Demographic profiles of respondents
The demographic characteristics of the study participants are demonstrated in Table 1.
All food handlers surveyed were aged between 20 and 55 years old; however, most of them (55%) were of middle age (30 and 49 years old). Most of the respondents (94.2%) were females. Approximately a third of food handlers (34%) interviewed had education at primary level. Over a half of food handlers (52%) were literate at the secondary education level. Among food handlers surveyed, 8.5% reported having vocational training and only 6% of respondents possess university degrees. Of these 358 food handlers, 17% performed duties as cooks, 30% were involved as kitchen assistants, 31% were food servers, 14% were part of the cleaning staff, and 8% were managers. A large proportion of participants (82.7%) had no or expired medical examination cards. No significant differences in food safety knowledge and attitudes were identified based on the gender, age, educational level, and work experience of the food handlers. This aligns with a study conducted by Abdul-Mutalib, Abdul-Rashid [18], which similarly found no significant association between the knowledge level of respondents and their socio-demographic characteristics. In contrast, McIntyre, Vallaster [19] reported that socio-demographic factors, such as the length of work experience in the food industry and the educational level of food handlers, were significantly linked to enhanced food safety knowledge. Further studies are necessary to gain a more comprehensive understanding of the impact of socio-demographic factors on the food safety knowledge and attitudes of food handlers. The majority of participants in the present study (94%) were females. In the Kazakhstani context, the prevalence of women working in restaurants is not unexpected, given that this demographic is traditionally seen as primarily responsible for household food preparation activities. In line with this cultural norm, the female labor force tends to dominate the food service sector. The substantial representation of female handlers in our study aligns with findings from similar previous studies [20,21,22].
More than two-thirds of respondents (69%) had 6 months to 2 years of experience in the food industry. In this study, the cumulative experience of food handlers in the food service industry was as follows: less than 1 year (44%), followed by 1–2 years (28%), 2–4 years (23%), and more than 4 years (5%). The limited diversity in food handling experience raises the concern of an elevated risk of food contamination, particularly due to the potential lack of adherence to good manufacturing practices. Approximately 34% of the food handlers had not advanced beyond primary education, and of this group, over 60% were female. Considering that women engage in diverse food handling activities both at work and at home, it becomes crucial to consider their educational background and literacy level when developing and implementing food safety training programs. Previous studies have demonstrated that longer job tenure is often associated with improved food safety practices and reduced risk of contamination. For example, food handlers with over 10 years of experience exhibited significantly lower rates of bacterial contamination compared to less experienced workers [23]. However, job experience alone does not ensure safe practices unless reinforced by structured training. Evidence suggests that formal education in food safety substantially enhances compliance with hygiene protocols and reduces critical violations during inspections [24, 25]. Therefore, both accumulated practical experience and regular food safety training are essential to ensuring safe food handling and minimizing contamination risks.
Food safety knowledge of respondents
Evaluation of food handlers’ food safety knowledge is illustrated in Table 2. Over half (57%) of the surveyed food handlers had not participated in any food safety training programs. This gap is concerning, as previous studies have demonstrated that formal training significantly enhances food safety knowledge and practices [26, 27]. The lack of training may explain the mixed levels of understanding observed in this study. For instance, while 80% of respondents were aware that improper food handling could cause foodborne illnesses, the majority (74%) relied on personal experience as their primary source of knowledge. This reliance on informal sources could lead to incomplete or inaccurate understanding of food safety principles. Only 19% of the food handlers reported receiving food safety knowledge through formal training, 9% from public health officials, and a mere 1% from media. The disparity in knowledge sources suggests that more structured and accessible training programs are needed to ensure comprehensive food safety education. Research by Seaman and Eves [28] highlights that well-designed training programs can effectively improve food handlers’knowledge and compliance with safety practices. Moreover, other studies have also demonstrated that theoretical and practical training contributes to improving hygiene conditions in establishments and changing the behavior of food handlers [25, 29,30,31]. The study also highlighted specific gaps in knowledge. For example, 40% of participants recognized expired food as a primary source of foodborne infection, while nearly half (48%) acknowledged that multiple factors, including uncooked, expired, and improperly stored foods, contribute to foodborne illnesses. This indicates a partial understanding that could lead to inconsistent application of food safety measures. Moreover, while 70% of respondents correctly identified the importance of hygiene, sanitizing food contact surfaces, and rinsing raw foods and utensils in reducing contamination risks, a significant portion (69%) failed to recognize all contributing factors to microorganism proliferation, such as lack of cleaning in the cooking area, unsanitized utensils, not wearing protective clothing, and poor food handling. This limited knowledge is consistent with findings from other studies, such as those by Green and Selman [32], which suggest that food handlers often have limited awareness of all critical control points in food safety. Regarding microbial proliferation, only one-third (33%) of participants correctly identified that germs proliferate better in warmed foods. This lack of knowledge about temperature control is particularly concerning, as proper temperature management is crucial for preventing foodborne illnesses [33].
Overall, the study underscores the necessity for comprehensive and regular food safety training for food handlers. Structured training programs, supported by public health initiatives and accessible through various media, can bridge the knowledge gaps identified. By improving education on all aspects of food safety, including cross-contamination, proper storage, and temperature control, we can significantly reduce the risk of foodborne illnesses. Enhanced training and continuous education are vital for ensuring that food handlers are well-equipped with the necessary knowledge and skills to maintain high standards of food safety.
Food safety self-reported attitudes of respondents
It is considered that food safety attitudes are an essential factor of food safety, specifically in preventing hazards of foodborne related diseases [34]. Data obtained from food handlers responses related to their food safety attitudes are demonstrated in Table 3. Of the study population, a large portion of respondents (71%) reported that ready-to-eat food must be maintained at 60℃ and above. Seventy-four percent reported that prepared food should be kept in refrigerator below 4 ℃. More than two-thirds of respondents (68%) were certain about possible germ proliferation in foods prepared in advance. The present study indicates that nearly 30% of the food handlers’ attitudes toward food contamination was found to be fair. Similar findings have been reported in prior studies, highlighting a deficiency in the knowledge of food handlers regarding cross-contamination and sanitization [35, 36]. These results suggest that food handlers may not be fully acquainted with the essential procedures required for proper sanitation and the prevention of cross-contamination. Osaili, Obeidat [35] assert that”food handling mistakes during food preparation have been associated with most incidences of foodborne diseases.”Given the incorrect execution of these operations, the likelihood of foodborne diseases increases. This may also indicate inadequate or a lack of training specifically addressing cross contamination.
Our findings demonstrated that overall knowledge among study respondents is consistent with those studies described by Lee, Halim [21], where most respondents were aware that they should wear protective clothing and not come to work if feeling sick. An overwhelming majority of participants (87%) reported that raw and cooked food should be kept separately to avoid cross-contamination. Almost all respondents (99%) stated that cleaning solutions and toxic chemicals should not be stored in close proximity to the food preparation area. Most of food handlers (61%) accurately believed that it is necessary to monitor the temperatures of refrigerators and freezers on a regular basis. Regarding self-hygiene, most participants (74%) knew the importance of hand washing after using the toilet. This aligns with the findings of Ansari-Lari, Soodbakhsh [37], which demonstrated an adequate level of knowledge regarding general sanitary measures among food handlers. However, one-third (33%) of the respondents provided incorrect responses concerning the procedures for reheating and preparation of food. It has become a common practice in food service establishments, particularly in self-service restaurants, to prepare food in advance. While some establishments employ water baths to maintain food temperature and inhibit the proliferation of harmful microorganisms, others leave dishes on shelves or tables for extended periods. This practice can result in food contamination and the proliferation of microorganisms [18].
Food safety self-reported practices of respondents
The responses of food handlers towards Food Safety Practices are outlined in Table 4. A majority of the participants, comprising 60%, indicated that they engaged in hand hygiene practices prior to food preparation or service. Among food handlers, 52% specifically reported the consistent use of antibacterial soap for handwashing. In terms of food preparation practices, 61% of respondents emphasized the importance of cleaning utensils and equipment before commencing food preparation. Moreover, a significant proportion of food handlers, totaling 72%, adhered to the practice of employing separate utensils for handling raw and cooked food items. Approximately 84% of food handlers affirmed their practice of inspecting the expiration dates on food items before their utilization. In contrast, a notable 74% of food handlers were unaware of established guidelines for food thawing procedures, with a propensity to thaw frozen food items at room temperatures.
Vast majority of food handlers, constituting 73%, demonstrated a concerning trend of reporting to their workplaces despite being ill, which consequently resulted in unfavorable scores in this regard. In terms of the thawing process for frozen food items, a mere 3% of food handlers followed the recommended food safety practice of refraining from thawing foods at room temperature. Conversely, approximately 82% of workers correctly observed the practice of wearing uniforms in food preparation areas. However, only 34% of food handlers demonstrated the habit of regularly laundering their uniforms. Lastly, approximately 37% of food handlers adhered to the appropriate food safety protocol of employing tissues when coughing or sneezing, followed by immediate hand washing. This outcome aligns with findings from previous studies by Parry-Hanson Kunadu, Ofosu [38] and Sneed, Strohbehn [39], which also reported suboptimal food safety practices among food handlers.
In our study, the scores related to personal hygiene aspects, such as the washing of hands and utensils before engaging in food handling activities were lower than that in the previous studies [18, 34, 37]. Although the majority of food handlers in this study reported using soap when washing their hands, the effectiveness of hand hygiene is highly dependent on proper technique. According to the Centers for Disease Control and Prevention, effective handwashing involves five essential steps: wetting, lathering, scrubbing for at least 20 s, rinsing, and drying [40]. Simply using soap without adhering to these steps may leave harmful microorganisms on the hands. Several studies have shown that inadequate handwashing practices contribute significantly to cross-contamination in food service settings [41, 42]. Therefore, it is imperative that all food handlers consistently adhere to the practice of handwashing at each stage of food production, especially before directly handling the food.
Knowledge, attitudes, and practices scores among respondents
Food handlers achieved scores ranging from a minimum of 1 to a maximum of 8 out of 8 on the food safety knowledge section of the questionnaire. The average score for food safety knowledge was 4.76 ± 1.44 (52%), indicating a low level of knowledge, as it fell within the 50–80% threshold. The scores for food safety attitudes among respondents ranged from 1 to 7 out of a possible 7. The average score for food safety attitudes was 6.11 ± 2.12 (87%), which is considered a good score. The food handlers achieved food safety practices scores ranging from a minimum of 1 to a maximum of 8 out of 10. The mean score for food safety practices was 7.15 ± 2.21, which is classified as a low score (40–80%).
In a similar study, Dudeja, Singh [43]. found that food handlers interviewed had good scores in food safety knowledge, attitudes, and practices. Likewise, Al-Shabib, Mosilhey [34] reported satisfactory scores in their evaluation of the KAP attributes of food handlers in Saudi Arabia. A study conducted in Malaysia among food handlers also demonstrated satisfactory scores in food safety knowledge, attitudes, and practices [18]. In contrast, Nee SiowOi and Norrakiah Abdullah Sani [44] reported that while food handlers in Malaysia demonstrated good food safety knowledge and a solid understanding of hygiene importance, their knowledge scores regarding food storage practices were poor.
Association among attributes related to knowledge, attitudes, and practices of food handlers
In accordance with Akoglu [45], a correlation is considered moderate to strong when Spearman’s rho exceeds 0.700, represented as rs > 0.700 (Table 5). Notably, there was a moderate to strong correlation identified between food safety knowledge and the food safety practices of food handlers, yielding an rs value of 0.775. Furthermore, this correlation was statistically significant (p < 0.05). A Spearman correlation analysis was also conducted to examine the relationship between food safety attitude and food safety practices scores among food handlers. The findings revealed a strong correlation, with an rs value of 0.733, and once again, this correlation was statistically significant (p < 0.05). This significant positive correlation implies that both the food safety knowledge and attitude of food handlers exert a discernible influence on their food safety practices. Similarly Ansari-Lari, Soodbakhsh [37] also reported a significant positive correlation between the food safety knowledge and food safety attitude of food handlers. Nevertheless, it is essential to note that imparting knowledge of personal hygiene alone does not suffice to ensure the accurate application of food safety knowledge, attitude and practice principles. Practical, hands-on training and the implementation of regular training programs are imperative in enhancing the overall state of food safety [18, 46].
The correlation between demographic factors and the attributes of food safety knowledge, attitudes, and practices
Chi-square test was performed to evaluate association between the demographic features of food handlers and their food safety KAP attributes. Notably, no statistically significant association was found between”age”and the food safety knowledge of food handlers (p = 0.061). However, it is important to highlight that all the other demographic characteristics demonstrated a statistically significant association (p < 0.05) with the food safety knowledge of food handlers, as indicated in Table 6. A chi-square test was also conducted to examine the association between the demographic factors of the participants and their food safety attitude. The findings indicated that”age”and”gender”exhibited no significant correlation with food safety attitude, as evidenced by p-values of p = 0.055 and p = 0.178, respectively.
In contrast, all other demographic characteristics, including level of education, professional category and current job tenure, displayed a statistically significant association (p < 0.05) with food safety attitude. Furthermore, the chi-square test revealed that, except for the”gender”of food handlers, all the other demographic attributes exhibited a significant association with their food safety practices.
The research findings revealed that there was no statistically significant link between age and the food safety knowledge of food handlers. Likewise, food safety attitude did not exhibit any notable correlation with the age of the food handlers. Among the various attributes related to KAP in food safety, only food safety practices displayed a significant connection with the age of the study participants.
Most of the food handlers (55%), within the age range of 20–33 years, demonstrated a significant association with food safety practices. Similarly, in Ireland, younger food handlers particularly those aged 26–35 years, exhibited a higher level of knowledge regarding standard food safety practices. This trend may be attributed to the increased exposure and dedication to learning food practices among younger food handlers [47].
Previously conducted evaluation of the KAP attributes of food handlers in Turkey, showed a significant difference among the food safety knowledge, food safety attitude, and food safety practices between male and female respondents. In contrast, Patil, Cates [48] reported that men demonstrated inadequate food safety practices.
Similarly, McIntyre, Vallaster [19] conducted a KAP attribute study in Canada, which concurred with the present research by demonstrating no association between the food safety knowledge of food handlers and their gender. Since current study predominantly comprised of male food handlers, it was not feasible to draw definitive conclusions regarding the impact of gender on food safety KAP attributes among food handlers in Kazakhstan.
Food safety knowledge exhibited the most robust correlation with the educational attainment of food handlers, followed by food safety attitude and food safety practices. A study conducted in Vietnam by Vo, Le [49] defined that a level of education positively influenced both food safety knowledge and food safety practices among food handlers. Additionally, Souza, Azevedo [50] found a significant correlation between the level of education and the food safety knowledge of food handlers. In another study, carried out in Brazil, it was observed that education had a significant correlation with the food safety knowledge of participants [51]. Similar findings were reported by McIntyre, Vallaster [19] in a KAP-based survey involving food handlers in Canada. Additionally, concerning the KAP scores of food handlers, Yarrow, Remig [52] found that a higher level of education was associated with improved KAP scores. Consequently, the present study concludes that the educational level of food handlers exhibits a significant association with food safety attributes based on KAP.
Despite the strengths of this study, several limitations should be acknowledged. One important limitation is that the research focused solely on individual-level knowledge, attitudes, and practices of food handlers, without assessing the implementation of broader food safety management systems such as Hazard Analysis and Critical Control Points (HACCP). Future research should consider assessing the presence and impact of HACCP systems to provide a more comprehensive understanding of food safety practices at both individual and organizational levels. Second, the findings are limited to a specific region and may not fully reflect the diversity of food safety practices across other parts of Kazakhstan. Consequently, future research efforts, with a focus on investigating the precise nature of the correlation between these food safety attributes and involving larger sample sizes, will contribute significantly to enhancing food safety standards in developing nations. Additionally, there is a need for future research to explore the impact of the COVID-19 pandemic on the food safety knowledge, practices, and attitudes of food.