Preventing food-borne illness in food service establishments: Broadening the framework for intervention and research on safe food handling behaviors.

Unsafe food handling practices in food service establishments are a major contributor to the transmission of food-borne illness. However, current worker education and training interventions demonstrate only modest success in changing food service worker behavior. We argue for more ecologically-oriented interventions that address both individual and contextual factors that influence safe food handling behaviors. We describe potential predisposing influences (e.g. knowledge, beliefs concerning risk of food-borne illness, perceived control, self-efficacy), enabling influences (e.g. intensity and quality of training, work pressure and pace, safety procedures and protocols, appropriate equipment) and reinforcing influences (e.g. management enforcement of policies, incentives for safe food handling, job stress and organizational justice) on worker behavior. Efforts to change food service workers' behaviors are more likely to be effective if they pay greater attention to the ecological context, address multiple influences on worker behavior, and view workers as partners in preventing food-borne illness in food service establishments.