminated poultry
improved over time, the Campy Training Kit did not significantly improve raw chicken handling
practices, even when supplemented by a 45-minute in-person, train-the-trainer educational
component. Overall, the full and the lite interventions were not significantly better than the wait
list control group on observational measures of food handling practices with exception of
thermometer use. Similarly, food handlers provided with either the full or lite intervention did
not report significantly more knowledge of Campylobacter or increased support from
management than the wait list control group.
Both the full and the lite interventions were significantly better than the wait list control
group in increasing thermometer use to verify chicken cooking temperatures. This is a
noteworthy exception to the overall finding of non-significance because obtaining the proper
cooking temperature is an important prevention measure for campylobacteriosis. It would appear
that distribution of the Campy Kits is all that is needed to improve thermometer use; the inperson training component did not provide additional benefit. The same finding holds true for the
other materials in the Campy Kit. Although the Campy Kit was distributed to all the facilities
receiving the full or lite intervention, utilization of the Campy materials was at most 51% in both
intervention groups. In other words, the in-person training did not result in greater use of the
Campy materials.
The results of the present study may be impacted by the Hawthorne effect (aka observer
effect). Recall that data collectors replaced their routine inspection procedures with a new format
that allowed them to administer the study surveys. This change was not hidden from the facility
managers and food handlers. In fact, data collectors informed operators that the visit was part of
13
EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
a special project about raw chicken and there was little doubt that they were being observed with
specific reference to their chicken handling practices. Unlike a routine inspection, which would
assess health and hygiene practices throughout the food facility, data collectors focused only on
raw chicken storage, preparation, and cooking. It has been well established that being observed
or monitored can increase behavior in a positive direction (Campbell, Maxey & Watson, 1995).
In addition to the Hawthorne effect, it is important to point out that the current study was
conducted at the same time as policy changes were enacted for food handlers which may have
increased knowledge of food safety. For example, 87% of respondents indicated that “all” or
“most” of the food handlers working their shift had valid food handler cards. Beginning July 1,
2011, food handlers were required to obtain a food handler card by taking a training course from
a recognized provider that provides basic, introductory food safety instruction as specified in the
California Retail Food Code Section 113948. The Hawthorne effect, coupled with changes in
food handler requirements, may explain high pre-assessment values and the observed
improvement in the wait list control group.
Study strengths include blind data collectors, standardization training provided to data
collectors, observational data (in addition measures reported by food handlers in interviews) and
large data set. Study limitations include binary yes/no responses and forced multiple choice
responses on the interview that may not capture more subtle information, missing/incomplete
data, and the possibility of different data collectors at pre and post assessment (which may add
more variability despite standardization training).
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Conclusion
We hypothesized that the Campy Training Kit delivered with a train-the-trainer
component (intervention-full) would improve raw chicken handling practices over the Campy
Training Kit by itself (intervention-lite) and a wait listed control group. While the interventionfull was not found to be more effective than the intervention-lite group or the wait list control
group, the Campy Kit was found to increase thermometer use to verify chicken cooking
temperatures. Considering that prevention of cross-contamination of raw chicken juice with
ready-to-eat foods and food contact surfaces is also an important prevention measure for
campylobacteriosis, more research is needed to develop training materials to minimize these risk
factors.
Acknowledgements
This publication is based on research funded by the Centers for Disease Control and
Prevention’s (CDC) Environmental Health Specialists Network (EHS-Net), which is supported
by a CDC grant award funded under CDC-RFA-EH05-013. San Mateo County acknowledges
the Registered Environmental Health Specialists who collected data. Special acknowledgement
also goes to Brenda Le and Laura Brown, PhD for their contributions to the study. Special thanks
goes to Vicki Everly for conducting the trainings and Prins, Williams Analytics, LLC for
providing support with data processing and analysis.
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
References
Abidin, U.F., Arendt, S.W., & Strohbehn, C.H. (2011). Proceedings from International Council
on Hotel, Restaurant, and Institutional Education Annual Conference: An Exploratory
Investigation on the Role of Organizational Influencers in Motivating Employees to
Follow Safe Food Handling Practices.
Batz, M.B., Hoffman, S., & Morris, J.G. Jr. (2011). Ranking the risks: the 10 pathogen-food
combinations with the greatest burden on public health. University of Florida, Emerging
Pathogens Institute. Retrieved from http://www.epi.ufl.edu/?q=rankingtherisks
Bryan, F.L. (1988). Risks of practices, procedures, and processes that lead to outbreaks of
foodborne diseases. Journal of Food Protection, 51, 498–508.
Campbell, J.P., Maxey, V.A., & Watson, W.A. (1995). Hawthorne effect: implications for
prehospital research. Annals of Emergency Medicine, 26(5), 590-4.
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communicable diseases in California, 2011-2014. Retrieved from
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neralCommDiseasesinCA2011-2014.pdf
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Weekly Report, 60, (22); 749-755.Retrieved from
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Prevention.
Centers for Public Health Preparedness. (2005). Train the trainer: Survey of CPHP resources.
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County of San Mateo Health System. (2012-2014). Communicable Diseases Quarterly Reports,
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Lillquist, D.R., McCabe, M.L, & Church, K.H. (2005). A comparison of traditional handwashing
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Environmental Health, 67(6), 13-16.
Orfaly, R.A., Frances, J.C., Campbell, P., Whitmore, B., Joly, B., & Koh, H. (2005). Train-thetrainer as an educational model in public health preparedness. Journal of Public Health
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United States Department of Health & Human Services. (n.d., updated August 25, 2015). Safe
minimum cooking temperatures. Retrieved from
http://www.foodsafety.gov/keep/charts/mintemp.html
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Table 1. Domains constructed from composites of survey questions
Facility Assessment Survey
Food Handler Survey
Cross-contamination in storage or thawing
Problems with training
Problems with storage practices
Support
Problems with thawing practices
Knowledge
Good preparation practices
Problems with sanitizing equipment
Good Wiping Cloth practices
Thermometer used
Chicken undercooked
Cross-contamination during cooking
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Table 2. Distribution of facility outcomes, by intervention group and time, and odds ratios
from population-averaged logistic regression model
Pre
Post
Outcome and group
Category
n (%)
n (%)
OR
95% CI
Cross-contamination
in storage or thawing
Full
Yes
35 (14.2)
18 (7.5)
0.87
0.41, 1.83
No
191 (77.3)
198 (82.5)
Missing
21 (8.5)
24 (10.0)
Lite
Yes
34 (13.7)
23 (9.6)
1.21
0.59, 2.49
No
196 (78.7)
192 (81.4)
Missing
19 (7.6)
21 (8.9)
Control
Yes
38 (19.1)
24 (12.5)
Ref.
No
138 (69.6)
157 (81.8)
Missing
23 (11.6)
11 (5.7)
Problems with
storage practices
Full
Yes
122 (49.4)
83 (34.6)
0.84
0.53, 1.33
No
108 (43.7)
141 (58.8)
Missing
17 (6.9)
16 (6.7)
Lite
Yes
140 (56.2)
76 (32.2)
0.35, 0.89
0.56*
No
93 (37.4)
145 (61.4)
Missing
16 (6.4)
15 (6.4)
Control
Yes
94 (47.2)
74 (38.5)
Ref.
No
87 (43.7)
111 (57.8)
Missing
18 (9.1)
7 (3.7)
Problems with
thawing practices
Full
Yes
14 (5.7)
7 (3.0)
0.69
0.20, 2.36
No
230 (93.5)
225 (94.9)
Missing
2 (0.8)
5 (2.1)
Lite
Yes
12 (4.8)
8 (3.4)
0.93
0.27, 3.19
No
230 (92.7)
222 (94.9)
Missing
6 (2.4)
4 (1.7)
Control
Yes
12 (6.0)
9 (4.7)
Ref.
No
182 (91.5)
181 (94.3)
Missing
5 (2.5)
2 (1.0)
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EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Table 2 (cont). Distribution of facility outcomes, by intervention group and time, and odds
ratios from population-averaged logistic regression model
Pre
Post
Outcome and group
Category
n (%)
n (%)
OR
95% CI
Good preparation
practices
Full
Yes
31 (12.6)
62 (25.8)
1.43
0.73, 2.80
No
174 (70.5)
142 (59.2)
Missing
42 (17.0)
36 (15.0)
Lite
Yes
28 (11.2)
46 (19.5)
1.19
0.59, 2.37
No
187 (75.1)
148 (62.7)
Missing
34 (13.7)
42 (17.8)
Control
Yes
27 (13.6)
42 (21.9)
Ref.
No
142 (71.4)
129 (67.2)
Missing
30 (15.1)
21 (10.9)
Problems with
sanitizing equipment
Full
Yes
40 (16.2)
30 (12.5)
1.18
0.60, 2.31
No
175 (70.9)
174 (72.5)
Missing
32 (13.0)
36 (15.0)
Lite
Yes
45 (18.1)
26 (11.0)
0.85
0.43, 1.69
No
177 (71.l)
182 (77.1)
Missing
27 (10.8)
28 (11.9)
Control
Yes
43 (21.6)
28 (14.6)
Ref.
No
133 (66.8)
135 (70.3)
Missing
23 (11.6)
29 (15.1)
Good wiping cloth
practices
Full
Yes
76 (30.77) 115 (47.92)
1.19
0.69, 2.05
No
131 (53.04) 90 (37.50)
Missing
40 (16.19)
35 (14.58)
Lite
Yes
85 (34.54)
87 (36.86)
0.72
0.42, 1.24
No
132 (53.01) 100 (42.37)
Missing
31 (12.45)
49 (20.76)
Control
Yes
58 (29.15)
75 (39.06)
Ref.
No
116 (58.29) 81 (42.19)
Missing
25 (12.56)
36 (18.75)
20
EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Table 2 (cont). Distribution of facility outcomes, by intervention group and time, and odds
ratios from population-averaged logistic regression model
Pre
Post
Outcome and group
Category
n (%)
n (%)
OR
95% CI
Cook uses
thermometer to
check temperature
Full
Yes
34 (13.77)
63 (26.25)
1.35, 3.93
2.30*
No
195 (78.95) 158 (65.83)
Missing
18 (7.29)
19 (7.92)
Lite
Yes
46 (18.47)
72 (30.51)
1.19, 3.34
2.00*
No
185 (74.30) 148 (62.71)
Missing
18 (7.23)
16 (6.78)
Control
Yes
42 (21.11)
42 (21.88)
Ref.
No
138 (69.35) 140 (72.92)
Missing
19 (9.55)
10 (5.21)
Chicken
undercooked when
tested
Full
Yes
23 (9.31)
8 (3.33)
0.35
0.11, 1.07
No
210 (85.02) 212 (88.33)
Missing
14 (5.67)
20 (8.33)
Lite
Yes
27 (10.84)
15 (6.36)
0.66
0.25, 1.78
No
208 (83.53) 201 (85.17)
Missing
14 (5.62)
20 (8.47)
Control
Yes
14 (7.04)
12 (6.25)
Ref.
No
170 (85.43) 168 (87.50)
Missing
15 (7.54)
12 (6.25)
Cross-contamination
during cooking
Full
Yes
129 (52.23) 79 (32.92)
0.79
0.49, 1.26
No
109 (44.13) 149 (62.08)
Missing
9 (3.64)
12 (5.00)
Lite
Yes
132 (53.01) 85 (36.02)
0.88
0.55, 1.41
No
109 (43.78) 138 (58.47)
Missing
8 (3.21)
13 (5.51)
Control
Yes
105 (52.76) 78 (40.63)
Ref.
No
83 (41.71) 104 (54.71)
Missing
11 (5.53)
10 (5.21)
21
EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Table 3. Distribution of food handler survey outcomes, by intervention group and time, and
odds ratios from population-averaged logistic regression model (excluding managers and
owners)
Pre
Post
Outcome and group
Category
n (%)
n (%)
OR
95% CI
Problem with training
on safe handling
practices
Full
Yes
24 (16.78)
14 (10.85)
0.65
0.26, 1.63
No
101 (70.63) 101 (78.29)
Missing
18 (12.59)
14 (10.85)
Lite
Yes
27 (18.37)
7 (5.79)
0.10, 0.84
0.30*
No
106 (72.11) 100 (82.64)
Missing
14 (9.52)
14 (11.57)
Control
Yes
28 (21.71)
22 (20.18)
Ref.
No
85 (65.89)
75 (68.81)
Missing
16 (12.40)
12 (11.01)
22
EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Table 4. Distribution of continuous food handler survey outcomes, by intervention group and
time, and differences from a linear mixed effects regression model (excluding managers and
owners)
Pre
Post
Outcome and group
n
M (SD)
n
M (SD)
b
95% CI
Support
Full
133
11.42 (1.12) 114
11.45 (1.11)
-0.26
-0.62, 0.10
Lite
139
11.50 (0.91) 108
11.51 (0.95)
-0.28
-0.64, 0.08
Control
116
11.19 (1.29) 94
11.48 (0.85)
Ref.
Knowledge
Full
143
4.26 (1.24) 129
4.97 (1.16)
0.13
-0.25, 0.52
Lite
147
4.41 (1.25) 121
4.81 (1.35)
-0.13
-0.52, 0.26
Control
129
4.19 (1.43) 109
4.73 (1.49)
Ref.
23
EDUCATIONAL INTERVENTION TO IMPROVE RAW CHICKEN HANDLING
Table 5. Utilization of materials identified in facilities by intervention group
Full (n=237)
Lite (n=234)
Control (n=192)
N
(%)
N
(%)
N (%)
“Campy” materials (Post)
Manuals/SOP
23.63 (9.97)
21.37 (9.13)
1.04 (0.54)
Shelf labeled
9.70 (4.09)
11.11 (4.75)
0.52 (0.27)
Educational posters
50.63 (21.36)
47.86 (20.45)
1.56 (0.81)
Checklists
5.06 (2.14)
4.27 (1.82)
0.00 (0.00)
Thermometer
45.15 (19.05)
41.88 (17.90)
2.08 (1.08)
24