Abstract
Background: The most fundamental solution to control pandemics is to promote public awareness and attitudes toward infectious
diseases. Food handlers in food preparation and distribution centers have a very effective role in the transmission, prevention, and
control of diseases due to the high level of contact with the general public. The present study aimed to investigate the impact of
training on the knowledge, attitude, and performance of food handlers in food preparation and distribution centers in Amlash, Iran
regarding the ways to prevent COVID-19 in 2021.
Methods: The participants in this interventional study were 300 food handlers in food preparation and distribution centers selected
through multistage random cluster sampling. A list of the participants was prepared and classified based on the type of their
businesses, and the participants were randomly assigned to intervention and control groups using the random allocation software.
The intervention focused on training for the prevention of COVID-19. Before and after the intervention, the knowledge, attitude,
and performance of the participants in the two groups were assessed using the questionnaire developed by Honarvar et al. The
validity and reliability of this questionnaire were confirmed. The collected data were analyzed using non-parametric Mann-
Whitney U, Wilcoxon signed-rank, and Kruskal-Wallis tests.
Results: After controlling the effect of pre-test scores with multivariate analysis of covariance (MANCOVA), the results showed that
the knowledge, attitude, and performance scores for the participants in the intervention group increased by 31%, 6.16%, and 10%,
respectively, after the training intervention and the scores for these variables were significantly higher than those obtained by the
participants in the control group (P<0.001). There was also a significant relationship between age and knowledge (P<0.001) and
attitude (P=0.043). However, the participant’s age was not significantly correlated with their performance (P=0.845). There was
also a significant relationship between the participants’ gender and performance (P=0.028).
Conclusion: Training can have an impact on the knowledge, attitude, and performance of food handlers in food preparation and
distribution centers. Thus, continuous training is essential for preventing COVID-19 among food handlers in food preparation and
distribution centers.