Knowledge, attitude and practice of hygiene and sanitation among food-handlers in a psychiatric hospital in Indonesia - a mixed method study

INTRODUCTION: In a psychiatric hospital that also provides nutritional service, food hygiene and sanitation is considered as an important factor to prevent infection. This study aimed to describe knowledge, attitude, and practice of hygiene and sanitation and the contributing factors in food-handlers of a psychiatric hospital. METHODS: A mixed method study was conducted in a referral mental health hospital in Central Java, Indonesia. To obtain the quantitative data, 37 food-handlers were recruited through a purposive sampling. A self-administered questionnaire was distributed to measure knowledge and attitude, while hygiene and sanitation practice was observed directly using a checklist. In-depth interview was carried out with food-handlers as well as supervisors of food production and distribution at the Nutrition Unit. Rank Spearman correlation and Kruskal Wallis test with content analysis were utilized for data analysis. RESULTS: A total of 33 (89%) and 31 (84%) subjects had respectively good knowledge and attitude regarding hygiene and sanitation. However, more than one third (38%) of food-handlers performed poor hygiene and sanitation practice. No correlations were found between knowledge, attitude, and practice regardless of any combination between two factors (p > 0.05). Possible causes of unfavourable hygiene and sanitation practice included person-related factors and human resource management. Further analysis indicated that training received by food-handlers had an association with their practices (p < 0.05). CONCLUSION: Knowledge and attitude on hygiene and sanitation are generally good among food-handlers in the psychiatric hospital. There is a need to improve the practice through training programs.