Food safety training designed systematically to impact the intended target audience is a vital part of maintaining a safe food system. The objective of this systematic review of peer-reviewed studies was to assess how current food safety training programs analyzed the needs of the target audience and how those trainings were designed, developed, implemented, and evaluated. The goal was to identify training design strategies that effectively impact safe food handling behaviors of food processors. Twenty-three peer reviewed studies evaluating the impact of food safety training on knowledge, attitudes, and behaviors of food handlers were identified and included in this study. Twenty-two (5/23) percent of the studies reported performing a needs analysis prior to developing training, mainly to gather demographic data on the target audience. The majority of the interventions were face-to-face (83%, 19/23), followed a behaviorist framework (52%, 12/23) and lasted less than 8 hours (43%, 10/23; 30%, 7/23 did not report length of training). Little information was reported on which tools were used to develop training. The evaluation design for the majority of the training programs followed an uncontrolled before and after design (65%, 15/23), 9% (2/23) were non-randomized controlled trials, and 26% (6/23) were randomized controlled trials. All of the studies included in this review evaluated one, two, or all three of the key learning outcomes, i.e., knowledge (83%, 19/23), attitudes (30%, 7/23), and behaviors (70%, 16/23). It was impossible to compare the effectiveness of the training interventions to each other due to high bias and the fact that not all were evaluated using the same methods. However, it appeared that training did have the greatest impact on knowledge and a lesser impact on attitudes and behaviors. Few studies reported performing follow-up testing to measure retention. The results of this study indicate that a systematic approach is not being taken in designing most food safety training. If food safety training programs are developed in a more systematic way, and evaluations are performed to at least Kirkpatrick Level 3, it appears there is potential for that training to become more impactful with regard to positive changes in knowledge, attitudes, and behaviors. A discussion and illustration of how training fits into the Food Safety Culture Maturity Model was provided.
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