INVESTIGATING RIYADH’S PUBLIC HEALTH INSPECTORS' ABILITY TO CONDUCT RISK-BASED FOOD INSPECTION, AND THEIR PROFESSIONAL NEEDS A Mixed-Methods Research Study
Sultan Abdullah Alsaleh BPubHlth-HP, MPH
Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy
School of Public Health and Social Work Faculty of Health Queensland University of Technology 2021
ﷲ ا ا
In the name of Allah, the Most Gracious, the Most Merciful
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Keywords
Environmental Health Officer (EHO), food safety, Food and Agriculture Organization (FAO), foodborne illness (FBI), Hazard Analysis and Critical Control Point (HACCP), Knowledge-to- action framework (KTA), Ministry of Municipal and Rural Affairs, Public Health Inspector
(PHI), risk-based food inspection, Saudi Arabia, traditional food inspection.
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Abstract
Background
Every year about 600 million –—almost 1 in 10 people in the world –—fall ill after eating unsafe food, and more than 400,000 people die. Public Health Inspectors (PHIs) perform important roles and have numerous responsibilities in efficiently protecting public health from foodborne illnesses (FBIs). Some of these roles and responsibilities include undertaking food safety assessments, enforcing local food safety legislation, and providing support to food establishments (i.e., restaurants) regarding the minimization of food safety risks. The processes of qualifying and training PHIs, and ensuring timely addressing of their professional needs are essential for the successful and safe development of the food industry in any country. At the same time, there is a significant knowledge gap in the food safety area in the Gulf Cooperation
Council (GCC) countries, including Saudi Arabia, which is related to the lack of a detailed understanding of the major issues preventing, or interfering with, the implementation and improvement of a food safety inspection approach.
Purpose
There are two key approaches towards food safety inspection at the food establishments across the globe —the traditional approach and the risk-based (modern) approach. The traditional approach typically focuses on reactive measures towards problems once they have been identified. In contrast, the risk-based approach recommended for adoption by the Food and Agriculture Organization of the United Nations (FAO) has a more proactive character, whereby it attempts to identify and address food safety issues before they actually become a public threat. The transition of Saudi Arabia to the risk-based food safety approach raises important questions about the professional needs of the Saudi PHI workforce for and during such a transition. Therefore, guided by the Knowledge-to-Action (KTA) framework, the aim
Page | iv of this Thesis was to identify the knowledge and skills needs of the PHIs in Riyadh to conduct risk-based food inspections, including any barriers and factors that may influence the effectiveness of the inspection process.
Methods
This research was conducted in two phases using both qualitative (phase 1) and quantitative (phase 2) methods and utilising a sequential exploratory design. In the first phase, seven semi-structured interviews were conducted with four PHIs, two senior Environmental
Health Mangers (EHMs) and the Coordinator of the Food Safety Diploma. The reason for the inclusion of the EHMs and the Coordinator in phase 1 was to obtain different perspectives.
Then, the information gathered from these interviews and the knowledge and skills framework of the Food and Agriculture Organization (FAO), were used to inform the development of the survey in the second phase. A survey was deemed to be a best fit in the current study to capture a large cohort of PHIs’ perceptions. A total of 502 PHIs were invited to participate in phase 2 and 301 completed and submitted it, resulting in a 60% response rate.
Findings
Results revealed that the levels of formal qualification of PHIs in Riyadh are significantly lower than in other developed and developing countries. Female PHIs typically have lower levels of knowledge and skills compared to their male counterparts. In addition, according to the conducted qualitative (Phase 1) and quantitative (Phase 2) investigations, the majority of participants demonstrated only limited levels of understanding and knowledge about Hazard Analysis and Critical Control Points (HACCP) principles, food sampling techniques, food microbiology and the English language as a communication tool with restaurant staff.
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Leading towards the anticipated transition to risk-based food inspections in Saudi
Arabia, special attention was focused on the professional needs of PHIs and issues that influence their performance, including on-going professional training. In particular, deficiencies in regular training and in the overall training arrangements to PHIs were also demonstrated by the current study. Additionally, lack of job satisfaction was another major finding of the study, with the highest levels of dissatisfaction being expressed with regard to motivation at the workplace, and the lack of support and security provided by the management.
It was also found that a large proportion of PHIs in Riyadh regarded the existing food safety laws and regulations are generally inadequate and not sufficiently clear. These were the issues
constituting the greatest perceived obstacles for the effective performance of PHIs and an
effective transition toward the risk-based inspection approach in Riyadh. In addition, the
obtained outcomes could also be generalised to other regions of Saudi Arabia and possibly,
other GCC countries.
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Table of Contents
Keywords ...... iii Abstract ...... iv Table of Contents ...... vii List of Figures ...... xii List of Tables ...... xiii Abbreviations ...... xv Statement of Original Authorship...... xvi Dedication ...... xvii Acknowledgment ...... xviii Conference Participation ...... xx CHAPTER 1: INTRODUCTION ...... 1 1.1. Background ...... 1 1.1.1. Food Safety Inspection in Saudi Arabia ...... 4 1.1.2. Contextual Factors ...... 5 1.2. Context...... 6 1.3. Scope…… ...... 7 1.4. Research Questions ...... 10 1.4.1. Primary Question ...... 10 1.4.2. Secondary Questions ...... 10 1.5. Aims and Objectives ...... 11 1.6. Methodology ...... 12 1.7. Thesis Document Outline ...... 13 CHAPTER 2: LITERATURE REVIEW ...... 15 2.1. Introduction ...... 15 2.2. Food Borne Illnesses (FBIs) ...... 16 2.3. Food Safety Inspection and Inspectors Role ...... 19 2.4. Practice Competencies by Country ...... 23 United Kingdom ...... 23 United States ...... 25 Australia ...... 27 Canada ...... 29
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2.5. Qualification by Country ...... 31 United Kingdom ...... 32 United States ...... 32 Australia ...... 33 Canada ...... 33 Saudi Arabia ...... 33 2.6. Traditional (Classic) Vs. Risk-based (Modern) Food Inspection ...... 34 2.7. The FAO and KTA Frameworks ...... 37 2.7.2. Knowledge and Skills Framework: FAO Risk-based Inspection Manual ...... 38 2.7.3. Knowledge Translation Framework: Knowledge-to-Action (KTA) ...... 43 2.8. Conclusion ...... 47 CHAPTER 3: RESEARCH METHODOLOGY ...... 49 3.1. Introduction ...... 49 3.2. Research Design ...... 50 3.3. Mixed Methods and Sequence Priority ...... 52 3.4. Choice of the Study Design ...... 56 3.5. Integration ...... 58 3.6. Ethical Considerations ...... 59 3.7. Conclusion ...... 61 CHAPTER 4: STUDY ONE – SEMI-STRUCTURED INTERVIEWS ...... 62 4.1. Introduction ...... 62 4.2. Methods of Phase 1 ...... 63 Development of the Interview Questions ...... 63 Double Translation Method...... 65 Recruitment and Eligibility Criteria ...... 68 Sampling ...... 69 Semi-Structured Interviews ...... 71 Ethical Consideration ...... 73 Data Analyses ...... 73 Trustworthiness ...... 75 4.3. Findings and Interpretation ...... 77 Introduction ...... 77 Participant Descriptions ...... 79 Emerging Themes ...... 81
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Interpretation ...... 82 4.4. Conclusion ...... 107 CHAPTER 5: STUDY TWO – CROSS-SECTIONAL SURVEY ...... 111 5.1. Introduction ...... 111 5.2. Methods of Phase 2 ...... 112 Description of the Study Design ...... 112 Survey Development...... 113 Double Translation Method...... 115 Piloting the Survey ...... 115 Eligibility Criteria ...... 117 Recruitment Strategies ...... 118 Administration of the Survey Using Key Survey ...... 119 Ethical Considerations ...... 120 Data Analysis ...... 120 5.3. Results…...... 123 5.3.1. Introduction ...... 123 5.3.2. Demographics ...... 123 5.3.3. Knowledge and Skills ...... 129 5.3.4. Training and Professional Development ...... 134 5.3.5. Challenges and Obstacles ...... 146 5.3.6. Education and Qualification ...... 154 5.4. Further Association Between the Variables ...... 156 5.4.1. Correlation Between Skill and Knowledge in Nine Areas ...... 156 5.4.2. Association Between Gender, Education, Years of Experience and Municipality and Skills and Knowledge ...... 158 5.4.3. Association Between Motivation and Gender, Education, Years of Experience and Municipality ...... 161 5.4.5. Association Between Gender and Municipality and Association Between Subjective Feeling About Preparedness for Inspector Job and Education Level ...... 165 5.5. DISCUSSION ...... 167 5.5.1. Introduction ...... 167 5.5.2. Demographics ...... 167 5.5.3. Knowledge and Skills ...... 169 General Comments About Knowledge and Skills ...... 169 Demographics and Knowledge and Skills ...... 171
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Food Safety Laws and Regulations ...... 172 Hazard Analysis and Critical Control Point (HACCP) ...... 174 Inspection Techniques, Using Devices and Sampling ...... 175 Sanitation and Hygiene, Food Microbiology and Pest Control...... 176 Communication and English Language Skills ...... 178 Scientific Research ...... 179 5.5.4. Training and Professional Development ...... 180 5.5.5. Challenges and Obstacles ...... 183 5.5.6. Education and Qualification ...... 184 5.5.7. Conclusion ...... 185 CHAPTER 6: INTEGRATIONS ...... 186 6.1. Introduction ...... 186 6.2. Knowledge and Skills ...... 187 6.2.1. Laws and Regulations ...... 187 6.2.2. Hazard Analysis and Critical Control Point (HACCP) ...... 189 6.2.3. Communication Skills ...... 192 6.3. Training and Professional Development ...... 194 6.4. Education and Qualification ...... 195 6.5. Challenges and Obstacles ...... 197 6.6. Conclusion ...... 201 CHAPTER 7: CONCLUSION...... 203 7.1. Introduction ...... 203 7.2. Significance and Strengths of the Study ...... 205 7.3. Methodological Aspects of the Study ...... 208 7.4. Major Findings and Actionable Recommendations...... 209 7.4.1. Introduction ...... 209 7.4.2. The Following Summarises 23 Major Findings: ...... 210 7.4.3. Recommendations and Actionable Strategies Based on the Major Findings ...... 215 7.5. Study Limitations ...... 219 7.6. Future Research ...... 222 7.7. Conclusion ...... 223 References ...... 225 Appendices ...... 245 Appendix A Ethical Approval- Queensland University of Technology ...... 245
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Appendix B Data Collection Approval- Ministry of Municipal and Rural Affairs, Saudi Arabia ....246 Appendix C Data Collection Approval – Saudi Arabia Cultural Mission, Australia ...... 247 Appendix D Data Collection Confirmation – Environmental Health Department, Riyadh Main Municipality, Saudi Arabia ...... 248 Appendix E Course Coordinator Interview Approval, Technical and Vocational Training Corporation is a training institute, Saudi Arabia ...... 249 Appendix F Participants Invitation Message - English ...... 250 Appendix G Participants Invitation – Arabic ...... 251 Appendix H Participants Information Sheet – Arabic ...... 252 Appendix I Interview Document - Public Health Inspectors (PHIs) ...... 253 Appendix J Interview Document – Environmental Health Manager (EHMs) ...... 258 Appendix K Interview Document for the Coordinator of the Food Safety Diploma at the Technical College of Riyadh ...... 262 Appendix L Survey Questionnaire – English Language ...... 266 Appendix M Survey Questionnaire – Arabic Language ...... 275 Appendix N Major Themes – Map ...... 286
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List of Figures
Figure 1.1 The main determinants of health (Dahlgren & Whitehead, 1991) ...... 2 Figure 1.2 Authorities involved in food safety in Saudi Arabia ...... 4 Figure 1.3 Map of Saudi Arabia (Alomirah, 2010) ...... 9 Figure 1.4 Current study process based on sequential-exploratory design ...... 13 Figure 2.1 The food production chain (CDC, 2015) ...... 17 Figure 2.2 New components of the food safety inspection (source: Ababouch, 2000) ...... 21 Figure 2.3 Three domains of public health (Griffiths et al., 2005) ...... 22 Figure 2.4 Knowledge-to-action framework (Graham et al., 2006) ...... 45 Figure 2.5 Scope of the study within KTA framework ...... 47 Figure 3.1 Convergent parallel design (from Clark, 2019) ...... 53 Figure 3.2 Sequential explanatory design (from Clark, 2019) ...... 54 Figure 3.3 Sequential exploratory design (from Clark, 2019) ...... 56 Figure 3.4. Research design overview ...... 58 Figure 4.1 Sample map of themes, sub-themes and participants' quotations ...... 75 Figure 5.1 Percentage distributions of male and female PHI participants by age ...... 125 Figure 5.2 Percentage distributions of PHI participants over the three indicated work experience categories, by education/qualification ...... 128 Figure 5.3 Language confidence, by gender, reading English, and speaking English ...... 132 Figure 5.4 Percentage distributions of PHI participants over the two categories of the Clarity variable ‘Clear’ and ‘Not clear’ ...... 149 Figure 5.5 The predicted dependences of the likelihood that PHIs would perceive the existing food safety laws and regulations as not clear ...... 151 Figure 5.6 The Bloom’s taxonomy knowledge pyramid representing the increasing depth of knowledge and skills resulting from a learning process (Armstrong, 2016) ...... 171 Figure 7.1 Example of outcomes linked to KTA framework ...... 210
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List of Tables
Table 2.1 Summary of qualifications and training requirement ...... 34 Table 2.2 Key differences between the two approaches ...... 37 Table 2.3 HACCP principles ...... 39 Table 2.4 The nine essential areas of skills and knowledge ...... 42 Table 4.1 Examples of the interview questions translation process ...... 67 Table 4.2 Description of interview participants ...... 78 Table 4.3 Samples from the themes and sub-themes ...... 106 Table 5.1 Sample of survey question translation process ...... 115 Table 5.3.1 Respondents gender and age ...... 126 Table 5.3.2 Years of experience and qualification, Public Health Inspectors ...... 127 Table 5.3.3 Public Health Inspectors’ workplace (municipality) ...... 129 Table 5.3.4 Inspectors’ confidence in nine areas of knowledge ...... 130 Table 5.3.5 Inspectors’ confidence in twelve areas of skills ...... 131 Table 5.3.6 Received training about food safety since started working as a PHI ...... 135 Table 5.3.7 Helpfulness of training content ...... 135 Table 5.3.8 Training attendance in the last 12 months ...... 135 Table 5.3.9 Intention to attend a training course even if there is no reward ...... 136 Table 5.3.10 Management of your own professional development (e.g., training, reading scientific articles) ...... 137 Table 5.3.11 Number of times PHIs learnt about something new that has contributed to their professional development ...... 137 Table 5.3.12 Agreement level with statements related to training and education ...... 138 Table 5.3.13 Ordinal logistic regression predicting frequency of attending training the in past 12 months ...... 139 Table 5.3.14 Prevalence of receiving training by gender, education level, years of experience, municipality, and the mean and standard deviation of motivation by receiving training ..140 Table 5.3.15 Receipt of training over the course of PHI career, logistic regression ...... 141 Table 5.3.16 Presence of barriers that prevent professional training attendance ...... 143 Table 5.3.17 Identification of potential barriers that prevent attendance of professional training (when answering yes or sometimes...... 143 Table 5.3.18 Topics that the participants identified a desire for further training ...... 144 Table 5.3.19 The most effective strategy for disseminating food safety information to PHIs ...... 145 Table 5.3.20 Usefulness of various resources for training and professional development ...... 146 Table 5.3.21 Communication and clarity of food safety (Level of agreement on a six-point Likert scale) ...... 147 Table 5.3.22 PHI perception that the existing food safety laws and regulations are not clear, multiple logistic regression for the odds ratios (OR) ...... 150
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Table 5.3.23 The frequency of encountering food from other cultures during inspection ...... 152 Table 5.3.24 When food from other cultures is encounter, possession of knowledge to inspect .....152 Table 5.3.25 Satisfaction level, job-related issues ...... 153 Table 5.3.26 Areas of PHI’s they find difficult or want to improve ...... 154 Table 5.4.1 Correlation between individual knowledge variables and the corresponding skill variables ...... 156 Table 5.4.2 Mean and standard deviation of knowledge and skill by gender, education level, years of experience and municipality ...... 159 Table 5.4.3 Regression analyses predicting knowledge and skill ...... 160 Table 5.4.4 Logistic regression analysis predicting knowledge and skill ...... 161 Table 5.4.5 Mean and standard deviation of motivation by gender, education, years of experience and municipality ...... 163 Table 5.4.6 Regression analysis predicting motivation ...... 164 Table 5.4.7 Logistic regression predicting motivation ...... 165 Table 5.4.8 Association between gender and municipality...... 166 Table 5.4.9 Mean and standard deviation of the item ‘My qualification program prepared me well for a real-life health inspector job’ by education level ...... 166 Table 6.1 Quotation samples from the qualitative study ...... 199
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Abbreviations
EHM: Environmental Health Manager
EHO: Environmental Health Officer
FAO: Food and Agricultural Organisation
FBI: Food Borne Illness
FCS: Food Control System
GDEH: General Department of Environment Health
HACCP: Hazard Analysis and Critical Control Point
KTA: Knowledge-to-Action Framework
MOMRA: Ministry of Municipal and Rural Affairs of Saudi Arabia
PHIs: Public Health Inspectors
WHO: World Health Organisation
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Statement of Original Authorship
I herewith assure that this thesis has not been partially or fully submitted to meet requirements for an award at this or any other higher education institutions. To the best of my knowledge and belief, the thesis contains no material previously published or written by another person except where due reference is made.
QUT Verified Signature
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Dedication
This work is dedicated to the soul of my father (may Allah be merciful to him), who was waiting for me to complete my PhD and return to my country to be beside him.
To my beloved Mother who is always there for me. Without her unconditional love and prayers, I would never have made it.
To my lovely wife, Meznah, and my children, Lilian and Kayan. for their love, patience and sacrifice that they have tolerated while I completed this thesis and ask them forgiveness for being very busy. Without their constant support and munificent care, this work could not have been completed.
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Acknowledgment
May all praise and glory be to Allah for bestowing on me the fortitude, the capability and the strength to undertake my Ph.D. It has been a challenging academic journey marked by both personal and educational ordeals.
Undertaking this PhD has been a life-changing and taxing experience for me, and it would not have been conceivable nor achievable without the genuine support and professional guidance I have received from many people. My heartfelt thanks go to all who have helped bring this thesis to fruition.
I have been blessed with a formidable supervisory team and would like to acknowledge the special people involved: Prof. Philip Baker, Dr. Darren Wraith and Ms. Belinda Davies.
My deepest appreciation goes to my principal supervisor, Prof. Philip Baker for his academic support, continuous guidance, and generous gifts of time during my PhD research. He has been an absolute inspiration for me as he guided my research work and focused my thinking, while at all times, encouraging me to pursue my dream. Without his help and support, this study would not have been possible.
Two other special people warrant my gratitude. Throughout my study, Dr Darren Wraith has been generous with his valuable suggestions and in particular, his knowledge and skills in research methodology. I will always remain indebted to him for helping me navigate the finer points of statistical data analysis.
Having Ms. Belinda Davies to advise me in food safety and environmental health has been of inestimable worth. Besides her overarching support and guidance in her field of expertise, I am particularly grateful to her for providing me the opportunity to undertake practical experience in food safety inspection at the local government level in Brisbane.
Moreover, particular thanks and appreciation go to Prof. Mark Brough for his academic support during the qualitative component development of the current study. His valuable input was a major factor in accomplishing this study.
I would not have been able to finish my Ph.D. course without the help and support of these amazing people.
I offer my thanks and gratitude to the Saudi Government for their valuable support and for granting me a Government scholarship that has extended over almost 11 years. This allowed me to pursue my Bachelor, Master and PhD studies here in Australia.
On a personal level, I thank my amazing cohort of fellow PhD students, in particular, Abduallah Alshareef, Emily Mann and John Cauchi for their constant support and their interminable encouragement.
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In this final part of my acknowledgement, I wish to recognise and thank the many participants in this study for their cooperation and contribution to my research. Without their collaboration and valuable input, accomplishing this study would have been impossible.
Lastly, to the official editors Anne Varnes and Carl Smith, I thank them for their services in proofreading and editing the thesis according to the standards and knocking this thesis into linguistic shape.
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Conference Participation
Alsaleh, S, (19-21 November, 2017) From traditional to risk-based food inspection in Saudi Arabia. Oral presentation at the 11th Dubai International Food Safety Conference, 2017. Dubai, UAE.
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CHAPTER 1: INTRODUCTION
This chapter provides the background (Section 1.1), context (Section 1.2), scope
(Section 1.3), research questions (1.4), aims and objectives (Section 1.5), as well as describing the methodology used in the research (Section 1.6). The chapter concludes with a thesis document outline (Section 1.7).
1.1. Background
Each year worldwide, eating unsafe food causes 600 million cases of foodborne illnesses (FBIs) and more than 400,000 deaths, resulting in the loss of approximately 30 million years of healthy living (WHO, 2015). According to the Centres for Disease Control and
Prevention (CDC), roughly 1 in 6 Americans (48 million people) fall ill from consuming unsafe food each year, 128,000 are hospitalised, and 3,000 people die of FBIs (CDC, 2011). In 2017,
841 FBI outbreaks were reported in the United States of America (US) and over half of the outbreaks (489, accounting for 64%) were associated with restaurants or other food outlets
(Mattson et al., 2017). There is a similar problem in Australia with 4.1 million cases annually of foodborne gastroenteritis, and an estimated 5,140 cases of non-gastrointestinal illness and
35,840 cases of sequelae. The annual estimation of hospitalisations due to FBIs in Australia is
31,920 cases (Martyn et al., 2014; Queensland Government, 2019). In Saudi Arabia, even the
FBI surveillance system is generally not adequate compared to those in developed counties.
Reflecting this inadequacy, the the number of reported FBI outbreaks has increased from 254 outbreaks in 2014 to 358 in 2018 (see Chapter 2 for further discussion) (Al-Mazrou, 2004;
Alsayegh, 2014; Todd, 2017; MOH, 2018).
Food safety is an important aspect of the Health Protection Domain, which is one of the three key domains of public health practice described by Griffiths, Jewell and Donnelly (2005).
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Health protection involves preventing and controlling infectious diseases through practices and policies such as regulating food and water and associated environmental hazards. Ensuring safe food requires the engagement of the key characteristics of the public health system such as working within national policy frameworks, operating at all population levels, and supported by information that is timely, accurate and accessible. Additionally, considering the Health
Determinants Model Figure 1.1, inefficient control of FBIs can hinder the socioeconomic development by straining health care systems, and harming national economies, tourism and trade (Whitehead & Dahlgren, 1991).
Figure 1.1 The main determinants of health (Whitehead & Dahlgren, 1991)
Food safety inspectors play a significant role within the public health system, in particular, protecting the public from FBIs through inspection of food establishments (e.g., restaurant) and ensuring that food is stored, prepared, and served in a safe manner (Grover et al., 2016; Hopper & Boutrif, 2007; Lammerding & Fazil, 2000; Pham 2010). Food inspection has the potential to identify problems and prompt corrective action that protects the public’s health and enhances the determinants of health and well-being. Currently, the literature
Page | 2 distinguishes between two key approaches to food safety inspection conducted by inspectors: the traditional approach and the (modern) risk-based approach (Houghton et al., 2008; Marvin et al., 2009).
The traditional inspection can be described as an approach that focuses on environmental aspects and end-product testing to determine their compliance with regulations
(FAO, 2015), while the risk-based inspection is an approach that focuses its inspection activities on risk factors to minimise the occurrence of FBI (FAO, 2015). Albersmeier et al.
(2009) summarised the traditional approach as one which tends to focus on reactive measures towards identified problems which cannot sufficiently ensure consumer protection. In contrast, the risk-based approach has a more proactive character, as it attempts to identify and address food safety-related issues before they become a public threat. Research findings indicate that the risk-based approach tends to be more effective in reducing FBIs (Buncic, 2006; FAO, 2015;
Sareen, 2014). Further discussion about the two approaches will be presented in Chapter 2.
In the last decade, many countries have moved their food safety inspection systems towards a more risk-based approach (Koutsoumanis & Aspridou, 2016). One of the most important factors contributing to the successful implementation of the risk-based approach is the skills and knowledge of food safety inspectors (FAO, 2008; Jones et al., 2004; Newbold et al., 2008). In 2008, the Food and Agriculture Organization (FAO) of the United Nations developed a manual to introduce risk-based inspection. The manual identified nine areas of knowledge and skills required for inspectors to be able to conduct risk-based inspection (e.g.,
HACCP principles, laws and regulations, communication, etc.) (FAO, 2015). HACCP’s definition and the skillset requirements and knowledge expectations of the modern food inspector will be further discussed in Chapter 2.
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1.1.1. Food Safety Inspection in Saudi Arabia
Food safety inspection carried out by Public Health Inspectors (PHIs) in Saudi Arabia and the majority of Gulf Cooperation Council (GCC) countries (of which Saudi Arabia is a member) is best described as ‘a classic and traditional food inspection role’ (Al-Kandari and
Jukes, 2009). In 2007 the FAO and World Health Organisation (WHO) conducted a regional meeting, and the resultant regional meeting paper stated that the inspection carried out by the majority of GCC authorities is an example of a ‘classic and traditional food inspection role’, where inspectors visit ‘randomly-selected’ food establishments and pass judgment based on physical examination and personal experience. Further, the inspector’s practice was based upon highly repetitive classic inspections. From these findings it can be concluded that the PHIs in the GCC have only limited technical knowledge regarding food inspection and lack the knowledge and skills required to utilise risk-based (modern) food inspection techniques and tools (Al-Kandari and Jukes, 2009). Accordingly, these inspectors need to be educated about contemporary expectations and food safety inspection practices.
In Saudi Arabia, the Ministry of Municipality and Rural Affairs (MOMRA) has a legislative and enforcement role in the food safety sector. There are approximately 2,700 PHIs across the country, working within the Environmental Health Departments (EHDs) under
MOMRA (current study scope). They are the main professionals responsible for inspecting food establishments, the supervision of slaughterhouses, commercial adulteration control, in addition to participating in reaction to FBI outbreaks (Alsaleh, 2015). Other responsibilities regarding the maintenance of food safety and quality (e.g., inspecting imported food and food factories, etc.) in Saudi Arabia are addressed by other governmental departments, including
Saudi Food & Drug Authority (SFDA), Ministry of Health (MOH) Ministry of Environment,
Water and Agriculture (MOEWA) and Ministry of Commerce (MOC).
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Figure 1.2 Authorities involved in food safety in Saudi Arabia
1.1.2. Contextual Factors
Manafa Capital, a finance company, published a report in 2019 based on data obtained from eight governmental departments. The report states that the restaurant market in Saudi
Arabia is worth up to 79 billion Riyals (approximately 21 billion US dollars). Around 52,000 facilities are counted in this sector and they employ 252,000 non-Saudi workers (Manafa,
2019). Saudis spend 5.7% of their income on food and beverage services and visiting restaurants and cafes is considered to be one of the most important activities in the country
(Manafa, 2019). Additionally, according to one of the Saudi Vision 2030 quality of life programs the country is currently lagging behind the developed world in terms of the restaurants-to-population ratio (2000 restaurants per one million people). The program aims to increase this ratio to 2100 restaurants per one million in 2020 and up to 3010 restaurants per one million in 2030 (Saudi Vision 2030, n.d.). Objective Number Seven in the Vision 2030 program requires MOMRA to provide a healthy local urban environment, and importantly, the relevant key performance indicators against which the performance of the Ministry will be evaluated include: An increase in the population satisfaction index with food safety; and a decrease in public health incidences (e.g., FBIs) (Saudi Vision 2030, n.d.).
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Another important determinant of health (Whitehead & Dahlgren, 1991) to consider is equity and the need to empower Saudi women and increase their labour force participation.
This will contribute to increasing economic growth and the purchasing power of the population, reducing the rates of cooking at home, and increasing the demand for food providing outlets and restaurants. According to the Organisation for Economic Co-operation and Development
(OECD), in 2018, Saudi Arabia had the lowest rate of female engagement in the labour market among G20 countries, with around 23% of the female population participating in the labour force (OECD, 2019). Nonetheless, this was an increase from just 14% in 1992 (World Bank,
2020). This trend towards the increasing engagement of women in the labour force in Saudi
Arabia is expected to continue in coming years (Saudi Vision 2030, n.d.).
These important social and economic changes constitute a major motivation for significant alterations of current food safety inspection practices in Saudi Arabia in order to ensure its compatibility with evolving social expectations and safety requirements in the modern food industries of the developed and developing countries. In 2019, Saudi Arabia announced the opportunity to privatise the food inspection system. Despite the lack of detail in this announcement, the expected privatisation of the food inspection system may provide further opportunities for the sector, as this period of transition could be a good time to introduce change and improvement to the current inspection approach.
1.2. Context
The most significant knowledge gap in the area of food safety research in Saudi Arabia is related to the lack of understanding of issues preventing or interfering with the improvement of food safety inspection practices. Particularly, the significant lack of research regarding improving PHIs ability to facilitate the transition from the current traditional food inspection approach to the contemporary and more efficient risk-based approach. Particularly significant
Page | 6 is the lack of research curious given the endorsement of this approach by the FAO which recommend its international adoption (Hopper & Boutrif, 2007) and anticipate it will significantly reduce foodborne risks and illnesses (Bunic, 2006; Hoag et. al. 2007; Sareen,
2014).
Moving toward the risk-based approach requires Saudi PHIs to possess a skill set and knowledge which covers a number of areas (e.g., HACCP principles, laws and regulations, communication, etc.) (FAO, 2015). The current research investigated the knowledge and skills required by PHIs to conduct risk-based inspections, including issues such as training, job satisfaction, and motivation that could impact on the PHIs ability to conduct effective food safety inspections.
Two suitable professional practice application and implementation frameworks were identified and applied for the purpose of the current study:
1) The Risk-Based Food Inspection Manual developed by the FAO of the United Nation
in 2008
2) Knowledge-to-action framework (KTA) developed by Graham and colleagues in 2006.
The FAO framework was used to identify knowledge and skills required by PHIs to conduct risk-based inspection, while the KTA framework was utilised to guide the process and achieve the aim of the current study (more details in chapter 2). This research also sits within other frameworks and theories that will be introduced in subsequent chapters.
1.3. Scope
The focus of this study is on PHIs working at EHDs in Riyadh, Saudi Arabia. These
PHIs are responsible for various environmental health issues such as food safety inspection, sanitation, inspecting non-food premises, licensing. Due to the limited resources available for
Page | 7 the current study and the time provided in the candidature, the scope of this research was limited to one critical area of their responsibilities, which is food safety inspections at food establishments (e.g., restaurants). Food safety inspections were chosen as it is a primary activity of their role. Managers of PHIs and PHIs educational institution (represented by the
Coordinator of the Food Safety Diploma) were also included at the primary phase of the current research to obtain different perspectives. Further description of the methodology will be provided in section 1.6.
Due to time constraints and the limited resources available to the researcher, Riyadh which is the capital city of Saudi Arabia was chosen as the optimum study location as it is central (Figure 1.3). Further, the selection of Riyadh is likely to increase the chances of having a greater impact compared with studying other cities in the country for the following reasons:
x There are 11 EHDs within Riyadh. These departments have the largest number of
PHIs (approximately 502) in comparison with the 12 other regions in Saudi Arabia
(Emmad, F. personal communication, May 10, 2015). For the sake of comparison,
the second largest city in Saudi Arabia is Jeddah with about 100 PHIs.
x Riyadh is the most populated city in the country with more than 7.6 million people
(General Authority of Statistics, 2018).
x It offers access to education facilities for PHIs at the Technical College (TVTC).
Since these features are not in existence in other regions, Riyadh was the ideal place for gathering the needed data to complete a well-rounded study. Further details about the study setting will be described in Chapters 4 and 5.
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Figure 1.3 Map of Saudi Arabia (Alomirah, 2010)
Saudi Arabia, officially the Kingdom of Saudi Arabia (KSA) constitutes about four- fifths of the Arabian Peninsula. The country’s economy is the largest in the Middle East and the 18th largest in the world (International Monetary Fund, 2018). Saudi Arabia also has one of the world's youngest populations, with approximately two-thirds of its population of 34 million being under 30 years old (General Authority of Statistics, 2018). Generally, the climate in Saudi Arabia is hot and dry in summers and mild in winters.
Although the actual scope of the study was limited to Riyadh, the obtained outcomes are expected to be generalisable to the 12 other regions of Saudi Arabia. This is because of the uniformity of the food safety inspection approach, laws and regulations and PHI qualification programs throughout Saudi Arabia. Whilst it is anticipated that the obtained outcomes of this study will be generalisable to the other regions of Saudi Arabia, it is acknowledged that some differences may occur between regions in logistic services and financial arrangements thus limiting the generalisability of the obtained outcomes. Despite the indicated territorial
Page | 9 limitations of the scope of this study, its outcomes could be useful for other Gulf Cooperation
Council (GCC) countries including Emirates, Kuwait, Bahrain, Qatar and Oman that share some similarities with regard to food safety inspection approach and PHI qualifications (Al-
Kandari and Jukes, 2009).
1.4. Research Questions
The research question is formed using a modification of the standard PICO format: an acronym for Population/People, Intervention, Comparison and Outcomes (Adams et al., 2009).
The PICO framework provides a useful structure to develop focused answerable research questions and this framework is primarily used for intervention studies (Adams et al., 2009).
However, PICO is often reformatted for other studies where there is no intervention and does not seek to test specific relationships between variables. For instance, in this study, the population (P) is the PHIs in Riyadh. However, there is no intervention or comparison. The outcome (O) is the identification of knowledge and skills PHIs need to conduct risk-based food inspections and other issues that may impact on PHIs performing their job effectively. The appropriate study designs for addressing this broad question are both qualitative and quantitative, and observational in nature (Petticrew & Roberts, 2003).
1.4.1. Primary Question
1. What knowledge and skills do PHIs in Riyadh require to conduct a risk-based inspection
(based on HACCP principles) at restaurants in accordance with FAO guidelines?
1.4.2. Secondary Questions
2. What is the current composition of the PHIs workforce in Riyadh and what are the issues
that prevent or impede PHIs from conducting effective food safety inspections and
enforcing food safety laws and regulations?
Page | 10
3. What are the levels of PHIs qualifications, knowledge, skills, and job satisfaction and
how could these characteristics be improved?
4. What is the current readiness of the PHIs workforce in Riyadh for the recommended
transition to the risk-based approach in accordance with FAO guidelines?
5. Based on the study findings, what measures could be recommended to improve food
safety inspection in Riyadh and broader Saudi Arabia?
6. To what extent, does the current education curriculum of the Food Safety Diploma at
Riyadh Technical College promote the HACCP principles?
1.5. Aims and Objectives
Aims:
Following the KTA framework, the aims of this thesis were to:
a) investigate and identify the knowledge and skills needed for PHIs to conduct risk-based
food inspections. Supplementary to this aim is the investigation and identification of
skill and knowledge gaps among Riyadh’s current PHIs, including barriers and factors
that may influence the effectiveness of food safety inspections. A further supplementary
aim is the investigation of the effectiveness of the PHIs qualification program in
addressing specific risk-based inspection's knowledge and skill (i.e., HACCP elements)
b) assess and adapt findings (from the above aims) to the local context and address
potential barriers and facilitators
c) to develop evidence-based information based on the findings for the authorities in Saudi
Arabia to facilitate an intervention to improve the ability of Riyadh’s PHIs to conduct
risk-based inspection and to perform their job effectively in order to provide safer food
for consumers thus protecting community’s health.
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Objectives:
The following objectives were developed to achieve the above aims:
1) To investigate perceptions prevalent among PHIs in Riyadh about their existing levels
of qualification, knowledge, and skills to conduct risk-based inspection, including any
issues interfering effective job performance
2) To investigate if the existing food safety laws and regulations in Riyadh are adequate
and sufficiently clear for PHIs to enable them to carry out food inspection
3) To review the professional training programs currently available to PHIs in Riyadh,
including any shortcomings of such programs
4) To identify food safety issues that PHIs would like further training in and the
preferred format of such training
5) To identify and characterise the major points of dissatisfaction and demotivation
within the PHI workforce in Riyadh that may influence their food safety inspection
performance
6) To identify gaps in the curriculum of the Food Safety Diploma at Technical College
(PHIs qualified institution) with particular focus on HACCP principles
7) To determine the degree of readiness of the PHI workforce for the expected transition
to the risk-based food inspection approach.
1.6. Methodology
This study was undertaken using a mixed methods approach and utilising a sequential exploratory design. This design combines qualitative and quantitative data collection and analysis in a sequence of phases (Creswell, 2013; Creswell and Plano Clark, 2007). In the first phase, the researcher collects qualitative data then analyses the data. In the second phase, of
Page | 12 the researcher collects quantitative data and then analyses the data. Figure (1.2) explains the process undertaken in the current study.
Figure 1.4 Current study process based on sequential-exploratory design
Information about the methodology is presented in chapter 3. Additionally, design- specific detail (e.g., development of interviews and cross-sectional survey instruments, recruitments, data analysis, etc.) are provided in the relevant study chapter.
1.7. Thesis Document Outline
The next six chapters explain the existing literature; research methodology; study one, the semi-structured interviews; study two, the quantitative cross-sectional survey; integration; and the conclusion.
Chapter 2 provides an overview of the existing literature regarding foodborne illnesses, the role and contribution of PHIs to food safety, PHI competencies by country, training and qualification requirements of PHI by country, traditional vs. risk-based inspection approaches,
Page | 13 the FAO knowledge and skills framework for risk-based inspections and the knowledge translation framework.
Chapter 3 explains the research methodology utilised in this study. Information were provided regarding the mix methods research, choice of the current study design ‘sequential exploratory’ and ethical considerations.
Chapter 4 describes phase one the ‘semi-structured interviews’ of the current exploratory sequential study. Starts with presenting the design-specific methods including the development of the interviews’ questions, the translation method of the interview questions, recruitment and eligibility criteria, etc. Then this chapter presents the findings and interpretation of data gathered through the semi-structured interviews.
Chapter 5 describes phase two the ‘cross-sectional survey’ of this exploratory sequential study. This chapter outlines the design-specific methods including the development of the cross-sectional survey, the translation method of the survey questions, eligibility criteria and recruitment, etc. Then, this chapter presents the results and discussions of the cross- sectional survey.
Chapter 6 integrate and compare the qualitative and quantitative outcomes obtained from phase one and phase two of this exploratory sequential research, including interpretation and explanation of any identified differences or similarities between the outcomes from the two adopted methodologies.
Chapter 7 presents the overall conclusive remarks, including the list of major findings of the thesis and their significance, the strengths and limitations of the study, recommendations and actionable strategies for food safety authorities resulting from the conducted analyses, as well as proposed future research directions.
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CHAPTER 2: LITERATURE REVIEW
2.1. Introduction
This review of literature seeks to provide information and background regarding the study’s research questions. It was conducted considering the recommendations by Rowley and
Slack (2004) and Fink (2014). The review of literature is ‘a summary of a subject field that supports the identification of specific research questions’ (Rowley & Slack, 2004, p. 31).
In addition to Saudi Arabia, the current literature review focuses on Australia, Canada, the United States (US), and the United Kingdom (UK). These countries were chosen because:
x they are perceived as having similar incidences of FBIs to each other. However,
it is not possible to compare rates in these countries to Saudi Arabia as the true
incidence of FBI in Saudi Arabia is unknown due to known issues of under-
reporting described earlier (Alsayegh, 2014; Al-Mazrou, 2004).
x these countries have a primary language of English ensuring the literature is
accessible
x they have developed risk-based food inspections. Comparing and contrasting
how each country approaches food inspector training and qualifications
provides a clearer picture of the commonalities and gaps in training and
preparation.
Health databases such as PubMed, Scopus, Cochrane, Medline and CINAHL were searched, along with the websites of some governments and international organisations (e.g.,
Food and Agriculture Organization of the United Nations (FAO), Ministry of Municipal and
Rural Affairs (MOMRA), U.S. Food and Drug Administration (FDA), Food Standards
Australia New Zealand (FSANZ), Centers for Disease Control (CDC), Food Standards Agency
UK, and Canadian Food Inspection Agency (CFIA)). These databases were the most relevant
Page | 15 in terms of finding literature pertinent to the study area ‘public health’. All relevant government reports and peer-reviewed food safety and inspection studies were included in the literature review. The literature search was primarily conducted in 2016 and updated later as the project progress.
Search terms and keywords used included ‘public health inspector’, ‘food safety inspection’, ‘food regulations’, ‘knowledge and skills’, ‘competency’, ‘training and qualification’, ‘professional development’, ‘public health inspectors’, ‘traditional inspection’
‘risk-based inspection’, ‘modern inspection’ and ‘foodborne illness’. These search terms were used for the fields of title, abstract and keywords. Boolean logical operators ‘AND’ and ‘OR’ were used to focus the search on relevant information. The differences in position title of food safety inspectors (e.g., Environmental Health Officer and Public Health Officer etc.) were also considered during the search process.
This literature review chapter is composed of Sections 2.2. Foodborne illnesses and 2.3. a review of food safety inspection and the inspector’s role. Section 2.4. reviews the required practices of a competent food inspector with reference to the United Kingdom, the United
States, Australia, and Canada. Section 2.5. discusses the qualification requirements in these countries and in Saudi Arabia. Section 2.6. compares traditional and risk-based food inspection.
Section 2.7. focuses on the two frameworks used in the current study ‘FAO Risk-Based
Manual’ and ‘Knowledge to Action’ framework.
2.2. Food Borne Illnesses (FBIs)
FBIs are a burden on public health and continue to be a significant cause of human ill health and death and impede socioeconomic development (CDC, 2011; Whitehead &
Dahlgren, 1991; WHO, 2015). An FBI is defined as an illness caused by consuming contaminated food or drinks. There are more than 250 types of FBIs.; most FBIs are caused by
Page | 16 bacteria, virus, or parasite. However, toxins and chemicals can also cause FBIs (CDC, 2020).
The severity of FBIs can range from mild such as stomach cramps and nausea, to life- threatening. Contaminated food most often results from failure to clean, separate, cook, and chill food correctly (CDC, 2020). Also, food can become contaminated at any point along the chain of food production (Figure 2.1). One of the critical points along this chain is the food business (e.g., restaurant) (Mattson et al., 2017).
Figure 2.1 The food production chain (CDC, 2015)
It should be noted that the FBI incidence presented in this section may not directly be comparable as Canada and US statistics relate to FBI’s in general, while Australia’s rates refer to gastroenteritis. Regardless of these variations, the comparisons are still helpful to form an understanding of the magnitude of the problem persisting in these countries. Worldwide, FBIs pose a serious problem. Every year there are over 600 million cases of FBIs causing approximately 400,000 deaths (WHO, 2015). The CDC (2017) estimate that in the US 48
Page | 17 million people (one of every six people) get ill from an FBI every year. Of those, 128,000 are hospitalised and 3,000 die. FBIs often come in the form of outbreaks with multiple people getting ill from one cause and one location. In the US in 2017, there were 841 FBI outbreaks, more than half of those outbreaks were caused by eating from restaurants and other food facilities (Mattson et al., 2017).
The US is not alone in its struggle with FBIs. Australia with an estimated population of
23 million, reported 4.1 million cases associated with gastroenteritis and 5,140 incidents with non-gastrointestinal illness, and 31,920 associated hospitalisations (Martyn et al., 2014;
Queensland Government, 2019). Reports from Canada indicated that there are 4 million people
(one in every eight people) who acquire a FBIs each year. Of these, there are 11,600 hospitalisations and 238 deaths (Government of Canada, 2016). In the UK in 2018, there were
2.4 million cases of FBIs with 16,400 hospital admissions (Holland & Mahmoudzadeh, 2020).
In Saudi Arabia, with a population of 34 million, the number of reported FBI outbreaks has increased from 254 outbreaks in 2014 to 358 in 2018. More than half of these outbreaks were associated with commercial sources (e.g., restaurants) (MOH, 2018; World Bank, 2020).
Although the number of reported FBIs has been increasing, the situation may actually be worse than reported. Al-Mazrou (2004) and Alsayegh (2014) argue that the systems for reporting incidences of FBI in Saudi Arabia are not as stringent or reliable as in developed countries resulting in insufficient and unreliable data. Evidence indicated that a surge in FBI outbreaks in Saudi Arabia is usually recorded during the hot summers, from June to August and during the annual Hajj (annual Islamic pilgrimage to Mecca). During the Hajj, the quantity of food purchased from outside eateries significantly increases and more people succumb to illnesses
(MOH, 2018; Jahan, 2012; Al-Mazrou, 2004).
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In the Saudi context, it appears that multiple factors including a hot climate (which provides favourable conditions for the growth of opportunistic pathogenic bacteria), inadequate knowledge of food safety among food handlers, and inappropriate food inspection and monitoring by PHIs contribute to the increased risk of FBI outbreaks in the community, thus providing a greater challenge for health professionals (Jahan, 2012; Al-Mazrou, 2004). Aljoudi et al. (2010) and Al-Mazrou (2004) argued that food temperature misuse, inadequate reheating treatment, and unhygienic handling were the most important factors causing FBI outbreaks.
Knowledge on food safety in the food preparation process and the risk factors that can lead to
FBI is low among the food handlers in Saudi Arabia. Training and proper health education messages are needed to raise the awareness of food handlers as well as the public in general
(Aljoudi et al., 2010; Al-Mazrou 2004).
2.3. Food Safety Inspection and Inspectors Role
Food safety inspection is the process of ensuring compliance of the food business with regulations and laws governing food safety and health (FAO, 2008). It is the heart of the enforcement system to ensure that food is safe for human consumption (Hutter et al., 2008;
FAO, 2008). A Food Safety Inspector, is an important part of the enforcement system and depending on the country, may also be referred to as an Environmental Health Officer (EHO), a Public Health Inspector (PHI), a Public Health Officer, or a Food Inspector (FI).
There were a number of reasons underlying the emergence of the food inspector as an independent position (Phillips & French, 1998). In the British context, the key reason was described in detail by Collins (1993). During the 19th and 20th centuries, the UK experienced an industrialisation boom where retailers and manufacturers had a rare opportunity to undertake food adulteration (Collins, 1993). The phenomenon became widespread and resulted in a high number of deaths, and this led to the creation of an appropriate framework and the emergence
Page | 19 of a new role – the food inspector (Collins, 1993; Phillips & French, 1998). In addition, the role of the food inspector has changed over time, as has public perception of the role
(Koutsoumanis & Aspridou, 2016). Early on, an inspector was perceived as an investigator whose main responsibility was to analyse evidence and correctly identify the cause of problem.
Later, the function shifted towards enforcement (Almanza & Nesmith, 2004).
Although food inspector capabilities have received surprisingly little attention
(Albersmeier et al., 2009; Johnston et al., 2013), there is a growing body of empirical literature demonstrating the significant role of the food inspector in ensuring food safety (Albersmeier et al., 2009; Wilcock et al., 2004). According to Cerit (2015), an inspector`s objectivity, knowledge of local laws and regulations and competency in conducting effective analysis can greatly influence the identification of food safety issues in the processed meat industry. Evans et al., (2002) conducted a study of a viral gastroenteritis outbreak in restaurants to illustrate the importance of food safety inspection and to demonstrate the complex analytical and experimental work that needs to be conducted in order to correctly identify the pathogen responsible for a given FBI. Lacors (2004) points out that the effectiveness of a PHI often depends on how successfully they combine two functions - advice and enforcement. Regardless of their specific skillset, knowledge, qualification, or expertise, a PHI needs to be able to successfully diagnose a problem, develop correctional actions and communicate and implement actions with the retailer (Caraher & Dowler, 2007; Johnston et al., 2014).
According to Ababouch (2000) and Mascini and Wijk (2009) the responsibilities of food inspectors have dramatically evolved during the last few decades. The major change has
been observed in a shift from a purely diagnostic and assessment driven role to more proactive
and risk-based evaluations (Mascini & Wijk, 2009). In addition, modern food safety inspectors
are expected to possess knowledge and expertise in risk management (Ababouch, 2000), as
well as an ability to develop effective correction actions (Figure 2.1). Varzakas et al., (2006)
Page | 20 argue that modern food inspectors are also expected to be able to communicate their findings to business representatives, discuss the obtained results, suggest corrective actions and perform follow-up inspections to ensure improvement has been achieved and the food safety issue has been eliminated. It can be argued that the position of food inspector has evolved from an analytical and enforcement approach to a proactive and risk-based approach (Johnston et al.,
2013).
Figure 2.2 New components of the food safety inspection (source: Ababouch, 2000)
Corrective Management Analysis Communication Follow-up actions
FBIs impede socio-economic development by straining health care systems and harming national economies (Chorna et al., 2018; Jaffee et al., 2018; Dahlgren & Whitehead,
1991; WHO, 2015). A recent economic evaluation conducted by the World Bank indicated that the impact of eating unsafe food costs low- and middle-income economies around US$ 110 billion in lost productivity and medical expenses each year (World Bank, 2018). According to the same study:
A large proportion of these costs could be avoided by adopting preventative
measures that improve how food is handled from farm to fork. Better managing the
safety of food would also significantly contribute to achieving multiple Sustainable
Development Goals, especially those relating to poverty, hunger, and well-being.
Also, The World Bank study supports a shift in food regulation and inspection approaches to achieve sustainable socio-economic development (World Bank, 2018). One of the important measures recommended to improve the food safety is building the capacity (e.g.,
Page | 21 food inspectors’ knowledge and skills, tools, equipment) to improve the inspection practices.
Taking that into account, food safety inspector’s practices and their inspection activities are significant and play major role in promoting public health and well-being (by protecting the public from FBIs), being one of the determinants of health (Whitehead & Dahlgren, 1991;
Grover et al., 2016; Hopper & Boutrif, 2007; Lammerding & Fazil, 2000).
Additionally, food safety inspection and the food safety inspector play a significant role in the Health Protection Domain within the Three Domains of Public Health Model (Griffiths et al., 2005). The model is based on the concept that public health is everybody’s business
(Griffiths et al., 2005). It holds that the different domains aid in understanding the vital aspects of public health and the three domains are not separate but overlap and depend upon each other
(Figure 2.3.).
Figure 2.3 Three domains of public health (Griffiths et al., 2005)
Juergen Voegele, the Senior Director of the Food and Agriculture Global Practice at the World Bank stated “Food safety receives relatively little policy attention and is under-
Page | 22 resourced. Action is normally reactive—to major foodborne disease outbreaks or trade interruptions—rather than preventative,” (World Bank, 2018). In recent years, public concern about FBIs and the safety of food is placing increasing pressure on government agencies to be more prescriptive and proactive in their policy and regulation of the food industry (Martinez et al., 2007; Elmsallati, 2011). Using the health protection domain concept, governments play a key role in protecting community health by creating policies and procedures that are associated with food safety inspection. For instance, governments can progressively work on improving the food safety inspection system by making it risk-based (more effective in FBI prevention) and providing the food safety inspectors with the necessary tools (e.g., knowledge, skills, and training to conduct risk-based inspection). This is to improve people’s health by providing standardised, evidence-based and ‘objective’ evaluations of food safety associated risks
(Buncic, 2006; FAO, 2008; Martinez et al., 2007; Koutsoumanis & Aspridou, 2016; Sareen,
2014).
2.4. Practice Competencies by Country
The required qualifications and duties of inspectors vary depending on the local context and the requirements regularly change due to the fact that more knowledge is accumulated, and new methods are developed to identify and combat food-related hazards (Koutsoumanis &
Aspridou, 2016; Johnston et al., 2014). This section will discuss the practice competencies currently required by the legislature of the UK, USA, Australia and Canada. These countries have been selected for benchmarking against since they have a developed and comprehensive risk-based inspection system in place.
United Kingdom
In UK, the food inspector position is referred to as an Environmental Health Officer
(EHO). They are required to possess a number of practice competencies by the jurisdiction of
Page | 23 the UK. According to Hobbs et al., (2002), the food industry of the UK is largely impacted by initiatives from within – often coming from supermarket retailers. The two key legislative frameworks determining the current food safety approach (as well as practice competencies of assurance staff) are the Food Safety Act of 1990, and legislature developed following the
Bovine Spongiform Encephalopathy crisis. Additionally, the Food Law Code of Practice
(FLCoP) issued under the Food Safety Act 1990, that gives instructions to local authorities to follow and implement when enforcing food law (Food Law Code of Practice, 2017) is another key piece of legislation.
The key characteristics of the current approach to food safety in the UK are monthly inspections and an overall delegation of responsibilities to the private sector (Hobbs et al.,
2002). The present goal of the food industry in the UK is to restore the level of confidence of its consumers (Hobbs et al., 2002; Hutter & Amodu, 2009). EHOs are required and expected to be able not only to conduct hazard analysis, but also risk-assessment and the development of correctional actions, which have to be clearly communicated to relevant stakeholders (e.g., retail management, the public and the media) (Hutter & Amodu, 2009). As pointed out by
Johnston et al., (2014), a EHO is expected to possess solid knowledge of Public Health, Food
Hazards and Laws and Practices related to food safety, regardless of their country of origin.
The UK EHO must possess knowledge and understanding of legislative requirements relevant for the UK (e.g., the Food Law Code of Practice and any other relevant guidance) (Loader &
Hobbs, 1998). An EHO must also possess knowledge of the HACCP evaluation routines and processes, as well as an overall ability to develop and perform necessary enforcement actions
(Loader & Hobbs, 1998). Individuals applying for higher rank positions are also expected, in
addition to the practice competencies outlined above, to plan and prioritise various food
standards programs (e.g., effective and regular monitoring, efficient use of the available resources). In the UK, only EHOs and official veterinarians are authorized to analyse, detain
Page | 24 or even seize food after they have established that it may pose risk to public health and safety
(Food.gov.uk, 2016).
Among the key types of practice competencies relevant to food and the function of the
UK EHOs are: the ability to perform inspections and audits; the responsibility to conduct verification and monitoring procedures; the ability to offer advice and education to retailers; and the competency to gather intelligence information concerning a specific food safety risk.
Additionally, EHOs are also expected to perform food sampling visits (Food.gov.uk, 2016).
Moreover, according to the current legislative framework, EHO are expected to possess proven practice competencies in the following three areas: sampling, inspection of food establishments and reactive investigation (Food.gov.uk, 2016). Furthermore, the Food Standard Agency
(Food.gov.uk, 2016) has developed a number of additional requirements for each of the listed competencies, detailing the expected level of competency from EHOs. For example, concerning the sampling competency, EHOs are required to possess practical knowledge of such important aspects as: knowledge of available databases and an ability to distinguish between national versus local sampling priorities; knowledge of both formal and informal sampling techniques along with tools to validate the chosen methodology; the ability to conduct a sound interpretation and extrapolation of the obtained results, and the ability to translate the obtained results into actual risks to public health (Food.gov.uk, 2016). Similar to the other countries discussed below, the legislative framework concerning food safety in the UK is subject to change, and so the practice competencies of EHOs are constantly evolving.
United States
The US food safety inspection system has developed incrementally over time, with significant work developed as early as 1957 (Teratanavat & Hooker, 2004). In contrast to the
UK, the US system of food safety is based on a network of national, state and various local level regulations (Becker & Porter, 2007). At least three state bodies (the Food Safety and
Page | 25
Inspection Service (FSIS), the US Food and Drug Administration (FDA), and the Centers for
Disease Control and Prevention (CDC)) employ food safety inspection specialists responsible for ensuring that the US commercial food supply is safe for consumers (as well as properly packaged and labelled). The key legislative frameworks regulating food safety procedures, including the competencies expected from the food safety inspections are the Food, Drug and
Cosmetic Act of 1984, the Egg Inspection Act 1970 , the Poultry Inspection Act and the Meat
Inspection Act 1957 (Teratanavat & Hooker, 2004). Additionally, the recent Food
Modernisation Safety Act of 2011 which aims to improve food safety and mostly impacts on the activities of the FDA is a further example (Kotsanopoulos et al., 2017).
Within the context of the US, there is a major difference between the practice competencies of federal food safety inspectors versus those at the state and local level. For instance, only federal level inspectors conduct inspections of food manufacturing facilities that are in contact with the FDA. The same categories of inspectors are required to possess competency in carrying out inspections of farms (Kotsanopoulos et al., 2017; Johnson, 2012;
DeWaal, 1999). However, state and local-level inspectors are the ones usually responsible for the investigation of local level outbreaks of various FBIs. Federal-level inspectors may only be involved in such assessments when the outbreak becomes larger (e.g., involving more than one state) (Teratanavat & Hooker, 2004). Similar to the expected competencies of food inspectors in the UK, the work of US inspectors is more focussed on assessment of potential risk, with slightly less emphasis on planning the complex measures needed to combat an existing threat and communicating it to the producer (retail outlet) of the specific type of product (DeWaal,
1999). In addition to the discussed competencies and proficiencies, US food safety inspectors are expected to possess a strong knowledge of HACCP principles and practices (Crim et al.,
2014). This is to ensure that the HACCP programs applied by the food establishments are working correctly. Taking that into account, the food safety inspectors should evaluate the
Page | 26
HACCP programs by either assessing the HACCP manual (documentation‐based review) or by an on‐site assessment and verification of whether the “approved” HACCP program is properly implemented (Kotsanopoulos et al., 2017; Johnson, 2012; Ababouch L. 2000).
The expected competencies of US inspectors also depend on the job level of the specific inspector (Crim et al., 2014). ‘Entry-level’ food inspection jobs require little more than the ability to conduct regular inspections (e.g., testing of end products and sampling) of specialised food facilities. Inspectors are expected to obtain training and demonstrate experience within a chosen career path; for example, mislabelling of products, risk assessment within the chosen industry, coordination of inspecting interventions (DeWaal, 1999). These competencies are not regulated by the local frameworks and are instead established by the hiring organization ‘third party auditors’ (DeWaal, 1999).
Newbold et al., (2008) point out that general guidelines and procedures adopted at the federal and local level of the US, are subject to constant changes. When these changes occur, all inspection staff, regardless of their experience and years in practice, are required to undergo re-training in order to standardise their approach to food safety assessment procedures
(Newbold et al., 2008).
Australia
Within the context of Australia, the discussed position is commonly referred to as an
Environmental Health Officer (EHO) (enHealth, 2009). The role of an efficient EHO has been recognised as an effective factor in the potential prevention of accidents such as the ‘Garibaldi
Incident’ of 1995, a mass food poisoning (Hobbs et al., 2002). In Australia, there are three levels in the food regulatory system corresponding to each level of government (local, state and federal). Each level has a specific role in protecting public health and safety through regulating food (including imported food) for human consumption (Food Standard Code,
Page | 27
2015). Australian state governments, according to Hobbs et al., (2002) are entities responsible for the development and implementation of legislative frameworks related to food safety. This situation, however, has led to the appearance of multiple frameworks across the different states.
In response to this situation ‘Australian Standards’ have been developed by the Agriculture and
Resource Management Council of Australia and New Zealand, which standardises the approach to multiple food safety related issues (Hester & Rossiter, 2016; Hobbs et al., 2002).
The ‘enHealth Environmental Health Officer Skills and Knowledge Matrix’ (enHealth matrix) has been developed in Australia to describe the essential skills and knowledge for
EHOs. The enHealth matrix is ‘a nationally agreed description of the skills and knowledge required to support the breadth of activities undertaken by EHOs’ (enHealth, 2009). The document identifies the food inspection skills and knowledge needed by EHOs in Australia.
These skills include communication for the provision of food safety information to businesses and the public, sampling techniques, applying HACCP principles for the identification of hazards, and analysis of foodborne illness records (enHealth, 2009). Similar to the UK and the
US, the key practice competencies expected from the EHO are associated with a knowledge of food hazards, the legislation, and an analytical toolkit necessary to identify a specific threat to food safety (enHealth, 2009; Hobbs et al., 2002). In addition, EHA accredited tertiary courses that provide EH Qualifications and the unit content is reviewed by peers.
Australia is undergoing a transition to the risk-based approach (Smith et al., 2016).
However, it has been facing some obstacles in the process of implementation (Smith et al.,
2016). Although all the required legislation and standards supporting risk-based inspections are in place, Smith et al., (2016, p. 6) indicates that ‘the difficulty lies in the implementation of such a policy approach, which is dependent on local councils for most of the implementation’.
According to Smith et al., (2016, p. 6), who cites a Productivity Commission finding from
Page | 28
2012, it is ‘the issue of a lack of resources at the local level’ which has been identified as the main obstacle to policy implementation. This is because the ground resources are a critical factor for the implementation of the Food Safety Standard as the Standard demands a specialised resource at the local level, that is, officers that have been trained in adapting the new risk-based approach methods to food safety rather than using the command and control methods of inspections and end product testing. (Smith et al., 2016, p. 6).
Canada
Within the context of Canada, the Canadian Food Inspection Agency (CFIA) as well as
Health Canada (HC) share responsibility for issues related to food safety (Hobbs et al., 2002;
Tonsor et al., 2009). Public Health Officers (PHOs) in Canada are expected to exercise various measures that are aimed at public health protection. The key practice competencies outlined by the current legislative framework include: conducting assessment of food safety issues at hand, enforcing local legislation related to food safety, and conducting practices aimed at minimising health risks to the public (Hobbs et al., 2002; Martinez et al., 2007). Officers are therefore expected to possess the knowledge and techniques required for food facility inspection,
knowledge of approaches to the development and implementation of public disease controls.
Similar to the regulations established by the UK, an emphasis is placed on an officer’s ability
to perform functions related to risk management, as well as having the communication skills
required to build the necessary rapport with third parties (e.g., retailers and the public) (Hobbs
et al., 2002; Johnston et al., 2013; Martinez et al., 2007).
Seed et al., (2013) point out that the current jurisdiction of Canada requires PHOs to
possess solid practical knowledge of activities related to risk assessment of a given situation
involving food safety risks. Within the context of Canada, Seed et al., (2013) emphasise the
importance for the officer to also consider the community component of any assignment, and
possible hazards involved. Officers are therefore encouraged to recommend solutions that can
Page | 29 be viewed as sustainable for the entire community (e.g., active involvement of the private sector, such as business owners, in food safety training and assessment processes) (Seed et al.,
2013).
Spriggs and Hobbs (1999) and Hobbs et al., (2002) point out that it is the CFIA that is responsible for both the accreditation of new inspectors (through the approval of Hazard
Analysis and Critical Control Points, or HACCP), and the inspection services themselves.
Certain aspects of inspection accreditation and standards may be under local (or provincial) jurisdiction. Similar to the UK, the private sector also develops initiatives concerning food safety Quality Assurance (QA) (Spriggs & Hobbs, 1999). Unlike the situation in the UK,
Canadian food safety management is largely shaped by external forces – particularly its exports of food to the US and new developing markets (Hobbs et al., 2002).
Saudi Arabia
In Saudi Arabia, the food safety inspector position is usually referred to as a Public
Health Inspector (PHI). The maintenance of food safety and quality is addressed by different governmental departments, including the Ministry of Municipality and Rural Affairs
(MOMRA), the Saudi Food & Drug Authority (SFDA), the Ministry of Health (MOH),
Ministry of Environment, Water and Agriculture (MOEWA) and Ministry of Commerce
(MOC) (Alsaleh, 2015). However, MOMRA, which was established by Ministerial circular in1966, has the major role in the legislation and enforcement of the food safety sector at the local level (Al-Mutairi et al., 2015). It has a significant role in setting food safety legislation, registration and licensing food businesses, regulating food and health inspection, supervision of slaughterhouses, dealing with FBI outbreaks, and conducting food and water sampling. The other governmental departments such as SFDA, MOH, MOC, MOEWA are generally responsible for regulating the safety and quality of imported food and drugs for people and animals, inspecting farms and large food factories, surveillance, recall and tracking systems
Page | 30 etc. (Al-Kandari & Jukes, 2009; Al-Mutairi et al., 2015). The key legislative frameworks regulating food safety procedures include: the conditions of poultry farms, egg and chicken sales (1983); the health conditions of slaughterhouses (1984); and the health conditions of food and health premises (1984) (Al-Mutairi et al., 2015).
Unlike the situation in the UK, USA, AUS and Canada, the food safety inspection approach in Saudi Arabia is traditionally based (Al-Kandari & Jukes, 2009). The food safety inspection visits are based on highly repetitive and classical inspection (Al-Kandari & Jukes,
2009). Additionally, the inspectors have only limited knowledge and skills regarding food inspection and lack the knowledge and skills required to conduct risk-based food inspection
(Al-Kandari & Jukes, 2009). In Saudi Arabia, there is a major difference between the practice competencies of MOMRA inspectors versus those working at SFDA (Al-Kandari & Jukes,
2009). For instance, only MOMRA inspectors are responsible for of food safety assessments, sampling, investigating FBI outbreaks, and enforcing local food safety legislation at small and medium-sized businesses such as restaurants. While SFDA inspectors conduct food safety assessments for imported food, and large-sized food businesses, such as food manufacturing facilities (Al-Kandari & Jukes, 2009; Al-Mutairi et al., 2015) Also, MOMRA food safety inspectors are not required to possess knowledge and skills in applying HACCP principles.
2.5. Qualification by Country
The qualification requirements of the food safety inspector position (e.g., EHO, PHI etc) can vary by country and sometimes by organisations within a country. The aim of this section is to compare and contrast the qualifications of inspectors in countries such as the UK, the US, Australia, Canada, and Saudi Arabia. The comparison has been summarised at the end of this section (see Table 2.2).
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United Kingdom
The UK has developed a number of rules and regulations concerning the qualification requirements of EHOs. More specifically, an EHO is expected to hold as a minimum an undergraduate degree from a University which offers programs approved by the Environmental
Health Registration Board and by the Chartered Institute of Environmental Health (CIEH)
(Cieh.org.uk, 2021; Food.gov.uk, 2016). It is also common for an EHO to possess a postgraduate qualification. In addition to formal education, UK officers undergo training practice, aimed at gaining practical knowledge (Cieh.org.uk, 2021). The training usually concludes with a formal oral assessment of the trainee`s knowledge, and examination of his/her experiential logbook (Food.gov.uk, 2016). After obtaining an appropriate degree and practical training, EHOs may become certified in the UK (Hobbs et al., 2002).
United States
Within the context of the US, the requirements for the food inspectors are comparable to those of the UK. Whilst the minimum educational requirement for an applicant is to hold an undergraduate diploma, specific qualifications greatly vary and depend on whether the candidate is applying for a job with United States Department of Agriculture (USDA), a local office or a private organization (Crim et al., 2014). Moreover, in relation to the growing threat posed by various FBIs, a number of states now require food inspectors to undergo special training aimed specifically at developing a better understanding of the most relevant FBIs
(Almanza & Nesmith, 2004). Such training is usually concluded with an examination, after which an attendee will obtain a state recognised certification (Almanza & Nesmith, 2004;
Crespi, 2001). In addition to the appropriate education and training, a number of federal and local level organisations, expect a food inspector to become certified through one of the accredited organisations (e.g., National Environmental Health Association (NEHA)) (Crim et al., 2014).
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Australia
In Australia, The Australian Qualification Framework (AQF) regulates all formally accredited training programs. The minimum requirement for an EHO position is a Bachelor’s degree in Environmental Health or a Bachelor’s degree in Public Health (enHealth, 2009).
Postgraduate qualifications majoring in environmental health may also be acceptable qualifications for EHOs.
The institution offering such bachelor-level and post-graduate programs must have accreditation from Environmental Health Australia (EHA). EHA in turn ensures that the courses and modules offered within the accredited programs develop the skills and knowledge the national system identified as essential for an EHO (enHealth, 2009).
Canada
In Canada, PHOs are expected to have a minimum of an undergraduate degree in an
Environmental Health Program from one of the six higher education institutions accredited by the Canadian Institute of Public Health Inspectors (CIPHI); for example, British Columbia
Institute of Technology, Cape Breton University, and Ryerson University (Butler-Jones, 2008;
Raphael & Briant, 2006; Seed et al., 2013). In order to obtain the necessary certification, a candidate PHO is expected to obtain a Bachelor’s degree, be certified by CIPHI and enrol in a field training practice (Seed et al., 2013). The practical training is completed by submitting reports and undergoing a written or oral exam. Some positions may also require additional training in specialised fields of knowledge; for example, toxicology, microbiology (Seed et al.,
2013). Unlike the US system, Canadian requirements are standardised across provinces.
Saudi Arabia
In terms of training, a program of food safety is run by the Technical and Vocational
Training Corporation (TVTC). TVTC is a government agency with responsibility for
Page | 33 vocational education and training in the Saudi Arabia. Prior to 2005, the educational prerequisite to be a Public Health Inspector was the attainment of a secondary diploma. The current educational requirement to become a PHI in Saudi Arabia commenced in 2005 when the program was expanded to include a two-year diploma with three months of field training after secondary school (tvtc.gov.sa, 2016). Interestingly, there are no opportunities for PHIs who want to undertake further study inside Saudi Arabia.
Table 2.1 Summary of qualifications and training requirement Qualification Training General Notes
UK Minimum Only after obtaining an It is also common for an EHO to undergraduate appropriate diploma and practical possess a postgraduate diploma training, EHOs may become qualification certified in the UK US Minimum Some states require inspectors to Qualifications vary and depend undergraduate undergo special training on what organisation applying for diploma AUS Minimum There are available opportunities Educational institution offering requirement for training such bachelor-level and post- Bachelor`s graduate programs must receive degree accreditation from Environmental Health Australia (EHA) Canada Minimum Officers required to undergo a Six educational institutions offer requirement field training. Some positions such bachelor-level degrees and Bachelor`s may also require additional they are accredited by the Public degree training in specialized fields of Health Inspection (PHI) knowledge Saudi Two-year There are available opportunities Prior to 2005, the educational Arabia diploma after for training prerequisite to be inspector was a secondary secondary diploma. school
2.6. Traditional (Classic) Vs. Risk-based (Modern) Food Inspection
The very first cases of the traditional (classic) food inspection in the US were in 1906 when the Federal Meat Inspection Act was passed (Cates et al., 2001). Traditional food inspections primarily focused on establishing effective hygiene control and dealing with any associated food safety issues on reactive actions (Albersmeier et al., 2009; FAO, 2015). In contrast, the risk-based (modern) food inspection approach began in the mid-1980s and is more
Page | 34 preventive than reactive (Albersmeier et al., 2009; FAO, 2015; FSIS, 2015). In alignment with
Health Domains Model mentioned earlier, the policy and regulation of risk-based inspections is more effective in health protection and minimising FBIs (FAO, 2015; Prakashbabu et al.,
2018).
The traditional approaches to food safety inspection are characterised as being resource- intensive and inefficient. Their focus is typically on responding to issues that have taken place or violations that are present rather than preventing those issues from occurring (Albersmeier et al., 2009; FAO, 2015; U.S. FDA, 2015). Additionally, traditional inspection allows for a satisfactory assessment of the general requirements at the time of inspection. However, this approach could prove futile if an inspector does not ask questions or inquire about the activities and procedures being employed by the establishment (Cates et all., 2001; FAO, 2015).
There are several disadvantages regarding the classical approach of food inspection.
First, the results obtained from this approach are retrospective, meaning that all costs have already been incurred if any hazards are identified in the end-product testing (FAO, 2015). If the involved personnel had the foresight to correct impending hazards, the extra costs would be greatly minimised. This way, safety procedures would be put in place from the outset.
Another disadvantage is that it is time exhaustive. When sampling and testing a product, it could take several days before a result is available. Variability in the chances of finding a hazard is yet another disadvantage (Sareen, 2014). In most cases, there are no hazards detected despite all the hard work involved in the sampling and testing phases. This results in the sense of ‘being in control’, which is arguably nothing but a false sense of security. In addition, results from traditional testing are often labelled using terms such as ‘acceptable, satisfactory, adequate, and suitable’. Inaccurate assessment by inspectors could result in increased food safety inspection costs without necessarily improving the effectiveness of hazard elimination
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(Sareen, 2014). As a result of these issues, the use of the newer and improved risk-based approach is encouraged.
The risk-based food inspection approach as previously mentioned is more focused on preventing issues and situations that can lead to FBIs than reacting to issues and situations and has been demonstrated to improve public health (FSIS, 2015; Hoag et al., 2007). This is because inspector practices focus not only on the conditions of the physical environment at food facilities (like in the traditional approach) but also on the risk factors that may cause FBIs
(e.g., improper food holding/time and temperature, contaminated equipment/protection from contamination, inadequate cooking, food obtained from unsafe sources, etc.) (FDA, 2018).
Implementation of the risk-based approach has several significant advantages, including the ability to effectively utilise management, personnel, and funds. This approach provides jurisdictions with a credible method of determining the frequency of food inspections.
The FDA’s 2001 Food Code suggests that food inspection of facilities be undertaken between one and four times a year depending on the severity of the impending hazards (FDA 2001).
There are four major steps in the risk-based inspection approach: hazard identification, hazard characterisation, exposure assessment and risk characterisation (Canadian Food Inspection
Agency, 2015). These steps are employed to minimise the risk of contracting FBIs by thoroughly inspecting food establishments (e.g., bakeries and restaurants) and helping them reduce risks through education and enforcement (FSIS, 2015).
The risk-based food approach is viewed as superior to the classical approach because it places an emphasis on preventive measures rather than corrective actions (Albersmeier et al.,
2009; FAO, 2015; FSIS, 2015; Sareen, 2014). Also, this approach uses limited resources in a more effective manner by knowing the impending hazards before they present. The risk-based approach investigates and applies enforcement action proportionate to the risk at hand and
Page | 36 places the responsibility for safety on the various stakeholders involved rather than the government.
Table 2.2 Key differences between the two approaches Classical Approach Risk-Based Approach Corrective measures Preventive measures Inspections are randomly planned Priority is based on risk factors Emphasis is on product and premises of Emphasis is on the process and control inspection to address risk factors Samples are collected for assurance Samples are collected for verification purposes purposes
2.7. The FAO and KTA Frameworks
2.7.1. Introduction
Theoretical frameworks can be described as the blueprints for a PHD thesis inquiry.
Theoretical frameworks serve as a guide on which to build and support one’s research program.
There are many views in the literature as to what constitutes a theoretical framework. Using frameworks is important in research studies and allows the thesis to be strong and structured.
As described by Osanloo & Grant (2016), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint”
(p. 12). Frameworks also connect researchers to existing knowledge by using relevant theory
(Imenda, 2014). Nevertheless, although there are several definitions of what constitutes a theoretical framework, the selected research framework should resonate with the aim and purpose of the research (Osanloo & Grant, 2016; Varpio et al., 2020)). As mentioned in Chapter
One, to assist and direct the research process to achieve the intended outcomes (see section
1.5.) two frameworks have been identified and used in the current research: (i) FAO Risk-
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Based Inspection Manual and (ii) Knowledge to Action Framework. These two frameworks will be discussed in the next two sections.
2.7.2. Knowledge and Skills Framework: FAO Risk-based Inspection Manual
FAO has supported the development of many standardised guidelines, in collaboration with many international, intergovernmental and governmental bodies (FAO, 2015). Following the Improved Food Safety and Quality at the National Level and the Along the Food Chain project, the FAO created the Risk-Based Food Inspection Manual (FAO, 2015). It was developed to support capacity building for better and effective national food control systems.
The specific objectives of the manual are:
x to provide food inspectors with implementable guidelines for conducting risk-
based inspections according to modern demands
x to provide a roadmap for food inspectors that can be used in their inspection of
primary production or processing operations across the entire food sector,
regardless of the specific product(s) handled or manufactured by the inspected
establishment
x to reorient food inspection from a product-based process to a risk-based process
x to serve as a training and reference tool for food inspectors.
In the current study, the FAO Risk-Based Inspection Manual was found to be an appropriate guideline that identified the knowledge and skills required by food inspectors to conduct risk-based inspection. The theories underpinning the principles of the manual allows the manual serves to an over-arching theoretical framework. For instance, HACCP is a systematic science-based preventive approach to control FBIs, and the FAO manual recommends that the food safety inspector should be well knowledgeableof its principles
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(Bryan & WHO, 1992; FAO, 2008; Hutter et al., 2009). Therefore, the FAO manual can be described as “blueprint that is borrowed” for the current study. In addition, based on the
Knowledge to Action (KTA) framework (discussed in section 2.7.3) the FAO Manual can be classified as third-generation knowledge that can be used within the action cycle of the KTA
Framework to better reach the intended users. As described by Graham et al., (2006) third- generation knowledge provides synopses such as practice guidelines, manuals and decision aids. Therefore, the information from the FAO Manual was taken into the action cycle of the
KTA Framework to facilitate the implementation knowledge translation process.
There are nine knowledge and skills areas (KSAs) identified in the manual as being essential for modern inspectors to undertake risk-based inspections. These will be discussed in this section and a summary has been provided at the end of this section (see Table 2.4).
KSAs 1: Comprehensive understanding of food laws and regulations FAO emphasises the need for inspectors to understand the legal framework guiding the inspection of food processing facilities. Inspectors must also have a thorough knowledge of the regulations pertaining to occupational and environmental safety, food transport and distribution as well as best practices in agriculture (FAO, 2008).
KSAs 2: Understanding and application of HACCP Principles Hazard Analysis Critical Control Point (HACCP) system is a rational, reliable, and cost-effective method for reducing the risks that can lead to FBId or food spoilage (Bryan &
WHO, 1992). In the manual, the FAO indicates that HACCP is a risk-based approach, and the inspectors need to have a good understanding of its elements. In addition to understanding the
HACCP elements, food inspectors should use inspections as an opportunity to educate manufacturers and food handling businesses on HACCP. For the proper application of
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HACCP, it is necessary for inspectors to obtain the necessary knowledge and certification on
HACCP guidelines (FAO, 2008).
Table 2.3 HACCP principles Principle 1 Conduct a hazard analysis
Principle 2 Determine the critical control points (CCPs)
Principle 3 Establish critical limits
Principle 4 Establish monitoring procedures
Principle 5 Establish corrective actions
Principle 6 Establish verification procedures
Principle 7 Establish record-keeping and documentation procedures
KSAs 3: Communication skills Other than conducting inspections, inspectors must have strong communication skills that allow them to engage effectively with stakeholders including management, small business owners, farmers, and others involved in the food value chain (FAO, 2008).
KSAs 4: Knowledge of sampling techniques To conduct effective product testing, inspectors must have comprehensive knowledge about different sampling tools and techniques, and safe handling of samples for laboratory testing. Advanced sampling techniques not only facilitate informed decision-making, they also ensure the integrity of the entire inspection process (FAO, 2008).
KSAs 5: Understanding of best practices regarding sanitation and hygiene For inspectors to evaluate whether food-processing facilities meet national and international standards, they must be knowledgeable about the various sanitizing agents and
Page | 40 their implications for food safety and quality. The inspector must also be knowledgeable about the interaction between cleaning materials and certain bacterial groups and be able to test the amount of these compounds in food to determine if the residue amounts are acceptable (FAO,
2008). Knowledge of hygiene practices including food hygiene and personal hygiene and the ability to communicate this knowledge to stakeholders is critical.
KSAs 6: Competency in inspection procedures Inspection of food processing facilities is a systematic and strategic process. To ensure that facilities adhere to national and international standards of food safety and quality, inspectors must be thoroughly knowledgeable in areas such as analysis of food safety issues and the performance of inspections and audits (FAO, 2008).
KSAs 7: Knowledge of food safety and quality standards Inspectors are required to understand food microbiology, food chemistry and food processing operations and other elements of quality pertaining to food manufacturing. It is
important that the inspectors understand these elements and their role in food safety and the
way these elements interact with one another (FAO, 2008).
KSAs 8: Skills to verify compliance In addition to possessing the requisite competencies to conduct inspections, an
inspector must also demonstrate verification skills and the ability to conduct effective
interpretation and extrapolation of inspection results. Professional experience gained over
several years of fieldwork enables inspectors to evaluate those issues and areas that are
important to upholding food safety (FAO, 2008).
KSAs 9: Genuine certification in related fields Professional food inspectors need prerequisite academic qualifications and professional
development to meet the needs of the fast-changing food industry (FAO, 2008). Food
Page | 41 processing entails a variety of matrices and interactions with external factors that could be chemical, microbial, or physical in nature. These interactions have implications for food safety, requiring thorough inspection by inspectors to protect consumers against fraud and food-borne diseases. Technology, consumer demands, management practices, and supply chain developments continue to change the food industry. These changes make it necessary for food inspectors to possess appropriate skills and knowledge to conduct inspections and evaluations that adhere to national and international standards.
These nine essential areas of skills and knowledge mentioned above are summarised in the table below.
Table 2.4 The nine essential areas of skills and knowledge to conduct risk-based food inspection Areas of skill and knowledge
1 Relevant laws and regulations
2 Understanding the HACCP principles
3 Communication skills
4 Food sampling techniques and testing methods
5 Understanding of best practices regarding sanitation and hygiene
6 Knowledge of food safety and quality standards
7 Skills to verify compliance
8 Inspection techniques
9 Original training certificate and required certificate updates
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2.7.3. Knowledge Translation Framework: Knowledge-to-Action (KTA)
This Section aims to firstly provide a background about the Knowledge Translation
(KT) terminology and the Knowledge to Action (KTA) framework, followed by the intended use of the KTA model that applied to the current study.
One of the most significant challenges in public health research is the translation of research evidence into practice and policy (Graham et al., 2006; Grimshaw, et al., 2012). To avoid such challenges, a process of knowledge translation needs to be considered early in research. The terminology KT has gained significant momentum in recent times due to its high impact in medicine and public health (Baumbusch et al., 2008; Straus, et al., 2013; Sullivan &
Cen, 2011). The Canadian Institutes for Health Research provide the following comprehensive
definition of KT:
the simultaneous process of synthesis, exchange and ethically sound application of
knowledge between researchers and users to catalyse the capturing of advantages of
research to result in improvements in health care, development of health care products
and services, and eventually lead to a better health care system is known as knowledge
translation (Straus, et al., 2013).
The significant impact of KT on promoting public health justifies its use in research
related to food inspection practice and the prevention of FBIs. Through KT researchers,
educators, and policymakers have been able to address the gaps between what is practiced and
what evidence-based studies reveal (Grimshaw, et al., 2012). Research studies carried out in
the Canadian food safety system have shown through knowledge translation strategy, that the
awareness and engagement of researchers and the government policymakers increases, which
has a positive impact on the safety of food (Wolfe, 2012). Also, the WHO Department of Food
Safety and Zoonoses (FOS) has adopted a KT strategy for the prevention of FBIs in its fifth
country-wide task (Press, 2013).
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In general, KT appears similar to regular knowledge dissemination, that is, making others understand the research data and its implications for real life. However, KT is a bit different from what has been commonly known as knowledge dissemination (Ward, et al.,
2009). Firstly, it involves a complex process (e.g., quality research). Secondly, the model must be system-enhancing (the process of translation and the domain of application). Thirdly, it must influence the behaviour of the participants and the outcomes. Thus, it differs from the traditional dissemination process since the knowledge must be created and the application must lead to beneficial and realistic results (Ward, et al., 2009).
The KTA framework was developed by Graham and colleagues in the 2000s, based on a review of more than thirty planned action theories to help in knowledge translation process
(Graham et al., 2006). The KTA framework contains two separate, but related components as illustrated in (Figure 2.4). The Knowledge Creation ‘funnel’ section demonstrates that knowledge needs to be progressively refined before it can be considered ready to be used
(Graham et al., 2006). While the Action Cycle section identifies the required activities for knowledge implementation. Additionally, these two components can influence each other, and the action cycle may occur sequentially or at the same time (Graham et al., 2006).
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Figure 2.4 Knowledge-to-action framework (Graham et al., 2006)
As mentioned in the previous section the FAO knowledge and skills framework are considered third-generation knowledge (product tool in the Knowledge Creation funnel) of the
KTA framework. To better reach the targeted users, this tool needs to be taken to the next stage
‘the action cycle’ (Graham et al., 2006). There are seven stages in the action cycle journey, and they can be carried out by multiple stakeholders and groups at different time. For example, researchers can complete stages, leaving the remaining stages to others to promote and facilitate (Graham et al., 2006). These stages are:
1) Identify a problem that needs addressing. Identify, review, and select the
knowledge or research relevant to the problem (e.g., FAO guidelines).
2) Adapt the identified knowledge or research to the local context.
3) Assess barriers to using the knowledge.
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4) Select, tailor, and implement interventions to promote the use of knowledge
(i.e., implement the change).
5) Monitor knowledge use.
6) Evaluate the outcomes of using the knowledge.
7) Sustain ongoing knowledge use.
Rycroft-Malone and Bucknall (2010) argue that despite the relatively recent publication of the KTA framework in 2006, its use has already been documented in a variety of nursing and public health journals and in health policy and dissertations. In addition, the face and content validity of KTA framework has been demonstrated in several studies and implementation projects (Galaviz, 2014; Graham & Tetroe, 2007; Harvey & Kitson, 2015).
Therefore, use of the KTA framework in the current study appears to be suitable for guiding the efforts which aim to provide evidence-based information and actionable strategies to food safety policy makers in Saudi Arabia. The use of this framework is intended to generate better interventions to improve food safety inspection practices at restaurant and subsequently provide safer food for consumers and promote public health. Figure 2.5 explains the current study scope (stages 1 to 3) within the action cycle of the KTA framework.
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Figure 2.5 Scope of the study within KTA framework
2.8. Conclusion
This comprehensive literature review discussed the foodborne illnesses issue as a burden on public health that is hindering socioeconomic development in the Health
Determinants Model. In addition, this chapter discussed the food safety inspection and the role of the PHIs in minimising the risk of FBIs and protecting public health within the Three
Domains of Public Health Model. Current practice competency and qualification requirements of PHIs by country and the differences between traditional and risk-based inspections in controlling the risk of FBIs were also discussed. The chapter concluded with an explanation of the two main frameworks used within the current study; (i) the FAO framework as the knowledge and skills guideline for the PHI in Riyadh to conduct risk-based inspections, and
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(ii) the KTA framework as strategies to adapt the knowledge from the FAO guideline to suit the local context and facilitate the implementation process. This leads to the next chapter of this thesis which will generally discuss the selected methodology and justification for the methods used to answer the research questions along with ethical considerations and approval from the related bodies.
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CHAPTER 3: RESEARCH METHODOLOGY
3.1. Introduction
This chapter discusses the methodology applied in this study; the study-specific methods and details will be discussed in the related study chapters (Chapters 4 and 5). The current research aimed to explore the knowledge and skills required by Public Health
Inspectors (PHIs) in Saudi Arabia to conduct risk-based food inspections and to investigate issues that could hinder PHIs in performing their duties effectively, that is, protecting the public from foodborne illnesses (FBIs) (see Chapter 1 section 1.5. for details). Despite the rapid changes occurring in the food industry and the noticeable transition in Saudi society from a traditional to a modern lifestyle, research around food safety and the PHI workforce is quite new, and many opportunities exist for further exploration and investigation (Al-Kandari &
Jukes, 2009; Al-Mutairi et al., 2015; Manafa, 2019; OECD, 2019; Saudi Vision 2030, n.d.).
Due to this lack of information, the developed research questions (see Chapter 1, section 1.4) were exploratory in nature. Consequently, a mixed-methods study design was selected, more specifically, a mixed-method design utilising a sequential exploratory approach (Creswell,
2013).
This chapter has been organised into four sections. The first section covers the research design of the study. Since this study adopted a mixed research design method, the approach is discussed in terms of its applicability in research. The second section covers methods of mixed research design and sequence priority. Different methods of mixed research design exist. As such, this section explores in detail the three major types and the sequence priority underpinning their application in research activities. The third section discusses the study design method used in this study. Extensive research evidence is discussed in this section to explain why a sequential exploratory approach of mixed study design was applied to carry
Page | 49 out this study. A detailed discussion regarding the research tools that were used to source data in the individual stages of the sequential exploratory approach is also provided. The fourth section covers the ethical considerations that were considered before undertaking this research study.
3.2. Research Design
As this thesis implements a mixed-methods design, the purpose of this section is to describe the journey in developing the study’s methodology across several research disciplines.
The foundational premise is that research design is identified as an arrangement of methods for the collection and analysis of data that aims to bring relevance to the purpose of a research study (Selltiz et al., 1962). It involves methods that are used for collecting valuable data, the development of data collection tools, sampling methods, and techniques for analysing the data to enable the researcher to effectively address the research questions (Cooper &
Schindler, 1998). There are three major research approaches in social science research: qualitative, quantitative and mixed qualitative and quantitative approaches (Creswell, 2014).
Qualitative study designs are grounded on the views of people and observe the research parameters from the perspectives of the study participants and are thus used to develop theories for explaining different behaviours and phenomena (Pole, 2007). Since qualitative research is exploratory, it is applied in research topics that are new or for which existing theories fail to apply (Creswell, 2014). On the other hand, a quantitative study design tests theories and measures relationships between variables and the effect of such variables on the research outcomes of interest (Creswell, 2014). For instance, this design is recommended in projects involving the determination of factors that lead to a certain phenomenon or the efficacy of a certain intervention.
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In quantitative research studies, data are collected through standardised methods which can be recorded and analysed using statistical methods, making it accurate and objective
(Pole, 2007). The major difference between the two methods is that in qualitative research, researchers rely on subjective information to construct a reality which is then used to explain a phenomenon theoretically while quantitative research is conducted through scientific analysis of data thereby developing a conclusion (Pole, 2007). A mixed or combined method is a recent research design that involves hypothesis and investigative approaches (Creswell & Clark
2007). As such, a qualitative study design is employed to theorise potential co-relations between certain characteristics of the research parameters. The outcomes of the first study are further reinforced via a quantitative approach which studies aspects in a research study that consist of data that can be computed via statistical and other scientific methods to investigate the topic.
A combined approach was chosen to study the knowledge and skills that PHIs in
Riyadh require to conduct a risk-based food inspection and to study the factors that may influence the effectiveness of the inspection due to its comprehensive scope as a study design.
Various researchers support the extensive scope of applying a combined approach in research.
For instance, Tashakkori and Teddlie (2010) report that the combined method is better than using a single method because it involves answering questions which are not examined by other methods and that the combined approach also provides a strong reference to the studies and different views. Additionally, combined methods can also cover the faults of other methods
(Tashakkori & Teddlie, 2010; Creswell & Clark 2007). Similarly, Creswell (2012) supports a mixed research design by stating that using qualitative and quantitative approaches in a single study is the best way to collect, study and analyse data. Furthermore, mixing quantitative and qualitative datasets in research proves helpful in understanding the research problem (Creswell,
2014). A study by Leech and Onwuegbuzie (2009) preferred using the combination of both
Page | 51 approaches, quantitative and qualitative datasets, in single study to examine a similar concept to the one undertaken in this study.
3.3. Mixed Methods and Sequence Priority
Mixed method research designs are composed of three approaches: parallel mixed methods design that is converging in nature; a sequential mixed methods design that is explanatory in nature and thirdly, a sequential mixed method design of exploratory nature.
These three designs are the main available approaches for mixing quantitative and qualitative components in a mixed study design (Creswell & Clark, 2018; Clark & Ivankova, 2016;
Andrew & Halcomb, 2009). Before applying a mixed-method study design in a scientific study, timing, weighting mixing, and theorising are key parameters that a researcher ought to consider
(Creswell & Clark, 2011). Under timing, the researcher has to consider whether their
qualitative and quantitative data collection occurs sequentially or concurrently. When weighing a preferred approach of mixed study designs, priorities such as audience of the study, the interest of the researcher and the key aspects of the study that need to be emphasised are important factors to be considered (Creswell & Clark, 2011). During mixing, a researcher decides on when and how the mixing will occur. Mixing can occur during collection of data,
its analysis or during the interpretation of collected data. Further, the mixing can take the form
of connecting, integrating or embedding the collected data. When theorising, the scientific
perspective that guides the research study is further investigated by the researcher to confirm
the suitability of a certain approach of mixed research study design.
(a) Convergent Parallel Design
One of the most common designs of the mixed-method study design is the convergent,
parallel design method according to Creswell (2014). It is relevant to use this design when
various methods have been used to endorse that the findings obtained can be applied to a greater
Page | 52 degree to vast populations. Various methods are used in the convergent, parallel mixed- methods design to support each other by employing quantitative as well as qualitative data collection and data analysis for similar parameters (Andrew & Halcomb, 2009). During the research process, the researcher carries out qualitative and quantitative studies concurrently
(Figure 3.1). Further, the researcher weighs the two methods equally and analyses the results independently. The researcher also tries to triangulate the methods by comparing the statistical results of the quantitative component to the findings of the qualitative component to develop a possible validation, convergence or corroboration of the parameters under study (Creswell,
2014).
Forming an integrative merging analysis of the findings is an essential step after triangulation. The researcher is able to determine the interaction of study parameters from a qualitative and quantitative perspective, single out the most important interactions and describe similarities in the findings (Creswell & Clark, 2011). Additionally, by merging the two data sets, a researcher can determine converging or diverging aspects of the research parameter
(Creswell & Clark, 2011). Later, an integrative interpretation of the analysis is developed to provide insights on the identified interactions. The interpretation provides a holistic discussion of the phenomenon under research. One of the advantages of the convergent parallel design is that little time is wasted as both quantitative and qualitative data sets are gathered together.
Figure 3.1 Convergent parallel design (from Clark, 2019)
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(b) Sequential Explanatory Design
It is believed that out of all the approaches in the combined method study design, the sequential explanatory mixed-method design is the simplest (Andrew & Halcomb, 2009). It is also commonly used by researchers with a strong emphasis on the quantitative aspect of data.
It involves collection of quantitative data and data analysis, followed by an extensive collection and analytical stage of qualitative data (Figure 3.2). A greater emphasis is placed on quantitative data while mixing of the data is done after the first quantitative results are obtained.
In the qualitative phase, a detailed explanation and understanding of the critical issues faced in the quantitative stage are also presented (Creswell, 2014). This design offers an extensive comprehension of the unanticipated issues or important distinctions that emerge from and are brought about by examining the overall population involved in the research (Creswell, 2014).
Figure 3.2 Sequential explanatory design (from Clark, 2019)
The findings inform the second step of the initial stage, and it is in the integration stage that the actual formulation of the outcomes is done. Although the two stages are separate, they are also connected, and an explicit theory can be formed to explain the overall result. The
Page | 54 strength of this approach emanates when research produces unintended results during the quantitative part of the study. In such a scenario, the qualitative stage of data collection can be directed towards addressing the peculiarities in the initial study in further detail. However, this approach may lack a definite theoretical perspective (Creswell & Clark, 2011). Another advantage of this design results from its straightforward nature in terms of separate steps and stages, making it easily applicable in the field. Additionally, it is also easy to report the results using the sequential explanatory approach. Despite having several strengths, the sequential explanatory approach is time-consuming since data is collected in two separate stages which are given the same priority in terms of duration (Creswell, 2014).
(c) Sequential Exploratory Design
A valuable part is played by the sequential, exploratory mixed methods design in formulating better measurements by recognising the factors to be evaluated (Creswell, 2014).
Additionally, the sequential exploratory strategy is useful when developing and testing a new instrument, which is the case in the current study (Creswell, 2013).
The sequential exploratory strategy has two main phases (Figure 3.3). Qualitative data are collected and analysed at the first phase, then utilising the outcome of this analysis to the development of a quantitative data collection tool which will be used to collect data in the second phase. Significant differences exist between the sequential explanatory and exploratory designs. For instance, sequential explanatory begins with quantitative data while the sequential exploratory approach begins with qualitative data (Creswell, 2014). Secondly, the explanatory approach is a method of choice when dealing with explaining relationships while the exploratory approach is better suited in investigating a phenomenon. Since the sequential
exploratory approach is better in investigating a phenomenon in a specific population, it aligns
with the objectives of this study.
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Figure 3.3 Sequential exploratory design (from Clark, 2019)
The sequential exploratory approach has several advantages in research. First, there is greater applicability of the sequential, exploratory mixed methods design for research carried out in a comparatively novel field, where it is vital to recognise critical issues. Secondly, it is beneficial for a researcher who intends to investigate not only a phenomenon but would also like to increase the scope of qualitative data. The approach leads to the further development of a new data collection instrument. Among researchers who are more familiar with the quantitative approach, the sequential exploratory approach presents qualitative data in a way
that is easy to understand (Creswell, 2014). However, it has a few disadvantages. For instance,
it is time-consuming. Also, when opportunities to integrate are identified, the researcher must
decide on which outcomes from either phase need to be incorporated (Creswell, 2014).
3.4. Choice of the Study Design
Within this study, a mixed-methods approach was used which blends qualitative and quantitative data collection and analysis methods (Creswell, 2013). It has been asserted from the literature that it is difficult to carry out mixed methods research; hence, the application of such designs should depend on their particular benefits for the research (Creswell & Clark,
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2007). It was vital to identify the priorities in the strategy design of this study before the mixed methods study research was conducted. In addition, determining the main mechanism for gathering data in any research is critical, and this may be quantitative or qualitative and may be awarded the same significance in the study (Creswell, 2014; Morgan, 1998). Nonetheless, it was claimed by Andrew and Halcomb (2009) that both methods do not need to have equal significance; rather, it should be ascertained.
This specific study utilised a sequential exploratory approach ‘‘QUAL→QUAN’’.
Sequential exploratory research, as mentioned above, is characterised by having a primary phase of qualitative data collection and analysis, followed by the second phase of quantitative data collection and analysis (Creswell, 2014). The lack of information and literature about the current competence of the PHI workforce and the food inspection related issues in Saudi Arabia led to the use of the qualitative method at the first phase to gather and explore more information relevant for the current study. Later, the gathered information was used to assist in developing the instrument (cross-sectional survey questionnaire) used in the subsequent phase of the data collection, which was useful in collecting a wide array of information, studying a large sample population over a relatively short duration and in generalising the study outcomes beyond the population being studied (Creswell, 2014; Walter, 2013; Travers, 2013). Further detail will be discussed in the related study chapters (Chapters 4, 5 and 6).
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Figure 3.4. Research design overview
3.5. Integration
Research is considered to have adopted a mixed-method study design when data is integrated at a single or multiple level in the research process (Andrew & Halcomb, 2009;
Fetters, et al, 2013; Guetterman, et al, 2015; Tashakkori & Teddlie, 2010). This is known as the mixing of data. A researcher needs to consider the relationships between the outcomes that
Page | 58 may be obtained at different levels of a research process, such as collection and analysis of data, or while discussing the findings. Integration of data in mixed study designs is discussed in a study done by Andrew and Halcomb (2009) who asserted that integration signifies a key ingredient of mixed methods research, and should be carried out during the stages of data collection, data analysis, data interpretation, or in the discussion of a thesis. The research questions determine the decision on when the findings are to be integrated and in what manner.
This incorporates the way it is developed, and if, during any phase of the research, secondary questions emerge (Andrew & Halcomb, 2009). Therefore, a researcher needs to indicate the way different qualitative and quantitative findings inform one another and offer unique responses to the research questions. In the current study, qualitative data and quantitative data were gathered and discussed individually. Integration of the data was done to provide more insight regarding the parameters under investigation. A point to note is that the findings of the initial study informed the data collection tool of the subsequent study; hence, instead of integration, it was interaction at this stage. Further explanation regarding the integration of findings from the qualitative and the quantitative studies are discussed in Chapter 6.
3.6. Ethical Considerations
Ethical clearance was obtained from the Human Research Ethics Committee (UHREC) of Queensland University of Technology (QUT) approval number (1700000384) (see
Appendix A). According to the ‘National Statement on Ethical Conduct in Human Research’
(NSECHR) Chapter 4.8: People in Other Countries:
When a researcher from an Australian institution proposes to conduct
research in another country, additional ethical considerations may arise.
In some situations, regard for the beliefs, customs and cultural heritage of
participants will require recognition of values….
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This current study has been designed, taking into consideration cultural and legal factors and obtained local and official support. Approval to conduct the research was obtained from the Cultural Mission of Royal Embassy of Saudi Arabia in Canberra (SACM), Ministry of Municipal and Rural Affairs in Saudi Arabia (MOMRA) and Technical and Vocational
Training Corporation (TVTC), Saudi Arabia (see Appendix B, 3 and 5). Data collection confirmation was obtained from the main Environmental Health Department in Saudi Arabia
(see Appendix D). Additionally, based on the information provided in ‘Chapter 2.1 Risk and
Benefit’ of the National Statement, there is no identified risk of harm in the two phases of this study, and any predictable risk is no more than the inconvenience caused by giving up time to participate in an interview or completing the survey questionnaire form.
With regards to Study One ‘Semi-structured Interviews’ and to minimise the risk and to ensure understanding of the study, the participants were informed about ethical principles, such as anonymity and confidentiality, a letter describing the study was given to the participants, along with an invitation and investigators’ contact details (see Appendix G and
8). Also, the study participants were requested to choose an interview date, time and select a place suitable to them. Additionally, in Study Two, submission of a completed survey was recognised as a consent to take part in the research. Any potentially identifying personal information was not acquired from individuals. Confidentiality of collected data was always guaranteed. Participation was voluntary, and Participant Information Sheets (PIS) with the investigators’ contact details were provided on the first page of the online survey (see Appendix
M). All documents in both studies were created in English and then translated into Arabic to meet the needs of the participants and to ensure fairness and respect (NSECHR, 2007). Further information about ethical considerations associated with the sampling and recruitment are discussed in the relevant study chapter.
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3.7. Conclusion
This chapter discusses the research design applied in this study to answer the research questions. A mixed study design was used due to its comprehensive scope as a study design.
Further, the applicability of a mixed study design in research is validated since various scholars such as Tashakkori and Teddlie (2010) and Creswell and Clark (2011) support the approach.
The three main approaches of mixed study design methods of research were discussed, and the rationale for the chosen research design, sequential exploratory, was presented. For instance, the sequential exploratory strategy in this study took place in two phases namely collection and analysis of qualitative data in the first phase, then in the second phase, the collection of quantitative data (Creswell, 2014).
The first phase of the study applied semi-structured interviews as data collection tools and involved seven participants (see Chapter 4 for more details). The findings of this stage informed the knowledge and skills framework and was used to develop a quantitative data collection tool. In the second phase, quantitative data were sourced from an online survey; its results were analysed with points of integration being developed (see Chapters 5 & 6 for more details). Due to ethical considerations, the participants undertaking the semi-structured interviews were informed about ethical principles, such as anonymity and confidentiality. A letter describing the study was also given to the participants, along with an invitation and
investigators’ contact details. In the second phase, research ethics were upheld since the
participation of the study subjects in the research was voluntary, and no personal information
was collected in the survey.
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CHAPTER 4: STUDY ONE – SEMI-STRUCTURED INTERVIEWS
4.1. Introduction
This chapter outlines the qualitative study, which is the first phase of this sequential exploratory study (see Figure 3.4). The aim was to provide firsthand insight into the current situation of food safety inspections and the PHI (Public Health Inspector) workforce in Riyadh,
Saudi Arabia. This study is novel because it aimed to understand—for the first time—the current food inspection practices, PHIs’ professional needs and their qualifications to modernise the inspection approach. Therefore, it was important to conduct a comprehensive qualitative study to identify any issues with food safety enforcement in Riyadh. As explained in the next section, qualitative analyses are typically focused on discovering certain phenomena where little prior knowledge exists about the degree of relevance of such phenomena to the question under investigation (Chenail, 2011; Jacob & Furgerson, 2012; Leech, 2002). Put differently, a qualitative analysis typically establishes a reasonable framework for the research questions (see Section 1.4) and issues that might be appropriate for the study. Therefore, the purposes of the qualitative study described in this chapter are twofold. First, it informs the development of the subsequent survey instrument by identifying issues associated with PHIs’ competence and the inspection approach in Riyadh (which were not previously known due to a significant lack of prior relevant studies). Second, it serves as an additional benchmark for further verification and comparison of the quantitative outcomes ‘the second phase of this research’, thus enhancing the validity of the adopted sequential exploratory approach.
The first part of this chapter provides details about the study methods. This is followed by the findings and interpretations of the major themes.
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4.2. Methods of Phase 1
The data-collection method for Phase One (see Figure 3.4) was from seven semi- structured qualitative interviews. This section includes a discussion of the development of the interview questions, the translation method, the training and preparations for the interviews, the recruitment process, the inclusion criteria, sampling, data analyses and trustworthiness.
Development of the Interview Questions
When creating interview questions, the role of the researcher should be as an investigator who wishes to discover certain phenomena from the interviewees’ perspectives.
This can be done by structuring interviews with open-ended questions starting with words like
‘who’, ‘what’, ‘where’, ‘when’, ‘why’ and ‘how’ (Chenail, 2011; Jacob & Furgerson, 2012).
Leech (2002) suggested that researchers have to determine what they really want to know, then write these ideas down before framing the questions. In this study, three structured guides for the interviews were developed (see Appendices 9, 10 and 11) according to the role of the interviewee—PHIs, Environmental Health Managers (EHMs) and the Diploma Coordinator.
The development of the interview questions was derived from the literature review (e.g.,
Ababouch, 2000; Al-kandari & Jukes, 2009; Al-Mutairi et al., Alsaleh, 2015; FAO, 2008; FSIS,
2015; Pham, 2009). The interview questions were then refined through discussions with the supervisory team (one of whom was a senior lecturer in environmental health, with extensive experience as an environment health specialist for local governments).
The purpose of the interview questions was to answer the overarching research questions specified in Chapter 1 (i.e., PQ1, SQ3, SQ5 and SQ6). The interviewer enquired about the skills and knowledge that PHIs need to conduct risk-based inspections, perform their job effectively, professional training, qualifications and curriculum content, in addition to the
challenges and obstacles to effective food safety inspections. Sample PHI interview questions
(see Appendix I) included the following: In terms of the food safety inspection, could you
Page | 63 please describe a typical inspection visit to a restaurant? (Props: from office to the inspection site, preparation, proper equipment, inspection official document and reporting.) How do you communicate with food handlers who don’t speak Arabic? What challenges have you faced in restaurant inspection during the last five years? To what extent does existing food legislation
(food law, regulations, standards) support or hinder food inspection? Why? What do you think that you and your colleagues need to change practice toward the risk-based approach? (Props: skills, knowledge, training, equipment and resources.)
One of the primary topics (under knowledge and skills theme) in the interviews was the
Hazard Analysis and Critical Control Point (HACCP), which is an important area of knowledge and skills to conduct risk-based food inspection. For this area, the questions were tailored according to the specific work of the participants. For example, PHIs were asked if they have knowledge about the HACCP principles and if they could evaluate a restaurant based on them
(see Appendix I). EHMs were asked what skills and knowledge a good PHI should possess considering the HACCP principles (see Appendix J). The Diploma Coordinator was asked whether the HACCP principles were taught in the previous secondary diploma or in the current undergraduate diploma (see Appendix K).
The interviews with PHIs focused on:
x work history and education, food safety inspection methods
x description of a typical inspection visit to a restaurant, knowledge and skills in
food inspection, their experiences and training, and gaps in what they can or are
able to accomplish
x their most significant food inspection issues in the last few years and
x current practices during inspections, challenges and obstacles, job satisfaction
and expectations.
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The interviews with EHMs focused on:
x their expectations of the PHIs during the inspections, opinions about the current
inspection process
x their most significant food inspection issues in the last five years, their beliefs
about what professional development PHIs need
x their beliefs about the existing inspection approach and ideas on possible
improvements as well as future expectations based on changes in food safety
knowledge and inspection methods.
The interview with the Coordinator of the Food Safety Diploma in Riyadh focused on:
x the qualification history and requirements for PHIs and differences (e.g.,
curriculums, admission requirements etc.) between the previous secondary
diploma and the current undergraduate diploma
x general knowledge and skills that graduates (PHIs) are expected to possess with
a focus on the HACCP principles
x current curriculum and the demands of modern food inspectorates
x future expectations and changes to the curriculum based on changes in food
safety knowledge and inspection methods.
Double Translation Method
According to the National Statement on Ethical Conduct in Human Research
(NSECHR) and to ensure accuracy, fairness and respect to the study participants, the interview questions (see Appendices 9, 10 and11) were initially created in English, then translated into
Arabic for use in interviewing the participants in Riyadh, Saudi Arabia where the native language is Arabic and English is a second language (National Health and Medical Research
Council [NHMRC], 2007). The initial creation of the interview questions in English was important, so that the questions captured the nuances of English language and culture through
Page | 65 clarity of meaning using correct grammar and spelling. The translated Arabic versions were then used in the interviews to allow participants to speak spontaneously with the researcher as
Arabic native speakers, rather than using English to discuss their experiences (which might not impart their true meaning).
Double translation is a method that involves initially translating the interview questions from the primary language to the target language and then back to the primary language again
(Neuman, 2011; Sousa & Rojjanasrirat, 2011). Translation provides an extra challenge to the researcher to achieve equivalence in concepts between the two languages. These difficulties include finding a suitable translator to convey the same meaning in the two different cultures and languages (Choi et al., 2012). Translating research instruments exacerbates the problems of alternating between languages with different linguistic systems and the occurrence of poor translations of items due to different cultural backgrounds. Translation problems and subjective interpretations may also be biased and shift the translation, because words in the target language may have no equivalent in the original language or might not convey the meanings implied by a term (Behr, 2015; Harkness et al., 2004).
To minimise translation problems, expert consultation is needed to assess if a word or several words reflect the same ideas or meanings in both the original and the adapted versions of the research instruments (Guillemin et al., 1993; Herdman et al., 1998). This also ensures research trustworthiness (Sperber, 2004; Squires, 2009). Moreover, as asserted by Sousa and
Rojjanasrirat (2011), the original instrument should be translated into the target language by at least two independent translators. In this procedure, it is preferable that the translation be done by someone who is bilingual and whose mother language is the target language (i.e., fluent in the source and the target language). The two translators should also have different backgrounds in both the content and the language format.
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The first translator (the researcher) of the current study completed his Bachelor’s and
Master’s degrees in Australia, has a background and practical experience in food safety and inspection in the target language and in the same country (Saudi Arabia). He is also an Arabic native speaker who studied in Saudi Arabian schools and is familiar with Arabic phrases and expressions as well as Arabic grammar and linguistic terms. As this is a PhD study, the researcher had financial and time constraints; therefore, he conducted the first translation process himself as a one-way translation method (translating the original questions into the target language). The researcher then gave these Arabic interview questions to an Arabic native speaker who is also bilingual. This translator is accredited as a professional translator and interpreter who has been certified by the National Accreditation Authority. He translated the
Arabic interview questions back into English to ensure accuracy and proper wording. A high degree of similarity was found between the two versions of the interview questions (see Table
4.1).
Table 4.1 Examples of the interview questions translation process Interview questions in English Interview questions translated Interview questions translated from English to Arabic by the from Arabic to English again researcher
How do you communicate /1 1/ﻛﯿﻒ ﺗﺘﻮاﺻﻞ ﻣﻊ ﻣﺘﺪاوﻟﻲ اﻟﻐﺬاء How do you communicate /1 with food workers who don’t واﻟﺬﯾﻦ ﻻﯾﺘﺤﺪﺛﻮن اﻟﻌﺮﺑﯿﺔ with food handlers who don’t speak Arabic? speak Arabic?
What challenges have you /2 2/ﻣﺎھﻲ اﻟﺘﺤﺪﯾﺎت اﻟﺘﻲ واﺟﮭﺘﮭﺎ ﺧﻼل What challenges have you /2 handled during restaurant اﻟﺘﻔﺘﯿﺶ ﻋﻠﻰ اﻟﻤﻄﺎﻋﻢ ﻓﻲ اﻟﺨﻤﺲ ﺳﻨﻮات faced in restaurant inspections inspections in the last five اﻟﻤﺎﺿﯿﺔ؟ ?during the last five years years?
What are the skills of a /3 3/ﻣﺎھﻲ اﻟﻤﮭﺎرات اﻟﺘﻲ ﯾﺘﻤﺘﻊ ﺑﮭﺎ What skills do highly /3 ?highly qualified PHI اﻟﻤﺮاﻗﺐ اﻟﺼﺤﻲ ذو اﻟﻜﻔﺎءة اﻟﻌﺎﻟﯿﺔ؟ ?competent PHIs have
What were the changes that /4 4/ﻣﺎھﻲ اﻟﺘﻐﯿﯿﺮات اﻟﺘﻲ ﺣﺪﺛﺖ ﻋﻠﻰ What changes have /4 ?occurred to the curriculum اﻟﻤﻨﮭﺞ؟ ?happened to the curriculum
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The original English interview questions and the back-translated English interview questions were compared to ensure that the format, wording and grammatical structures were similar in meaning and relevance. Following this step, the two English versions were presented to the supervisory team (who are English native speakers and research experts), and they provided further insights about the construction of the research instruments and the clarity of the interview questions. Thus, the research instruments used in the current study (developed using well-established translation approaches) made the data more reliable and valid
(Reichenheim & Moraes, 2007).
Study Setting As described in Chapter One, the study was conducted in Riyad, the capital city of Saudi
Arabia. It is located at the country’s centre and has the country’s largest population of “more than 7 million” people (CDSI, 2015). In comparison with the other 12 main cities in Saudi
Arabia, Riyadh was an ideal place for gathering the needed data because it offered access to the PHIs’ education facilities at the Technical College (TVTC) and the work place of the
Diploma Coordinator. Additionally, there are 11 Environmental Health Departments (EHDs) within Riyadh. These departments have the largest number of PHIs (502 PHIs) (Emmad, F. personal communication, May 10, 2015). Consequently, choosing Riyadh as the study location will likely increase the chances of having a greater impact compared with studying other cities in the country. More details are provided in following two sections.
Recruitment and Eligibility Criteria
According to Travers (2013), the composition of the sample size in qualitative interviews is more important than the actual size of the sample. This aspect is consistent with methodological considerations for the conduct of qualitative research as outlined in Section
3.1.3 of the NSECHR (NHMRC, 2007). This principle advises the researcher to recruit participants with different roles and experiences to collect complex data about the
Page | 68 phenomenon. For instance, in addition to the main targeted population of this study (the PHIs), other participants were also included, such as the PHIs’ managers (EHMs) and the PHIs’ educational institution (represented by the Coordinator of the Food Safety Diploma at the
Technical College of Riyadh). These participants were included in the study to obtain different perspectives from PHIs and to understand their expectations about PHIs and the inspection process. These different perspectives helped frame the data collection instrument of the second phase of this research and the integration of the findings from both phases.
In 2005, the qualification requirement for PHIs in Saudi Arabia changed from a secondary diploma to an undergraduate diploma (two and a half years after high school).
Hence, PHIs with an undergraduate diploma may have different points of view and levels of knowledge compared to PHIs who hold secondary diplomas. To gain a broader perspective and avoid missing part of the targeted population with different characteristics (which may cause bias and affect the results), the researcher included two PHIs from each group. Further, to ensure the required depth of theoretical and practical knowledge, a minimum of five years of experience was another selection criterion for PHIs.
One of the obstacles for male researchers in Saudi Arabia is the lack of female participation (particularly with interviews and recordings) due to cultural and religious factors.
Additionally, the NSECHR (NHMRC, 2007) states that the customs and cultural heritage of research participants should be recognised and respected. For these two reasons, only male participants were included in this stage of data collection.
Sampling
This research applied the ethical principle of fairness in the recruitment and selection of participants. In compliance with the principles of the NSECHR (NHMRC, 2007), a data collection approval letter was provided by the Ministry of Municipal and Rural Affairs
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(MOMRA) (see Appendix B) indicating support and authorisation for the study. To avoid unfair exclusion and to ensure that everyone could be considered, the main Environmental
Health Department at Riyadh Province Municipality provided the researcher with a list of the names and workplaces of all PHIs (502 people) as the sampling frame. In accordance with the ethical principles of respecting and minimising the risks of inconvenience from over-recruiting for the four representative people needed, a random sample of only 20 PHIs were sent an invitation to the qualitative interview. Randomised selection of 20 people was undertaken from the complete sampling frame of all PHI names placed in an Excel program. Using the randomised number function in Excel, the 20 PHIs with the highest random number were visited by the researcher at their workplace. To facilitate informed consent, they were provided with a printed copy of the invitation letter and information sheet containing all the necessary information. PHIs who received the invitation letter and met the criteria were requested to contact the researcher within three days to express their interest in participating. If the researcher did not receive an adequate response within this period, the protocol provided plans to invite another 20 PHIs from the randomised list. However, the second stage of recruitment was unnecessary as seven PHIs from the first round of 20 invitations expressed their interest.
The first four of the seven who expressed interest subsequently provided consent and were included in this study. Following the ethical principle of respect, the researcher expressed his gratitude to the remaining PHIs for their interest in participating.
Although the sample size of four PHIs participants might be regarded as small, however, the aim of these interviews in Phase 1 was not to generalise the findings or to determine the frequency of the issues (which is the purpose of the of the quantitative study -
Phase 2) but, instead, to obtain a background about the current food inspection activities to inform the development of the survey. Furthermore, Saudi Arabia is unique in that it is an absolute Monarchy and there is more consistency in approaches than would be expected in
Page | 70 countries which have significant diversity. Thus, interviews with four PHIs are likely to capture the scope.
In addition to the four PHIs identified through random selection, three other participants
(two senior EHMs and a Diploma Coordinator) were identified using purposive selection.
Purposeful sampling is a widely used technique in qualitative and quantitative research for identifying and selecting participants based on specific characteristics (Palinkas et al., 2015).
The two EHMs were selected because they have more than seven years of experience as EHMs, so a high level of theoretical and practical knowledge is ensured. Further, these two EHMs were known as being highly experienced in food inspection policymaking in Riyadh.
Regarding the Coordinator, there is only one relevant educational institute in Saudi Arabia (the
Technical College), which has two branches (the main branch is in Riyadh). This college provides a Food Safety Diploma and the Coordinator of this diploma is the key person who can provide useful information relevant to the PHI qualification program. Therefore, the participation of the EHMs and the Coordinator in the data collection was significant.
The researcher contacted the EHMs and the Diploma Coordinator prior to the data collection trip to undertake stakeholder engagement. After explaining the current research to them, they expressed a preliminary agreement to participate in the study. Then, during the data collection trip to Riyadh, the researcher visited them at their workplaces and provided an
information sheet about the study with a formal invitation. During these visits, they were given
the opportunity to ask any questions and the arrangements for the interviews were negotiated.
Semi-Structured Interviews
Interview preparation
Although the researcher was experienced in conducting interviews, the supervision team stressed the importance of conducting the interviews at the highest quality possible to achieve the
Page | 71 objective of the project in accordance with Chapter 3 of the NSECHR (NHMRC, 2007). Hence, the researcher participated in a mock interview with the supervisory team to practise and refine his skills. The interview preparation process included refining specific interview skills and developing awareness of the interviewer’s and interviewees’ body language. This procedure was informed by established data collection research, which found that refining the researcher’s interview skills through practice and appropriate techniques increases the quality of the data received (Yanow & Scwartz-Shea, 2014).
Applying the supervision team’s feedback, the researcher practised and refined his interviewing skills through two more mock interviews with two PhD students at the Faculty of Health at QUT.
Through reading the literature, following the supervision team’s feedback and practising through mock interviews, the researcher became confident in his ability to conduct a high-quality interview to ensure accurate data collection.
Interviews
In Phase One (see Figure 3.4) of this research, seven face-to-face semi-structured interviews were conducted between June and July 2017 with the following individuals:
x four PHIs from the different environmental health departments in Riyadh
x two EHMs in Riyadh
x the Coordinator of the Food Safety Diploma at Riyadh Technical College.
This type of interview was determined to be appropriate and effective to explore in depth the participants’ personal experiences and to develop a thorough understanding of the current situation of the PHI workforce, food inspection practices and the PHIs’ qualifications
(Creswell, 2014). This structure allowed the researcher to obtain the information needed to achieve the aim of the study, while at the same time allowing the participants to talk about what they believed to be important.
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The interviews were conducted following ethical standards (see Section 3.5), the principles described by Oltmann (2016) and the procedures for conduct described in the ethics application. In accordance with the methodology, interviews were shaped by both the interviewer and the respondent along with the circumstances of when and where the interview occurred. Given the ease of accessing face-to-face interviews, phone or Skype interviews were not needed. The subject matter was not sensitive, and it was unlikely that body language affected data interpretation. The selection of the interview locations was based on the participants’ preferences. The study was explained in detail to each interviewee and consent forms were signed prior to the interviews. Each interview was in a private room and the average length was one hour.
Before starting the interviews, all participants were informed that they had the right to refuse to answer any question without explanation. Additionally, in accordance with Oltmann
(2016), the researcher did not take notes during the interview to be less distracting. While the researcher did have a set of questions that every participant was asked, they were also asked to tell stories to illustrate their points. Through these stories, the researcher gathered additional
data to support the study results. All interviews were recorded with the participants’
permission. The interviews were then transcribed by the researcher and each transcript was
later given to the participant for verification.
Ethical Consideration
Ethical clearance was obtained from the QUT Human Research Ethics Committee
(UHREC) approval number (1700000384) (see appendix A). Refer to Chapter 3 (section 3.5)
for more details about the ethical aspects of the research.
Data Analyses
Interview data were analysed using the thematic analysis approach. Braun and Clarke
(2006) define thematic analysis as a scientific technique for identifying, analysing and
Page | 73 reporting patterns within data. There are six steps in thematic analysis were used. This involved, as suggested by Braun and Clarke (2006), the researcher should begin by
‘familiarising himself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report’ (p. 87). Thematic analysis method is especially useful for exploring the perspectives of various study participants (i.e.,
PHIs, EHMs and the Diploma Coordinator), finding similarities and differences and discovering unexpected insights (Nowell et al., 2017). Also, this method assists the researcher in creating a clear and succinct final report (Nowell et al., 2017).
At the beginning of the analysis, the researcher read the seven transcripts several times and immersed himself in these data, which provided an initial interpretation and answers to the research questions (i.e., SQ3, SQ5 and SQ6); he then gave codes to these data that portrayed the meaning. Codes were defined according to a word, phrase or paragraph that aligned to the
research purpose (Braun & Clarke, 2006; Yi, 2018). Inductive coding was applied, so that the researcher created the codes without a preconceived idea about identifying the themes. Similar codes were then grouped into categories, which were further developed into themes and subthemes (see Table 4.2 for examples) (Braun & Clarke, 2006). At the end of the thematic analysis process, the researcher generated a map (see Figure 4.1) that summarised the themes and subthemes along with participants’ quotations (see Appendix N for full version). It was difficult to translate all quotes in this map due to the limited resources available to conduct the
thesis. However, the important quotes were translated and included in the interpretation section
of this chapter.
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Figure 4.1 Sample map of themes, sub-themes and participants' quotations
Trustworthiness
The aim of the work was to produce trustworthy findings. Trustworthiness means that the study has results that are accurate in all aspects of data collection and results. To demonstrate trustworthiness, researchers must show that the data analysis has been conducted consistently, precisely and thoroughly by informing the reader of details about the process of data collection and analysis. Establishing trustworthiness justifies the findings and adds to the validity of the research. Components of trustworthiness include credibility, dependability, transferability and conformability (Nowell et al., 2017).
Credibility Ensuring credibility, an aspect of trustworthiness, requires the researcher to connect the findings of the study with prior research and accepted research practice. This demonstrates the truth of the research. The two most common forms of establishing credibility are triangulation and member checking. Member checking can be considered a component of triangulation
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(Hussein, 2009). This study established credibility by asking the participants to review their interview transcripts to ensure accuracy—this is a concept known as ‘member checking’.
Member checking is important to establish the accuracy of any statements discussed in the data
(Hussein, 2009; Thomas, 2017). After participants reviewed their transcripts, they did not make any corrections.
Dependability Dependability establishes the study’s results as consistent, repeatable and aligned with the primary data. One mark of a dependable study is that another researcher could analyse the same process and draw similar conclusions (Graneheim et al., 2017). However, due to the limited resources available to the researcher and to ensure the scientific principle of reproducibility, the researcher conducted the analysis himself and provided sufficient details of the methods. Additionally, the researcher has worked closely with the supervisory team to ensure that the necessary information was included and that the findings were in conjunction
with the data provided by the study participants.
Transferability To establish transferability, the researcher must provide evidence that the findings can
be applied from the setting observed to other situations, contexts and populations. Within
qualitative research, transferability—also known as external validity—is developing
generalisability or validity. Researchers cannot guarantee that a study can be applicable to other
research; the goal is to demonstrate that it could be applicable (Hussein, 2009). This study used
the method of thick description to establish transferability (Kim et al., 2017). This method is
commonly used by ethnographers, but it is also used by other types of qualitative researchers.
Using thick description requires the researcher to provide detailed information regarding their
research process, including data collection procedures and descriptions of where and when the
interviews occurred (see previous sections in this chapter). This approach also includes a clear
Page | 76 discussion of the cultural and social contexts present during data collection (see Section 3.5).
From the description provided by the researcher, the reader has a clear picture of the entire research experience (Holloway, 1997).
Confirmability Confirmability is usually established with credibility, dependability and transferability; it occurs when researchers demonstrate that their findings are based on the information provided by the research participants rather than any type of researcher bias (Amankwaa,
2016). To demonstrate confirmability, illustrative text in the form of direct quotations from participants—which were translated from Arabic to English language (see next section)—were provided to support the findings. Further, the collected data were interpreted based on the participants’ expressions and the researcher’s understanding of the lived experiences of PHIs.
The researcher’s knowledge, having worked as a PHI for five years in Saudi Arabia, provides a context in which to understand the experiences expressed by the PHIs in this study.
Additionally, the description should include details regarding data coding and a description of what the themes mean. For this study, the researcher provided complete descriptions about the aspects of coding, the creation of themes and the process of interpreting the data.
4.3. Findings and Interpretation
Introduction
The target population of the current study is the PHI workforce in Riyadh. Additionally, two EHMs and the Food Safety Diploma Coordinator at Riyadh Technical College have been included to obtain different perspectives and contextual information. Table 4.2 presents a summary of the participants.
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Table 4.2 Description of interview participants
Participants Qualification Years of experience Two PHIs Secondary diploma 15 to 20 years Two PHIs Undergraduate diploma 6 to 8 years Two EHMs Bachelor in Veterinary Medicine 9 to 13 years Coordinator of the Food Safety Master in Food Sciences About 25 years Diploma
This interpretation aims to provide a general understanding of current PHIs’ inspection practices and the challenges they experience. Their level of knowledge and skills within specific areas of risk-based inspection, their training and professional development, and their qualifications will also be explored.
Based on the researcher’s general perception, the study participants showed that they had knowledge and experiences relevant to the study’s objectives. Each participant had unique experiences and thoughts to share in addition to the development of common themes that most or all the participants discussed. They showed little hesitation in sharing information. It appeared that they believed their story was important, and they were eager to contribute. In this discussion, participants were given pseudonyms (except for the Food Safety Diploma
Coordinator who agreed to using his name). The interviews provided the researcher with a thorough understanding of the current issues surrounding the topic of food safety inspection practices and the PHIs’ qualifications. The participants were also able to share their academic qualifications and personal work experience. The following section presents a description of each participant.
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Participant Descriptions
PHI Number One: Abd Al-Latif #1 Abd Al-Latif graduated from the Secondary Institute of Health Inspectors in 1997. In his late 30s, he has worked as a PHI for over 20 years. His employment includes several environmental health administration roles in Riyadh. Abd Al-Latif mentioned that the turnover among many administrations at the city of Riyadh had given him unique experiences that few other inspectors possess. From the beginning of the interview, Abd Al-Latif appeared enthusiastic and answered questions without hesitation.
PHI Number Two: Fahd #2 Fahd has a diploma from the Secondary Institute of Health Inspectors that he earned in
1998. He has 15 years of experience as a PHI. He has worked at several environmental health administrations in Riyadh. He also has experience working as the Vice Manager of the
Environmental Department. Before the interview, Fahd appeared unsure as it was his first time to participate in an interview for a study. However, after the researcher reminded him that his participation was voluntary and that he could stop or choose not to answer any question at any time, he was relieved and proceeded with the interview without hesitation.
PHI Number Three: Yasser #3 Yasser differed from the other participants. He has less experience but has a higher academic qualification. He is in his late 20s and has an Undergraduate Diploma in Food Safety that he obtained in 2008, two and a half years after high school. He has eight years of experience as a PHI. All his experience has been for the same department. Before beginning the interview,
Yasser was quiet and appeared anxious. It was revealed during the interview that he was not satisfied with the current state of food safety inspection, and he was slightly nervous about sharing that.
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PHI Number Four: Othman #4 Othman also holds an Undergraduate Diploma in Food Safety. He is in his late 20s and has six years of experience in food safety inspections. He has worked in three different environmental health departments in Riyadh. Othman’s ambition was evident during the interview; he reported having goals to pursue additional studies in the field but did not have that opportunity within Saudi Arabia (and the same could be said for his colleagues). After completing his undergraduate diploma in 2009, he travelled to the United States to study at his own expense. He completed English language studies but was unable to continue for financial reasons; he then returned to Riyadh. Othman showed enthusiasm during the interview and eagerness to further develop his food safety inspection skills.
EHM: Falah #5 Falah has a Bachelor of Veterinary Medicine—a degree held by many Saudi Arabian
EHMs. He has 13 years of experience as the Assistant General Manager of Quality and
Development at Riyadh Province Municipality in addition to his EHM position. He contributed to a food safety inspection developmental project in Riyadh. This project resulted in the implementation of new technology in food inspection and within the field inspection system, which is currently used. Although very busy, he agreed to participate in the study as he has many ideas to further develop the field of food safety inspection and PHIs. He is also concerned about the current food safety inspection system.
EHM: Sami #6 Sami received his Bachelor of Veterinary Medicine in 2008. He worked as an Assistant
Manager of Environmental Health for two years and then as an EHM for seven years, totalling nine years. He also has a second job as the Assistant General Coordinator of the 11 environmental health departments in Riyadh. His interview was useful and informative. It
Page | 80 lasted one hour and 20 minutes, which was longer than the other interviews that lasted an average of an hour.
Coordinator of the Food Safety Diploma: Khalid #7 Mr Khalid is 50 years old and has 25 years of experience working in the food safety education field. He graduated in 2010 with a Master’s in Food Sciences and completed a bachelor’s degree in the same field in 1990 at King Saud University. He is currently employed as the Coordinator of the Undergraduate Food Safety Diploma (the current PHI qualification prerequisite) at the Technical College in Riyadh. Prior to this, he was the Coordinator of the
Secondary Diploma (the previous PHI qualification prerequisite) from 1990–2005. In 2005, the secondary diploma changed to an undergraduate diploma, and its name changed from the
Health Inspection Secondary Diploma to the Food Safety Diploma. Additionally, Mr Khalid
was a senior member of the Curriculum Development Committee of the Food Safety Diploma.
He also worked as one of the promoters for the change from an undergraduate diploma to a
bachelor’s degree. This interview informed the researcher about curricula, teaching methods
and the PHI qualification program over the past 25 years.
Emerging Themes
The emerging themes developed through the thematic analysis methods were areas that were common between the majority or all the participants. These themes also related directly to the primary and secondary research questions identified in Chapter 1 (i.e., PQ1, SQ3, SQ5,
SQ6). For each of the major themes, the researcher provided support, detailed explanations and quotations based on the data obtained from the participants. Through the thematic data analysis, four major themes emerged:
1. knowledge and skills
2. training and professional development
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3. education and qualifications
4. challenges and obstacles.
Within each of these themes, several subthemes were identified (see Table 4.3 at the end of the next section for samples of themes, subthemes and participants’ quotations). Some of these subthemes overlapped, even though the type of work differed among the participants
(PHIs, EHMs, the Food Safety Diploma Coordinator). This overlap will be discussed within the interpretation of the data in the next section.
Interpretation
Theme One: Knowledge and Skills PHIs play a significant role in the Health Protection Domain (see Figure 2.3) within the
Three Domains of the Public Health Model (Griffiths et al., 2005). In terms of food safety (an important aspect of health protection), PHIs are required to protect the public from foodborne illnesses (FBIs) by conducting regular inspections and ensuring that restaurants are safely
preparing and serving food for public consumption. Ensuring effective food safety inspections
is linked to PHIs’ abilities in terms of knowledge and skills. For instance, the successful
implementation of risk-based food inspections is heavily dependent on the PHIs’ skills and
knowledge (FAO, 2008; Jones et al., 2004; Newbold et al., 2008). According to the FAO risk-
based knowledge and skills framework (previously discussed in Chapter 2), PHIs should
possess adequate knowledge and skills within specific areas such as laws and regulations, the
HACCP principles and communication to enable them to conduct risk-based inspections.
In the interviews, the PHI participants were asked questions to evaluate the extent of
their knowledge and skills related to risk-based food inspection. The findings link directly to
the primary and secondary research questions (see Chapter 1), which cover the knowledge and
skills that PHIs in Riyadh require to conduct risk-based inspections and issues that prevent
them from performing effective inspections and enforcing food safety laws and regulations.
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From the theme of knowledge and skills, four subthemes were developed: the HACCP principles, communication, laws and regulations, and foods from different cultures.
Subtheme 1: The HACCP Principles The individual responses of the PHI participants about their understanding of the
HACCP principles differed based on their specific qualifications. For instance, the PHIs who completed a secondary diploma (the PHI qualification prerequisite prior to 2005) did not know the HACCP principles as they had received no training on them during their course. In contrast, the undergraduate diploma (the current PHI qualification prerequisite) provides some information about the HACCP principles, but it lacks extensive details. It was reported that the
HACCP principles were only studied simply and superficially. Therefore, in-depth discussions about HACCP and its seven principles were not possible during the PHI interviews. For instance, PHI participant Abd Al-Latif #1, who holds a secondary diploma, stated:
I have never studied the HACCP, and I’m almost sure that all my colleagues who hold
the secondary diploma do not know anything about it. We heard about it at work, but
we do not know its nature or how it works.
The other PHI participant who holds the secondary diploma, Fahd #2 shared the same perspective regarding the HACCP. He stated, ‘I don’t remember that we studied HACCP during the diploma, and I have no background about it.’
PHI Yasser #3, who holds an Undergraduate Diploma in Food Safety, discussed the
HACCP principles. He stated, ‘I remember that we took it during the diploma. We studied it and hazard evaluation, but in a simple way. To be honest, now I really don’t know anything about it because we do not need it at work.’ The other PHI participant who holds the same undergraduate diploma also discussed the understated way that the HACCP principles were addressed during his studies, Othman #4 added, ‘I only know HACCP as a topic and that it is a risk based approach but I can’t recall any further information about it.’
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One of the EHMs (Falah #5) supported the perspective that the PHIs are not required to evaluate food establishments based on the HACCP principles. He stated, ‘We’ve got restaurants that apply the HACCP system, but the PHIs cannot evaluate it because they are not qualified’. Khalid #7, who is the ex-coordinator of the secondary diploma and the current coordinator of the undergraduate diploma, concurred with other participants:
The HACCP principles never existed as course material for the secondary diploma, but
it has been added in later years. The secondary diploma curriculum wasn’t changed for
15 years from 1990 to 2005; however, the HACCP principles have now been simply
added to the current undergraduate diploma.
Considering participants’ comments, PHIs lack knowledge and skills regarding the
HACCP principles and evaluating restaurants based on these guidelines. Logically, if PHIs have little to no knowledge of the HACCP principles, they cannot accurately inspect restaurants based on these requirements. According to the FAO framework (2008), the HACCP is risk- based and needs to be understood by the PHI to be able to identify food safety hazards and eliminate the risk of FBIs. Therefore, if the expectation is that restaurants implement the
HACCP system, PHIs must have extensive knowledge of its components. In addition, if restaurants do not implement the HACCP system, the FAO framework recommends that the
PHIs should have an adequate understanding of the HACCP principles and inspect the restaurants based on these principles. Further, PHIs are advised to utilise their inspection visits to promote the application of the HACCP principles.
Based on the above participants’ comments, it’s evident that even with the changes and developments that the undergraduate diploma curricula are undergoing, the HACCP component is not receiving the focus during instruction that it should. Since the HACCP principles provide important knowledge and skills necessary to conduct a risk-based inspection, those seeking a PHI qualification diploma should not only learn the HACCP
Page | 84 principles in a class, but every class should include case examples of the HACCP principles as applicable to the specific class content.
Subtheme 2: Communication As the discussions with the study participants about PHIs’ knowledge and skills progressed, issues regarding communication skills became apparent. According to the FAO framework (2008), communication is a crucial competency falling under the knowledge and skills required to conduct a risk-based inspection. During the interviews, when the PHI participants were asked if they experienced any communication difficulties during their inspection visits (such as when communicating with restaurant workers and operators), issues regarding language barriers were reported. For instance, while English is a common language in Saudi Arabia, Arabic is the first and the official language. There are also many foreign employees, most of which are non-Arab countries, within the restaurant and food industry in
Riyadh, Saudi Arabia. As such, some restaurant operators speak English, Arabic, English and
Arabic, and some speak a different foreign language. All PHI participants agreed that they had experienced problems with language barriers. PHI Abd Al-Latif’s #1 said:
Sometimes, I confront a problem in delivering the information with non-Arabic
speakers. My English skills are poor, and maybe the restaurant worker speaks neither
Arabic nor English, so we are unable to talk to each other, and I sometimes use sign
language. In some cases, I realise that the worker does not understand me, but the
worker appreciates what I’m doing.
PHI Othman #4 highlighted the importance of communication:
If I’m not able to communicate with workers in restaurants, I write notes in the visitor
log, so that the owner can review them and talk with their employees to convey the
information. It’s disappointing that you cannot deliver what you want to say, and you
just give them the fine and leave.
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The PHI participants’ responses revealed that their current communication practice is not effective in correcting current food safety violations and preventing any possible future food safety concerns. If restaurants simply pay the fine for a food safety violation and workers do not learn what needs to be corrected regarding the violation due to communication issues, the significant role of PHIs in the Health Protection Domain (see Figure 2.3) of protecting the community by decreasing the occurrence of public health incidents (i.e., FBIs) becomes ineffective (Griffiths et al., 2005). Although restaurant managers or owners who pay the fine may inform employees what the fine was for, this could be miscommunicated to employees or without the necessary detail that leads to improvements in food safety and reduces the risk of
FBIs. Conversely, when PHIs can communicate directly to restaurant staff during the inspection visit, staff can learn from the PHIs, which should be a key source of food safety information. The goal should be to improve food safety and protect community health, not merely collect money from fines. However, the above statements from both PHIs demonstrate their desire to do their job well. Indeed, all the PHI participants repeated this desire to find a way to communicate to perform their job as best they could.
Further, their managers, the EHMs, also had their own perspective on the communication issue. One of the EHMs, Falah #5, spoke about the communication issue from the restaurant owner’s perspective, which is often shared with him in his management role:
Sometimes the restaurant owners come to my office to review a fine and talk it through,
and they assure me that they don’t know what goes wrong. The PHI just gives them the
fine and leaves without correcting or explaining the fault that they have got themselves
into so that they can avoid it in future.
This is a conflict between PHIs and restaurant staff and owners. It demonstrates that restaurant workers and owners want to do things correctly, yet they struggle due to communication challenges. PHIs have the same frustrations. However, one of the EHMs, Falah #5, considered
Page | 86 that it was the PHIs’ responsibility to resolve the lack of communication due to language barriers. It was seen as their responsibility to ensure proper communication. He stated, ‘The
English language level of the PHIs is inferior, and with this cultural diversity in the country and the increasing number of international restaurants and foreign labour, the PHI has to be able to speak English to facilitate the communication process’. Falah #5 also raised another concern: ‘There are some food products that have their contents written in English, and so the
PHIs couldn’t read or evaluate them’.
Based on the discussions with the EHMs and PHIs, it is clear that communication challenges are inhibiting the correction of food safety violations and preventing future improvements in food safety. Both restaurant workers and PHIs desire improvements but are experiencing difficulties in communicating with each other. A new method of communication should be developed to ensure that PHIs and restaurant staff and owners can communicate effectively.
Subtheme 3: Laws and Regulations As the discussions with the study participants continued, concerns about the understanding of the regulations governing food safety were raised. In every country, laws and regulations are enforced in many fields of practice. In the food industry, food inspection ought to be enforced under the mandate of, and in accordance with, the legislative framework of the laws governing a country (FAO, 2008). In the interviews, participants were asked to discuss their perspective on the laws and regulations, which is an essential area of knowledge and skills outlined in the FAO framework of risk-based food inspection (FAO, 2008). Common issues that arose from the interviews were lack of clarity in regulations, outdated laws and the need for laws to protect PHIs while performing their duties.
EHM Sami #6 reported, ‘Because of the lack of clarity in some regulations, the PHI has to ignore some violations during the inspection’. He added:
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Some requirements related to food safety are not available; for instance, we don’t have
among the regulations about the safe way to unfreeze chicken. Sometimes we have to
contact other authorities personally, such as the Saudi Food and Drug Authority, to
retrieve such information.
The PHIs also supported this idea of a lack of clear information. For example, PHI Abd Al-
Latif #1 commented, ‘There is a lack of some regulations that support the PHI in performing his duties. For example, the regulations that are concerned with meat grilling to medium and reheating food such as macaroni and lasagne.’
Considering the above responses, the lack of clarity among PHIs regarding food safety regulations is a significant concern. For instance, the lack of clarity leads to some PHIs ignoring some regulations, which results in persistent food safety violations in restaurants. Such instances of ignorance or disregard of food safety violations pose a significant food safety risk in the public sphere. According to the FAO framework (2008), PHIs must have a clear grasp of the food and safety regulations in their country since that knowledge is vital in empowering their inspections. Further, the lack of adequate information on food and safety regulations impacts on their practice and may lead to legal consequences.
Lack of clarity about food safety regulations is also linked to the theme of communication discussed above—in terms of communication between EHMs and those working in the Saudi Food and Drug Authority. EHMs should communicate with the Food and
Drug Authority when issues around clarity of regulations arise. The EHMs could then create revisions and communicate the changes with PHIs. This issue of communication with the Food and Drug Authority from the perspective of PHIs and EHMs should be further investigated.
Another point was made by PHI Fahd #2 about many of the regulations being outdated and difficult to change:
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The regulations that we follow are somehow old. Some of them were issued 15 years
ago, and there are few changes within them. They don’t take the PHIs’ opinions into
consideration. The regulations need to be updated, and there should be flexibility in
future updates in addition to taking into consideration the views of the people involved.
PHI Yasser #3 concurred:
The regulations need to be updated to catch up with pace … There’s a point. There’s
no strict punishment for the one who commits a violation repeatedly in a short time. It
is supposed to be doubling in punishment if it happens again, and there should be a
lawsuit if it happens frequently.
It appears that the municipal authorities (where EHMs and PHIs work) are not being reactive towards the field challenges faced by the PHIs. The connection between those in the field (EHMs and PHIs) and the food safety policymakers at the municipal authorities needs to be more clearly analysed to determine the best way to overcome the identified challenges with the current laws and regulations.
Another required update to the laws and regulations was reported by a PHI participant:
Sometimes the restaurant owner impedes and prevents the PHIs from checking a certain
room inside the restaurant because it has a tremendous number of food safety violations.
And he is ready to pay a simple amount of money to hinder the inspector’s duty, but he
doesn’t open that room because it contains a lot of violations, and it has fines that
amount to more than the ‘inspector hindering’ violation fine. The regulations have to
be updated to solve such problems.
This statement demonstrates that hazardous health and food safety issues can occur that are often not corrected because the restaurant owner is able to pay a fine. The regulations need to be revised to empower PHIs to access everything within the premises. It is also evident that consequences other than a simple fine need to be implemented. When serious food safety issues
Page | 89 exist that can harm public health, PHIs should be able to forcibly close the establishment until proper corrections are made. For instance, some developed countries have successfully implemented legal actions that involve closing non-compliant premises. In the United
Kingdom, PHIs frequently visit food outlets without an appointment to investigate whether the owners are upholding food safety regulations; they also take strong enforcement actions on non-compliant premises such as seizing unsafe foods, serving a legal notice or prosecution
(FSA, 2020). In the United States, defaulting food premises are closed down, and their owners are suspended from carrying out their business until they meet the necessary legal obligations or correct the violations (DC.gov, 2020).
Some violations might not warrant immediate closure. For instance, restaurant inspection reports contain field notices, priority violations or priority foundation violations.
Such violations should be corrected by the owner within a specific time frame or legal action is taken against them (DC.gov, 2020). Therefore, in less serious circumstances, a list of violations and a correction plan should be discussed with the owners—with the expectation that everything will be corrected by a specific date, or the business will be shut down.
The participants also expressed concern about insufficient legal protection for PHIs.
EHM Sami #6 said:
Some PHIs work hard, but the fear of not being legally protected discourages them from
doing their job. Two weeks ago, one of the PHIs had a problem with a restaurant owner.
The owner swore at the PHI, and he submitted a lawsuit to the authorities. I was
surprised yesterday as they called me and told me that the PHI had been arrested and
driven to the police station.
Both PHI and EHM participants reported that a legal department was needed to support the PHIs to ensure that they could perform their duties without repercussions when they found violations. For instance, according to Yapp and Fairman (2006), when PHIs enforce food and
Page | 90 safety regulations in food establishments in the United Kingdom, they experience a lack of trust in the food safety legislation from the business’s owners. This lack of trust may lead some food business investors to consider that they are being targeted or that the investigation is biased (Yapp & Fairman, 2006). Such claims affect the PHIs’ performance since threats and other forms of intimidation from the owners of the offending premises discourage them from performing their duties. Therefore, the need to protect PHIs is warranted as it will empower them to take action regarding food safety concerns on any food establishment regardless of its status or the influence of its owners.
Subtheme 4: Foods from Different Cultures The participants were also asked about foods from different cultures. This topic arose when the PHIs and EHMs were asked about the challenges they encounter in food safety inspections. Three of the PHIs mentioned that they had difficulty with foods from other cultures, as they had little knowledge about the safety requirements of those foods. PHI Yasser
#3 summed up this issue:
My colleagues and I face difficulty checking the safety of food that comes from
different cultures. Sometimes, we even feel that we don’t have adequate food safety
information about foods from our own culture, then how about foods that come from
different cultures.
As PHIs lack food safety knowledge about these foods from other cultures, they have created their own ways of inspecting them. PHI Othman #4 described his inspection approach:
‘If I saw a food that I don’t know how to inspect, such as Asian, Italian or Western, I would judge it just from the smell’. Such a method is not a scientific approach to inspecting the safety of food.
EHM Sami #6 also commented on this issue:
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I always receive enquiries from the PHIs about some food from different cultures with
a strange aroma, should we dispose of it or not. To be honest, we don’t do anything, I
tell the PHI to leave them because we know nothing about it.
This finding is supported by Pham (2010), who reported that the lack of food safety information and knowledge about foods from different cultures was a prevalent issue among PHIs in
Canada. As such, the lack of food safety information is a significant issue that needs to be conveyed to the relevant administrations and policymakers. Regulations need to be updated, and proper training should be provided to PHIs to inspect the safety of those foods effectively.
Theme Two: Training and Professional Development Continuous training and professional development are essential for career development.
In the food safety field, training of PHIs is important since the food industry undergoes many developments (such as the new method of inspection, the risk-based inspection approach).
Thus, professional development enables a person to regularly attend to important areas of career development and take appropriate action to reduce any shortfalls in their knowledge
(Halton et al., 2015). Professional development also allows a person to compete positively with others in the same line of duty. Organisations benefit from having a workforce where all employees are motivated to learn, enhance their skills and make more significant contributions to the organisation’s success.
The interviews with participants addressed the theme of training and professional development. The findings relate to the secondary research questions highlighted in Chapter 1: issues that impede PHIs from conducting effective food safety inspections, training and job satisfaction, and how these characteristics could be improved. The analysis of participants’ responses led to the creation of three subthemes: lack of motivation, scarcity of training opportunities and the failure of training to target PHIs’ needs.
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Subtheme 1: Lack of Motivation The PHI participants expressed a lack of motivation in attending the training. PHI
Yasser #3 stated, ‘Attending training and workshops used to be one of the factors that was formally considered by the department to get a job promotion as PHIs. It was a big motivation for us to attend further training when opportunities were available.’ Another PHI Othman #4 mentioned, ‘Unfortunately, after applying a new administrative system, we won’t benefit from the training in counting points for a job promotion. This is very frustrating for me and my colleagues and has affected our performance.’ EHM Falah #5 sums up this disconnect: ‘The
PHI misses three main things, and I mention it in every meeting with the municipal leaders and policymakers: motivations, training and logistic service availability’. These statements indicate that the higher administration at the municipal authority is not in touch with the PHIs; the authority does not take the PHIs’ demands into account.
From these responses, it seems that the absence of professional development incentives has affected PHIs’ job performance as they are demotivated. According to Hariyati and Safril
(2018), continuous professional development increases job satisfaction as employees become motivated to climb the career ladder, which promotes better performance. Therefore, training and professional development incentives need to be provided to the PHIs to increase their motivation and job satisfaction.
PHIs are not currently rewarded for obtaining further training past their qualification diploma. EHM Falah #5 explained:
There’s no specific mechanism or training plan to improve the PHIs’ knowledge and
skills, it’s just personal efforts from us as managers. Sometimes we hold a training
course inside the work building, but unfortunately, there aren’t a sufficient number of
PHI attendants because there are no motivations to attend.
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For PHIs to sacrifice their time and spend it on training and professional development, the rewards should be a job promotion, better pay and increased responsibilities. Without these rewards, the current situation will continue to deteriorate. For instance, the previous theme of
PHIs’ knowledge and skills revealed significant knowledge gaps in the HACCP principles, communication, laws and regulations, foods from different cultures, and keeping abreast of food and safety and inspection developments. These gaps could be resolved through ongoing training and professional development. However, PHIs’ lack of motivation to attend training could hinder them from improving their knowledge and skills in implementing risk-based inspections. Moreover, this lack of motivation could be a significant barrier to knowledge use within the Knowledge-to-Action framework (see Figure 2.4), which needs to be addressed
(Graham et al., 2006).
Subtheme 2: Scarcity of Training Opportunities Along with a lack of motivation, PHI participants report having few opportunities for additional training. PHI Fahd #2 stated, ‘The training opportunities are few. Although there are no motivations to attend, I have been trying for two years to get training, but I haven’t managed.’ This demonstrates that even if PHIs have the motivation to attend additional training, they are unlikely to receive training opportunities. Such an outcome is supported by
PHI Othman #4 who states, ‘Training courses aren’t available for all PHIs, and if you manage to get one, then it’s just luck’. The costs of not providing access to training or other learning opportunities can be high; the affected employees fall further behind over time, and they may be less able to advance (DiPietro et al., 2011). However, this has to be considered in conjunction with the lack of motivation mentioned above. If PHIs are offered training, they may not attend as there is no benefit. When people do not attend, there is no reason to offer training.
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Subtheme 3: Failure of Training to Target PHIs’ Needs In addition to the other challenges around training and professional development, there is also an issue with the relevance of training to PHIs’ needs. PHI Yasser #3 explains:
Unfortunately, there is nothing new within the training course subject I attended before.
Its content was the same as what we studied in the undergraduate diploma. The only
difference is that they deal with you as an employee not a student.
PHI Othman #4 echoed this view:
Training courses, if found, have irrelevant content that doesn’t satisfy our actual needs.
For instance, the course ‘The Method of Behaving with Managers’, which is currently
available to PHIs, I don’t need it as much as specialised training in food safety issues.
PHI Yasser #3 mentioned another concern about targeting needs, and talked about the need for specialised training when first starting the PHI job:
The PHI must be reoriented when first employed. I was unemployed for two years after
graduation, and I forgot many things that I had learnt during my studies. When I got the
job, I was deployed to the field and made food safety inspection visits without
preparation.
This need for induction training when just starting the job is also necessary for another reason.
As PHI Abd Al-Latif #1 explains, ‘All training courses are oral in the form of lectures, and there are no applied or practical ones. The data pointed to the inspector’s opinion on the content is not taken into consideration.’ For PHIs to do their job accurately and effectively, they must have hands-on training that addresses their specific needs (Newbold et al., 2008). EHM Falah
#5 stated:
The authorities who provide courses for the PHIs and other government employees,
such as the Institute of Public Administration, the Technical College and Saudi Aramco,
do not take our opinions as managers into consideration in the course content or
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coordinate with us. They just provide random courses. Some training course topics and
their contents are not renewed, and few PHIs attend those courses. PHIs who attended
found out that it was the same as the one they attended four years ago.
EHM Sami #6 gave a specific example of this issue:
Some time ago, we sent the Ministry a proposal to develop training courses for PHIs,
and we provided a list of the required training based on the needs of PHIs. However,
the proposal was declined as they claimed that it was not our specialty, but it was the
responsibility of the Institute of Public Administration.
It is concerning that those who provide the training, demonstrate little interest in listening to the PHIs about what training courses they need to perform their food safety inspection duties better.
The last issue regarding training and professional development is the challenge of municipality providing new protocols and technology that PHIs are expected to use but no training is provided. EHM Falah #5 stated, ‘The electronic field system, ‘Raqeb’ was provided.
It is an electronic inspection system, but the PHIs haven’t been trained to use it.’ This demonstrates the significant lack of a systematic approach towards the PHIs’ training and professional development. Therefore, the current PHI training approach may require an overhaul to ensure that training is properly emphasised and adequately resourced.
Theme Three: Education and Qualifications PHIs’ education and qualification requirements vary from one country to another and sometimes by organisations within a country (see Table 2.2). In Saudi Arabia, the PHI qualification requirement before 2005 was a secondary diploma. This changed in 2005 when the program was expanded to a two-year undergraduate diploma with three months of field training after secondary school (tvtc.gov.sa, 2016). This undergraduate diploma is managed by the Technical and Vocational Training Corporation. The quality of education directly affects
Page | 96 the PHIs’ reliability. Thus, the questions from which this theme developed covered the benefits that PHIs received from their qualifications in their daily food safety inspection work as well as their opportunities to pursue studies. From these questions and based on the participants data, two subthemes emerged: the curriculum of the PHI qualification program and barriers in pursuing education.
Subtheme 1: The Curriculum of the PHI Qualification Program PHI Othman #4, who holds an undergraduate diploma (the current qualification prerequisite), stated:
I took a course within the undergraduate diploma in food manufacturing and another
one in meal planning, and they don’t have any relation with my work as a PHI because
a part of it was in the field of nutrition and the other part was about inspecting factories.
Neither of them is within the list of my duties as a PHI at the municipality. I evaluate
my benefit from the curriculum at 30 per cent.
Abd Al-Latif #1, who has a secondary diploma (the qualification prerequisite prior to 2005) had a similar perspective. He said, ‘I believe that a great deal of what we studied does not have a relation with the work reality. We study something and work another thing. Studying
Mathematics, Algorithms and Chemistry for instance.’ It is important to recognise that the purpose of these questions was to ascertain their thoughts about how the curriculum related to their jobs. The value of the curriculum as a whole, such as ascertaining the value of
Mathematics and Chemistry, was not discussed. It is common for degree students to have to take general education classes (such as Mathematics, Science, Literature and other subjects) to create a well-rounded education. In the response from the undergraduate diploma holder, the crucial aspect is that the food and safety classes did not relate to his work. It is these classes that should relate to the real work that students will be doing when they finish their studies.
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However, another PHI, Yasser #3 (who holds an undergraduate diploma) had a different perspective:
I believe that the curriculum is good as a whole, and we benefited from some courses
in our fieldwork. For instance, the course ‘Inspection Criteria’ provided us with the
rules and regulations that we need in our daily work. As for the English language
curricula, there were two courses, but there might be dereliction from the students in
learning it. In addition, not practising English language in our daily life makes us forget
it.
The Diploma Coordinator Khalid #7 revealed another significant concern. He was asked to talk about the difference in curriculum between the secondary and undergraduate diplomas. He said, ‘There has been no change in the curriculum of the Secondary Diploma of
Health Inspection since its establishment in 1990 to 2005’. He added:
The first review of the curriculum occurred when the undergraduate diploma was
created 1426H (2005) in order to prepare the new diploma. After that, another review
was done in 1434H (2014), but some of them were executed in 1438H (2016). In the
meantime, another review is taking place.
The curriculum continues to be revised. Data from the PHIs’ participants indicated that some topics and subjects that would be helpful were not taken into consideration. Based on the
Coordinator’s data, there has been no change in the secondary diploma curriculum for 15 years.
This may have contributed to the lack of knowledge and skills of PHIs who hold this diploma, which was evident from their responses under the knowledge and skills theme (the first theme of this interpretation section). New research findings and inspection methods relevant to food safety have not been added to the curriculum for this lengthy duration.
Additionally, the PHIs appeared frustrated about the teaching methods used by instructors. The Diploma Coordinator Khalid #7 informed the researcher of this issue:
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The teaching method hasn’t been changed in either the secondary or the undergraduate
diploma, which is the conventional method of teaching just from one side. The trainee’s
evaluation is a joint process between the organisation under which the trainee trains and
the cooperative training coordinator at the Technical College. We have also got another
problem as the supervising organisation on training (i.e., the municipality) does not care
about evaluating the PHI under training, and they consider the trainee as a burden. And
we cannot press on these directions because their work in supervising the trainee is
voluntary.
By this comment, it could be interpreted that students are earning their diplomas but do not have the practical knowledge and skills to perform their food safety inspection job immediately. It appears that both the curriculum and the pedagogical approach need to be revised to better match the needs of food safety diploma students. Further investigation about the curriculum and the pedagogical approach is beyond the scope of this project. However, it is proposed that the teaching approach and the cooperative training of PHIs deserve further investigation.
Subtheme 2: Barriers to Pursuing Education As identified earlier, training opportunities are difficult for the PHIs to access. This appeared frustrating for those PHIs who have ambitions to advance their careers and learn more about their career choice. In addition to the difficulties in receiving training, they also have barriers in pursuing education. PHI Fahd #2 stated, ‘The PHIs must be developed by allowing them to continue graduate studies in the field. I know a lot of PHIs who would like to pursue their studies, but obstacles such as the admission requirement prevent them from doing so.’
EHM Falah #5 provided additional information regarding pursuing studies for PHIs:
The Public Health Faculty at the Electronic Saudi University contacted us to provide
and organise further qualification opportunities for PHIs. They cooperated with us by
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replacing some difficult admission requirements such as the International English
Language Testing System (IELTS) criterion (which is considered as a barrier for
interested PHIs) with easier English course requirements in the study plan. It’s a
wonderful thing but since a couple of months ago, there has been a new system in which
if a government employee gets a new qualification during their work life, it is useless
in terms of job promotion. And that’s a disappointing matter because getting a benefit
from the qualification is an important motivation in pursuing studies.
The Food Safety Diploma Coordinator also had an opinion, as he should, regarding
PHIs’ education. He reported:
There are requirements to turn the current undergraduate diploma into a bachelor’s
degree. The higher administration asked us to announce the opening of admissions to
find out the number of interested PHIs who would be willing to continue their study
taking into consideration a sufficient number to open such a program. But few PHIs
came to register. I think the TOEFL admission requirement, which is an international
English language assessment, was an obstacle. And I think that’s why few came to
register, and the bachelor program was then declined.
Additionally, he stated, ‘There will be another obstacle for the PHIs. The Bachelor Degree in
Food Safety won’t be free of fees like the current diploma.’ This is true even though education in Saudi Arabia is free and university students receive a monetary stipend during their studies
(Allahmorad, 2020). While additional courses in English will certainly help the PHIs to do their
work better—such as communicating with foreign food handlers, reading food labels and the
like—there might be no advantage in requiring PHIs to pass a highly advanced English assessment (such as TOEFL) for admission. This would be an additional barrier for PHIs to obtain a higher degree and improve their knowledge and skills. This highly advanced English requirement could be replaced by other proper English courses options that attract PHIs to
Page | 100 continue their education, achieve a higher degree (e.g., Bachelor) and improve their competency. This would be similar to other developed and developing countries where most
PHIs hold bachelor’s degrees in a field related to food safety (Johnson et al., 2014; Maldonado-
Simán et al., 2019).
Theme Four: Challenges and Obstacles The challenges and obstacles PHIs experience while working were an obvious concern for most participants (some of these challenges were partially discussed in the previous theme as the topics are interrelated). All PHIs and EHMs talked about challenges and obstacles openly indicating they held concerns before the interview. These issues impede PHIs from conducting effective food safety inspections not just with the current traditional inspection approach but also with risk-based approach implementation in future. From the broader topic of challenges and obstacles, four subthemes developed: the efficiency of the field system ‘Raqeb’, the PHIs’ devices storage case, the annual evaluation of PHIs and transport difficulties.
Subtheme 1: Efficiency of the Field System Raqeb Through the participants’ responses, a common concern was identified: the notion that leaders in the municipalities who make decisions are not acknowledging the needs and suggestions of those working in the field. Raqeb is an electronic field system developed to
assist PHIs to perform their duties. PHI Fahd #2 said, ‘The electronic field system Raqeb needs
to be improved, and they should take the inspector’s opinion into consideration. They didn’t
take our opinion when they first introduced it to us. Therefore, disadvantages appeared. It even
sometimes hinders the inspector’s work.’ Two other PHI participants supported this need for
development. Abd Al-Latif #1 said, ‘Raqeb is a successful system, but it needs improvements’.
Similarly, PHI Othman #4 commented, ‘Raqeb is an excellent system, but it needs to be
updated based on our remarks and suggestions’.
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As the PHIs work directly in the field and are the main users of the Raqeb system, they have the most knowledge of how it works. However, they have suggested that their opinion is not sought by leaders in the municipalities. The PHIs report that there are many obstacles with the system that could be corrected to enable them to do their jobs more accurately and efficiently. Every PHI participant had a different example of these obstacles. PHI Yasser #3 said:
Distribution of the shops is done randomly in Raqeb, and there are six shops and
restaurants a day to inspect. The problem is that some days I have simple and small
shops or restaurants allocated to me by the system, which require less effort with the
inspection. And on some other days, I have a lot of pressure with very large restaurants
that need a lot of time and effort to inspect properly. This issue affects performance and
decreases our concentration as we try to finish faster.
This obstacle was echoed by PHI Fahd #2:
Every day we have five or six shops to inspect, and sometimes the first shop allocated
to me is far from the second one, and you know the traffic in Riyadh city. It might take
an hour or an hour and a half to reach the next shop. The problem with Raqeb is that it
doesn’t give us shops close to each other, and this consumes our time and affects the
inspection quality.
PHI Othman #4 also expressed this concern: ‘I suffer from Raqeb and the location. One time,
I stopped my car at the location given by the system and started to look for the shop, but I found it on the next street.’ Similarly, PHI Fahd #2 mentioned: ‘Sometimes, we go out to the assigned location, but we find that it has been closed and its license has been revoked’.
The PHIs are frustrated and have strong feelings about the daily challenges they experience with the Raqeb system. According to their responses, Raqeb is supposed to be a reliable system that makes its food inspection duties easy. However, several issues hinder its
Page | 102 efficiency. This in turn affects the inspection process as the PHIs are assigned to the wrong premises, which hinders the quality of food safety inspections.
EHMs, however, have a more positive view regarding the Raqeb system. EHM Falah
#5 stated:
One advantage of the Raqeb is solving the problem of punctuality in inspections
because it is electronic. In 2007, we worked on overall checking the shops, and we
found that 40 per cent of the restaurants hadn’t been visited for the last five years.
EHM Sami #6 supported this idea:
Raqeb has made a paradigm shift in the work of inspection. It gave approximately equal
rates in inspection visits. In addition, it disintegrated bullying by some PHIs on certain
shops or laziness in inspection and just visiting the nearby shops.
It seems from the EHM participants’ responses that the Raqeb system has some advantages that increase the overall efficiency of the food safety inspections. The challenges that were identified above could easily be overcome through program revisions. However, if leaders in the municipalities (the key role player in regulating food safety to protect community health within the Health Protection Domain, see Figure 2.3) are not listening or seeking feedback from the main users (the PHIs), it could be concluded that revisions are not made to address the PHIs needs. This could prevent PHIs from conducting effective food safety inspections.
Subtheme 2: PHIs’ Devices Case A devices case (bag) is given to each PHI. It includes five different food safety
inspection devices that are used to determine food safety and quality and collect food samples
if needed. EHM Falah #5 reported, ‘Devices have been provided to the PHIs, but the PHIs
don’t use those devices’. Knowing this certainly gives a different perspective on the
interpretation. PHIs have expressed frustration that they often lack what is needed to do their
Page | 103 jobs correctly, yet they are given tools to help them. The following PHIs’ comments settle this conflict.
When PHI Othman #4 was asked about the devices case, he remarked, ‘The case is too big just like the travel bag and inconvenient to carry, and it includes tools that we do not need daily such as a sample reservation refrigerator’. PHI Abd Al-Latif #1 stated, ‘The devices need to be upgraded and calibrated, and we need to take training courses on how to use them’.
Similarly, another PHI said, ‘We haven’t had training on how to use them’. This, adds support to the training issues raised during the discussion above and reflects a recurring concept that has emerged throughout this interpretation: the idea that PHIs are not provided with what they need (e.g., training in using some devices) to perform their job accurately and efficiently. The higher administration believes that they are providing helpful tools to the PHIs. However, they do not communicate with the PHIs to obtain their input, and they do not provide proper training on using the tools. As a result, these tools are not always what is needed. It appears that the lack of PHIs’ training in using these devices—and the lack of PHIs’ training in general—is an issue that the EHMs understand, but solving this issue is beyond their control.
Subtheme 3: Annual Evaluation of PHIs A concern emerged about the annual performance evaluation of PHIs. Fahd #2 remarked, ‘The PHIs’ annual evaluation report is unfair and doesn’t involve the inspector’s productivity’. In addition, EHM Sami #6 explained, ‘The PHIs’ annual evaluation report has some problems that frustrate the PHIs. For instance, 80 per cent of the PHIs’ work is in the field, but the annual report form criteria only focus on office work.’ This is an important finding as it potentially contributes to a lack of motivation (as discussed earlier under the theme of lacking motivation regarding advanced training). PHIs know that there is no reward for being productive, and unproductive PHIs can still receive good work evaluations. There appears to be a lack of motivation to work their best in the field because of the improper annual report
Page | 104 criteria. The most important component of a PHI’s work is completed in the field through food safety inspection visits, so the annual report should primarily focus on this area. Updates could be done on the performance review process by considering the needs of PHIs and the nature of their work. As argued by Nelson (2000) and DeNisi et al., (2006), for a performance appraisal to be successful, it must consider the demands and expectations of the employee because this will generate a sense of fairness, which is itself a huge motivator.
Subtheme 4: Transport Difficulties First, it was reported that there was a shortage of cars provided by the department for
PHIs to use during their work hours. Further, PHI Othman #4 stated, ‘Even the current work cars provided by the department are not insured, so if the PHI had a car crash, he has to repair it at his expense.’ This concern was echoed by another PHI participant who said:
Some PHIs don’t go for inspection visits for months because their work cars are
damaged and need to be repaired. They request to get their car fixed from the services
department at the municipality, but they are not responsive. I sometimes use my own
private car for work.
Additionally, he commented about the problem of paying for petrol: ‘They give us just 100 litres a month, and this isn’t sufficient as we go out daily for inspection visits. The means of transportation is a challenge, and the PHI pays from his own wallet.’ This contributes to the lack of motivation experienced by PHIs and demonstrates a lack of support from the administration to the PHIs. When inspectors must use their own funds to perform their role, there is a significant problem (although it is recognised that not all PHIs will have concerns about using their own finances or vehicles). To determine the effects among the PHI workforce and food safety inspection procedures in Riyadh, the transport difficulties and the other identified challenges and obstacles have been considered in Phase 2 of the current study, the online survey. Further discussion is provided in Chapter 5.
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These are all concerns that have been mentioned in the interviews within the context of
the challenges and obstacles theme. Most of these challenges are points of serious frustration
for PHIs and could be eliminated or minimised through better communication and relationships
between the different stakeholders (i.e., policymakers, municipal leaders, EHMs and PHIs).
Table 4.3 provides samples from the themes and subthemes discussed above along with
quotations from participants.
Table 4.3 Samples from the themes and sub-themes Themes Subthemes Quotations from participants Knowledge Laws and ‘Because of the lack of clarity in some regulations, the PHI has to ignore some and Skills regulations violations during the inspection.’ (EHM Sami #6)
The HACCP ‘The regulations that we follow are somehow old. Some of them were issued principles 15 years ago, and there are few changes within them. They don’t take the PHIs’ opinions into consideration.’ (PHI Fahd #2) ‘We’ve got restaurants that apply the HACCP system, but the PHIs cannot evaluate it because they are not qualified.’ (EHM Falah #5)
Communication ‘Sometimes, I confront a problem in delivering the information with non- Arabic speakers. My English skills are poor, and maybe the restaurant worker speaks neither Arabic nor English, so we are unable to talk to each other, and I sometimes use sign language. In some cases, I realise that the worker does not understand me, but the worker appreciates what I’m doing.’ (PHI Abd Al- Latif #1) Training and Lack of ‘There’s no specific mechanism or training plan to improve the PHIs’ Professional motivation knowledge and skills, it’s just personal efforts from us as managers. Development Sometimes we hold a training course inside the work building, but unfortunately, there aren’t a sufficient number of PHI attendants because there are no motivations to attend.’ (EHM Falah #5)
‘The training opportunities are few. Although there are no motivations to Scarcity of attend, I have been trying for two years to get training, but I haven’t managed.’ training (PHI Fahd #2) opportunities ‘Training courses, if found, have irrelevant content that doesn’t satisfy our Failure of actual needs. For instance, the course ‘The Method of Behaving with training to Managers’, which is currently available to PHIs, I don’t need it as much as target PHIs’ specialised training in food safety issues.’ (PHI Othman #4) needs Education The curriculum ‘There has been no change in the curriculum of the Secondary Diploma of and of the PHI Health Inspection since its establishment in 1990 to 2005’. He also said, ‘The Qualifications qualification first review of the curriculum occurred when the undergraduate diploma was program created 1426H (2005) in order to prepare the new diploma. After that, another review was done in 1434H (2014), but some of them were executed in 1438H (2016). In the meantime, another review is taking place.’ (Diploma Coordinator Khalid #7)
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Barriers in ‘The PHIs must be developed by allowing them to continue graduate studies pursuing in the field. I know a lot of PHIs who would like to pursue their studies, but education obstacles such as the admission requirement prevent them from doing so.’ (PHI Fahd #2)
Challenges Efficiency of ‘The electronic field system Raqeb needs to be improved, and they should and Obstacles the electronic take the inspector’s opinion into consideration. They didn’t take our opinion field system when they first introduced it to us. Therefore, disadvantages appeared. It even sometimes hinders the inspector’s work.’ (PHI Fahd #2)
Annual ‘The PHIs’ annual evaluation report has some problems that frustrate the evaluation of PHIs. For instance, 80 per cent of the PHIs’ work is in the field, but the annual PHIs report form criteria only focus on office work.’ (EHM Sami #6)
4.4. Conclusion
Summary
In this phase, qualitative data were gathered through seven semi-structured interviews
with four PHIs, two EHMs and the Food Safety Diploma Coordinator. The aim was to
understand the current situation of the PHI workforce, including their daily food safety
inspection practices, the barriers and difficulties they experience, and issues with their
qualifications and training. The transcribed data of the interviews were analysed using the
thematic analysis method, and four major themes emerged: knowledge and skills, training and
professional development, education and qualifications, and challenges and obstacles.
Generally, the PHIs’ responses showed that they lack understanding in several
knowledge and skills areas that are essential for conducting risk-based food inspection as
outlined by the FAO knowledge and skills framework (Section 2.7.2), such as the HACCP
principles, communication, and laws and regulations. The PHIs’ responses regarding their
understanding of the HACCP principles differed based on their qualifications. PHIs who hold
secondary diploma did not know the HACCP principles; as it is not taught in the secondary
diploma. Those PHIs who hold the undergraduate diploma provided a few details about the
principles of HACCP, as it was taught in the undergraduate diploma but only in a superficial
way. However, all PHIs (holding either qualification) lacked the ability to conduct restaurant
Page | 107 inspections based on the HACCP elements. Communication is another important area of knowledge and skills. All PHIs experienced problems when communicating inspection results to restaurant workers because of language barriers. This is a significant issue as it is inhibiting the PHIs from communicating food safety information and correcting any identified food safety violations. PHIs’ lack of understanding of the HACCP principles and their communication difficulties could hinder their ability to conduct effective risk-based inspections.
Regarding training and professional development, all PHIs advised there is a significant lack of training opportunities offered to them. Few training opportunities are available, and when available, they do not meet their needs. This lack of regular and up-to-date training could explain the identified lack of knowledge and skills among the PHIs. Further, the PHIs’ responses indicated that they do not have the motivation to attend training courses. This is because attending training will not result in any benefits to them in terms of job promotions or
any other rewards. This lack of motivation could be a significant barrier to knowledge use
within the Knowledge-to-Action framework (see Figure 2.4) because the gaps in PHIs’ risk-
based inspection knowledge and skills could be resolved through ongoing training, but the PHIs
need to be motivated to attend.
The challenges and obstacles the PHIs experience during their work were discussed
during the interviews. Two common issues were explored. First, the participants discussed the
efficiency of the electronic field system Raqeb, which is the electronic system developed to
assist the PHIs in performing food safety inspections. All PHIs mentioned that the system needs
to be updated based on their feedback to increase the efficiency of food safety inspection visits.
Second, the criteria of the PHIs’ annual evaluation report are deemed unfair as the PHI’s
productivity is not considered. This is an important finding as it possibly contributed to their
recognised lack of motivation, knowing that an unproductive PHI can still have a positive
annual work evaluation. The PHIs expressed that these issues could probably be addressed if
Page | 108 the municipal leaders listened to their feedback on the Raqeb system and the annual evaluation report.
Throughout the interviews, a recurring challenge emerged: the municipal leaders/higher administration are unresponsive to the feedback and the needs of PHIs. If the administration and decision-makers (who play an important role in the Health Protection Domain, see Figure
2.3) were open to feedback from the PHIs working in the field (important frontline players in the Health Protection Domain) and the corresponding revisions were made, the food safety inspection practices could be improved. This would make a significant difference in the safety of food at restaurants, thus protecting the community from FBIs.
Limitations and further research
The qualitative interviews identified significant issues, experiences and challenges about the current food safety inspection practices in Riyadh. As the intent of these seven semi- structured interviews was to understand, and not infer, generalisations cannot be made based on the findings of this phase alone. The responses obtained from participants may not be
representative of the larger population of PHIs in Riyadh. Additionally, according to the
NSECHR (NHMRC, 2007), the customs and cultural heritage of the participants should be
respected. As such, only male participants were involved in this data-collection process, which
resulted in gender bias. Another limitation is that not all nine areas of risk-based inspection
knowledge and skills were discussed in the interviews. Only the major areas (such as HACCP,
communication, and laws and regulations) were discussed. This was due to the interview time
limitations as several other issues needed to be covered. To address known limitations, the
researcher conducted the further research as an online survey (Phase 2 of this research). These
limitations necessitated a representative survey of all PHIs, male and female, in Riyadh to
explore whether the needs and perceptions identified in these interviews were representative of
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PHIs across Riyadh. Further, all the knowledge and skills areas were further investigated in
Phase 2 of this research (the online survey in Chapter 5).
In conclusion, this qualitative study identified key aspects of the current situation of the
PHI workforce including a lack of understanding in several knowledge and skills areas essential for conducting risk-based food inspections. This research, with its known limitations, identified key themes, thereby establishing the groundwork for further surveys and analyses as described in the remaining chapters of this thesis.
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CHAPTER 5: STUDY TWO – CROSS-SECTIONAL SURVEY
5.1. Introduction
This chapter focuses on Phase 2 (Figure 3.4) of this sequential exploratory study and comprises the quantitative component. The aim was to explore and investigate the composition of the current PHI workforce in Riyadh, their perceived levels of knowledge and skills in risk- based food safety inspection including issues that prevent or impede PHIs from performing their job effectively (see research questions and objectives sections 1.4 and 1.5).
The qualitative insights collected and discussed in the previous Chapter (Phase 1,
Figure 3.4) enabled the identification of issues and problems with the food safety inspection practices and PHI workforce in Riyadh, as perceived by the participants of the semi-structured interviews. The identification of possible problems and issues by the interviewees participating in the qualitative study provided a basis to explore whether some of these issues were prevalent in a much larger group of participants and enabled the identification of related factors. An important goal of the quantitative study presented in the current Chapter was two-fold:
x Firstly, based on the previously collected qualitative information (see Chapter 4),—
the FAO knowledge and skills framework (see section 2.7.2), and the Knowledge-
to-Action (KTA) framework (see section 2.7.3)—a valid survey instrument was
designed to collect quantitative data from a large cohort of PHIs in Riyadh,
including the demographic characteristics of PHIs and their perception regarding
their knowledge and skills in risk-based inspection, the legislative and regulatory
framework, professional training and motivation/satisfaction, etc.
x Secondly, the collected data were analysed quantitatively (see below in this
Chapter) to confirm and statistically characterise the potential problems and issues
indicated by the qualitative study, including the identification and quantification of
the effects of a variety of demographic, legal and workplace factors on the
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knowledge and skills of PHIs, their motivation at the workplace, professional
training and PHIs readiness for the expected transition to a risk-based food
inspection approach.
The first part of this chapter presents the study methods including description of the study design, survey development and translation process, piloting the survey, inclusion criteria, recruitment strategies, administration of the survey and analysis methods associated with the study. Subsequently, this chapter presents the results of the study and then the chapter concludes with a discussion of these important findings.
5.2. Methods of Phase 2
Description of the Study Design
The current study uses a quantitative cross-sectional design for collecting data by employing an online self-administered questionnaire. This approach to data collection was chosen to reach, and collect extensive data from, a large number of PHIs in Riyadh. The pre- set questions in the questionnaire tool enabled coherent and targeted responses from a large sample of participants to the specific issues that were regarded to be of a particular interest for the study and the developed research questions (i.e., PQ1, SQ2, SQ3, SQ4, SQ6). Subsequent comparative analysis of the obtained database is conducted using statistical methods. The quantitative analysis is typically used to compare responses from different groups of participants in the considered PHIs cohorts, and for the establishment of any significant relationships between variables or groups of variables measured by the survey instrument. The development of a valid and useful survey instrument often requires prior knowledge or
expectation of which questions should the participants be asked, and these questions should
also be linked to the considered research questions and aims (see section 1.6) of the project (De
Vaus, 2001). Such an approach is used in this study to determine and characterise the
Page | 112 perceptions of PHIs regarding their knowledge and skills in risk-based inspection, including any barriers and obstacles encountered on the way towards improvement of inspection practices and adoption of the risk-based inspection approach.
Survey Development
Several questions are usually considered prior to drafting survey questions. The following are some questions that may be initially posed: ‘Why should I utilise a survey?’
‘What specific knowledge or information do I wish to acquire?’ ‘Can this data be gathered by other any other methods?’ ‘What kind of information do I have to collect?’ As Weisberg, et al., (1996) suggest, any research must begin with an objective, and the more complete the research objectives, the greater is the likelihood of constructing a stronger survey. The current study’s objectives have been articulated through the six research questions in Chapter 1. These questions were partially answered in Phase 1 of the research; however, these responses were elicited from a sample of 7 of participants. A survey enables responses to be captured from a larger group of PHIs and can examine relationships between perceptions about their knowledge and skills of risk-based food inspection, training and professional development and various job-related challenges.
As there was no existing or suitable survey addressing the research questions outlined in this thesis, a new survey was developed and constructed using the following two resources:
1- FAO knowledge and skills framework; that is, the Risk-Based Food Inspection
Manual developed by the Food and Agriculture Organization (FAO) of the United
Nation (see chapter 2 section 2.7.2)
2- Information gathered through the semi-structured interviews at Phase 1 of this
research (see chapter 4).
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The questions relating to knowledge and skills (see Appendix L, items 1 and 2) were developed based on the nine areas of knowledge and skills identified in the FAO knowledge and skills framework (FAO, 2008). These nine areas are considered essential for PHIs to undertake risk-based food inspection. Analysis of responses from Phase 1 (semi-structured interviews) were also used to create items; for instance, PHIs’ perceptions about the current efficiency of training programs available to PHIs (see Appendix L, items 3 to 11). Also, questions were created relating to PHIs’ perceptions about different challenges and obstacles that affects their job performance and the efficiency of food safety inspection (see Appendix
L, items 12 to 16). Further, the developed items related to PHIs’ training programs and the challenges and obstacles were considered useful in the identification of the potential barriers and facilitators to knowledge use within a KTA framework Figure 2.4 (Graham et al., 2006).
The developed closed-ended questionnaire consisted of 23 items including checklists, ranking questions, and two-choice/multiple-choice questions. A Likert scale was utilised to measure the strength of PHIs’ perceptions. Likert scales often provide an effective way to measure the strength of response in social studies research studies (Hair et al., 2007) rather than yes/no or agree/disagree responses. The Likert scale, which ranges from 1 to 6, has a middle point (Neutral/Indifferent) instead of the extremities of excessive agreement. Respondents also find it difficult to provide their opinions when encountering scales with values greater than six or seven points (Dawes, 2008). Consequently, they are more likely to choose random answers if a researcher presents them with more than 7 points (Dawes, 2008). Therefore, the choice of the ranges from 1 to 6- point Likert scale for the survey items was chosen.
After the creation of the survey items, they were reviewed by the supervisory team and approved after several modifications were made to be clearer. Additionally, according to the
National Statement on Ethical Conduct in Human Research (NSECHR) and to promote and ensure respect, accuracy and fairness to participants, and increase the response rate, the
Page | 114 developed survey was constructed in the English language (see Appendix L), then translated into Arabic (see Appendix M) which is the native language of the targeted participants
(NHMRC, 2007).
Double Translation Method
An initial translation of the survey questions from the source language (English) into Arabic
(the first language in Saudi Arabia) was conducted by the author. The translated survey was then checked by four Saudi PhD students in QUT in the area of public health, one of whom is specialising in food safety. Then, a double translation of the interview questions was used (see section 4.2) (Neuman, 2011; Sousa & Rojjanasrirat, 2011). The output indicated that the translation reflected a high similarity level between the two English versions of the survey questions, that is, the English and Arabic surveys were a good match in wording. Table 5.1 presents a sample of the compatibility of the final Arabic and English survey questions.
Table 5.1 Sample of survey question translation process Survey questions in English Survey questions translated Survey questions translated from English to Arabic by the from Arabic to English again researcher
How confident are you in/1 1/ﻣﺎ ﻣدى ﺛﻘﺗك ﻓﻲ ﻣﻌرﻓﺗك وﻣﮭﺎراﺗك How confident are you with/1 your current knowledge of the اﻟﺣﺎﻟﯾﺔ ﻟﻠﻣواﺿﯾﻊ اﻟﺗﺎﻟﯾﺔ؟ your current knowledge of the following topics? following subjects?
Regarding food safety, how/2 2/ﻓﯾﻣﺎ ﯾﺗﻌﻠﻖ ﺑﺳﻼﻣﺔ اﻷﻏذﯾﺔ ، ﻣﺎ ﻣدى In terms of food safety, how/2 important is it to consider each أھﻣﯾﺔ ﻣراﻋﺎة ﻛل ﻣن اﻟﻘﺿﺎﯾﺎ اﻟﺗﺎﻟﯾﺔ؟ important do you consider each of the following issues? of the following issues?
Would you like to attend a/4 4/ھل ﺗرﻏب ﻓﻲ ﺣﺿور دورة ﺗدرﯾﺑﯾﺔ Would you be interested in/4 training course even if there is ﺣﺗﻰ ﻟو ﻟم ﺗﻛن ھﻧﺎك ﻣﻛﺎﻓﺂت؟ attending a training course even if there is no reward? no reward?
Piloting the Survey
Construction of the survey involved a pilot study which allowed any problems and benefits to be identified (Bryman, 2004; Balnaves & Caputi, 2001). Bell (1999) claimed that a
Page | 115 pilot study should be conducted on the gathered data to ascertain whether all research questions are clear and remove any items that do not yield usable data. Moreover, Cresswell (2012) indicated that conducting a pilot study for survey construction aids in determining whether the participants can understand and complete the survey. Consequently, the survey was also trialled to verify the participants’ level of comprehension and understanding.
There are several methods that can be used to identify the minimum sample size for a pilot study. Hill (1998) suggested that a sample of 10 to 30 would be sufficient for a pilot study.
The questionnaire was piloted with a small group of targeted participants to ensure the effectiveness of the questionnaire. The survey was distributed to 15 PHIs in Riyadh for testing in the actual environment to ensure the quality and efficiency of administration of the questionnaire—four of the participants were the same PHIs interviewed in Phase 1. The rationale for choosing the same four people was that convenience sampling is generally used during a pilot study due to its easy accessibility, whereas random sampling is typically used during the final data collection for parametric statistical testing (Fraenkel et al., 1993). In addition, the participants who were interviewed in the first phase of the research were familiar with the research purpose. Therefore, they were able to provide feedback related to the interview-specific information to develop the survey items.
Changes to the Survey after the Pilot Study Several amendments were made to the survey based on the feedback from the
participants. For example, six participants responded to a question in the ‘Communicate
Inspection Results’ section —‘How confident are you with your current skills?’—indicating
that they were confident in their communication skills except with restaurants workers who
only spoke English (not Arabic). The question created some confusion for them, and the
researcher consequently added a question related only to their English knowledge and skills
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and another question related to their communication skills (see questions 2. J, K and L,
Appendix L).
Communication with food handlers and business operators is an essential skill needed
by PHIs to conduct their work effectively (e.g., Communication of food safety information,
inspection results). This feedback provided an insight, allowing the researcher to add another
question to the survey related to difficulties in communication to help assess the significance
of this issue. The question ‘To what extent do you agree or disagree with the following
statements’ ‘Whenever I meet food handlers who speak a different language from my own, I
find it difficult to communicate food safety information to them’ (see Question 12.A,
Appendix L).
Further feedback related to Question 6 in the survey, ‘Do you manage your own professional development?’. Seven participants responded to this item, indicating that the
question was not clear, and it could be improved by providing some examples. The researcher
amended the question and added an example to make the question clearer— ‘Do you manage
your own professional development? (e.g., training, reading scientific articles)’ (see Question
6, Appendix L).
Eligibility Criteria
PHIs in Riyadh, Saudi Arabia have several environmental health responsibilities, such
as food safety inspection, licensing, inspecting non-food premises. The focus of this cross-
sectional study was limited to PHIs (502 PHIs in total) who conduct food safety inspection in
Riyadh. Several criteria for the participants and organisations were included in this study.
These criteria can be grouped under two sections as outlined below:
x Participants criteria:
o All Public Health Inspectors (PHIs)
o PHIs who conduct food safety inspection
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o Male and Female
o All different ages.
x Organisations criteria:
o Working across the Environmental Health Departments (elven
departments in total) including the General Department of
Environmental Health (GDEH) in Riyadh, Saudi Arabia
o Under the Ministry of Municipal and Rural Affairs (MOMRA).
Recruitment Strategies
The PHIs participants were recruited in accordance with ethical approvals and as follows: x After obtaining the data collection approval from the Ministry of Municipal and Rural
Affairs (see appendix 2), the PHIs were invited to complete the online survey through two
methods:
1- Their work emails. Invitation via an email circulated to the PHIs, inviting them
to participate in the research.
2- Existing PHIs groups in WhatsApp messenger. WhatsApp is the primary means
of communication in Saudi Arabia with 73% of its population being active users
(Clement, 2019). PHIs generally use WhatsApp rather than email to
communicate. The author was added to the WhatsApp group by the admin of
each group after visiting them personally at their workplace in Riyadh city. This
was necessary as sending out by email only might result in a lower response rate
and also a potential selection bias. x A Participants Information Sheet (PIS) was provided with the invitation (see Appendix G
and 8) along with the online survey link. Participants were reminded about the voluntary
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nature of their participation. They were also informed that they could withdraw from the
participation at any stage before clicking on the submission button at the end of the online
survey. x The survey was available in Arabic to be accessed by the PHIs for a five-week period
between December 2018 and January 2019. The first reminder of the invitation was sent
through email and WhatsApp two weeks after the first invitation, and the second reminder
was sent five days before the end of the duration.
Administration of the Survey Using Key Survey
Key Survey is very convenient because it is easy to use and provides extensive features
to help develop and distribute online surveys. It also provides a place where data can be
collected in a secure environment, which contributes to protecting participants’ identity and
the confidentiality of their responses. The online survey, which included 23 multiple choice
questions, rating scales and dropdown menu questions deemed appropriate because it was
more convenient than a hard copy survey for the following reasons:
1. Provides the highest level of convenience for the respondents as it enables them to
answer the questionnaire according to their own pace, chosen time, and preferences.
Thus, increasing the response rate.
2. Easier and faster to capture a larger sample.
3. Management of the data collection process could be stored in one place without danger
and eliminating the possibility of human error.
4. No cost was required for printing, papers, pens, and envelopes to post the surveys via
mail.
5. Key Survey was designed and formatted for use with Excel and SPSS software allowing
for the analysis of data to be easier and more accurate.
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Ethical Considerations
Ethical clearance was obtained from the QUT Human Research Ethics Committee
(UHREC) approval number (1700000384) (see Appendix A). See section 3.5 for more details about the ethical aspects.
Data Analysis
The analysis of quantitative data was undertaken using SPSS version 24. Nine items were used to measure inspectors’ confidence in areas of knowledge required for their jobs, and an average score of these items was calculated to form a ‘knowledge’ scale. Twelve items were used to measure inspectors’ confidence in areas of skill required for their jobs, and an average score was also calculated to form a ‘skill’ scale. The Cronbach’s alpha of these two scales indicated that they had high internal consistency (see results section below). Descriptive analyses of these two scales were performed by gender, education, years of experience and municipality. Knowledge and skill were then regressed on these variables to determine and examine any significant effects of such variables on the perceptions of knowledge and skills by the participating PHIs. Similar analysis was performed for motivation. Descriptive analysis of motivation was performed by gender, education, years of experience and municipality, followed by regression analysis.
Descriptive analysis on whether a PHI received training was examined by gender, education, years of experience, municipality and motivation. Logistic regression was then used to examine relationships between receiving training (dependent variable) and gender, education, years of experience, municipality and motivation as the independent variables. An association between gender and municipality was examined using a chi-square test and association between the item ‘My qualification program prepared me well for a real-life health inspector job’ and education level was examined using ANOVA. Chi-square is appropriate for examining association between two categorical variables (e.g., yes or no). The question on
Page | 120 qualification was measured using a Likert scale, hence ANOVA is appropriate as the test examines whether there is a statistical difference between the means. Given the sample size of about 300 individuals, the distribution of the mean score was assumed to be approximately normal because of central limit theorem (Casella & Berger, 2002).
The use of parametric methods, such as ANOVA and regression, for the analysis of
Likert scores variables is often debated in the literature (Sullivan & Artino, 2013). For example,
for ANOVA, one concern often raised is the ability to meaningfully draw inference from a
mean value resulting from a Likert score (0, 1, 2, 3, etc) which is not a continuous variable and
has defined upper and lower bounds (Norman, 2010). Norman (2010) argued that these
critiques are unfounded when the sample size is reasonably large as the normality of the
sampling group mean can be guaranteed by the Central Limit Theorem (CLT), a statistical
theorem proved by the French mathematician Pierre-Simon Laplace two hundred years ago
(Fischer, 2010). According to the CLT, the group mean of a series of identical and
independently distributed random variables (such as individual score from a Likert scale) will
follow a normal distribution, regardless of the shape and distribution of the original random
variables. Such results have been consistently demonstrated analytically and through
simulation in numerous standard mathematical statistics textbooks (e.g., Larsen & Marx, 2017;
Casella & Berger, 2021).
For this study where ANOVA was applied, the distribution of the target variables was
unimodal and measured with a 5-point scale. These variables were also independent and
identically distributed, and the sample size of the current study was close to 300. Therefore, all
the conditions of the CLT have been satisfied and the CLT guarantees that the distribution of
the group mean of the target variable resembles a normal distribution even if these variables
were measured with a 5-point scale and have defined upper and lower bounds. A further
Page | 121 assumption of ANOVA relates to equal variances (between groups). In this study, we found the variance between groups for the target variables to be similar.
For the multiple regression analysis, the key variables were knowledge and skills, and these two variables were constructed from the mean score from multiple questionnaire items.
One concern raised for taking a simple average was that each item is weighted equally. This is a valid concern when the number of items is small (e.g., 3 or 4 items), the items are measured with different scale or the internal consistency of the items is low (Cronbach’s alpha < 0.7)
(Tabeachinck et al.,, 2007; DiStefano, Zhu & Mindrila, 2009). In this study, knowledge and skills are calculated from nine and twelve items respectively. All of the items were measured using the same response scale, and the internal consistency of both knowledge and skills are high (Cronbach’s alpha > 0.8). Therefore, averaging the items to form a scale was acceptable and appropriate. Further, a sensitivity analysis was performed by dichotomising both knowledge and skills, and repeating the regression analysis using logistic regression analysis.
Similar conclusions were found using both methods, demonstrating the robustness of the analyses.
Where statistical regression models with multiple independent (predictor) variables were developed, pair-wise interactions between the involved predictor variables were also considered to provide further insight. Although all possible pair-wise interactions were considered and checked using Bonferroni correction in each of the developed models, only statistically significant interactions were retained in the final models (and the tables showing the model outcomes – see below). This is the standard statistical approach to ensure that no significant interactions have been missed in the multiple (linear or logistic) regression models
(Freund, et al, 2006). Any significant interactions were subsequently interpreted in order to understand their meanings in the context of the conducted analyses and the existing food safety environment in Riyadh.
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5.3. Results
5.3.1. Introduction
This analysis is based on the results of a survey completed by Public Health Inspectors
(PHIs) working in the eleven different municipalities in Riyadh, Saudi Arabia. All the inspectors in Riyadh, a total of 502 (the sampling frame), were invited to participate in the study by completing the survey. A total of 426 (84%) inspectors started the survey and 301 completed and returned it resulting in a 60% response rate. Unfortunately, no relevant information was obtained about those PHIs who did not complete the survey, and this did not allow an examination of whether there were particular groups less likely to participate. The
125 participants who started the survey but did not complete it were excluded because they failed to provide valid data for analysis and only answered the first one or two questions. No relevant demographic information was obtained about these participants, as the demographic questions were placed at the end of the survey instrument (Appendix L). Another reason for exclusion was the lack of required consent to participate as submitting the completed survey was considered as consent for participation in this study. Also, the responses to the last open- ended item in the survey, ‘Please provide any additional comments you would like to mention’,
did not provide valid comments to analyse apart from success wishes and prayers to the author
which is culturally understood.
5.3.2. Demographics
An important part of the survey instrument was to obtain the relevant demographic
information about the study participants, which is essential for an adequate interpretation of
the quantitative findings. Evaluation and comparison of the findings for distinct demographic
groups enabled valuable insights into the characteristics of the available sample of PHIs and
summary statistics of their responses. Therefore, this section presents the demographic
characteristics of the respondents (Tables 5.3.1, 5.3.2 and 5.3.3).
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The majority (n=259) or 86% of the study participants were male, with only 13% of the respondents being female (n=40) (Table 5.3.1). This difference is possibly due to the undergraduate Diploma in Food Safety in Saudi Arabia being available only to males, and that female PHIs have different educational backgrounds and a limited range of responsibilities
(e.g., inspecting female businesses) due to different cultural and social factors. Age was categorised into four groups with the largest number of participants being between 30 and 39 years old (63%), followed by those between the ages of 18 and 29 years (24.9%), 40 through
49 years (9.6%), and 50 through 59 years (1.3%). This age distribution of PHIs is significantly different from what typically occurs in some developed countries (Johnson, et al., 2014; Pham, et al., 2010), where the typical age of PHIs is significantly higher—see the Discussions Chapter for more detail. For further information about the considered sample of PHIs, the F2-test was used to obtain the distributions of percentages of male and female PHIs within different age categories (Fig. 5.1). According to the F2-test, there is a significant difference between the percentage age distributions for male and female PHIs (p = 0.017). In particular, female PHIs are likely to be older than male PHIs, and this is particularly notable in the categories of 18 to
29 years (lower percentage of females compared to the percentage of males) and 30 to 39 years
(higher percentage of females compared to males)— Fig. 5.1. This suggests that younger females might be less interested in the PHI profession, or not confident in their performance in the PHI role, or experience greater difficulties with obtaining the required qualifications.
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Figure 5.1 Percentage distributions of male and female PHI participants by age
Note: Male PHIs: 259 participants; Female PHIs: 40 participants (Table 5.3.1).
Because females have a significantly lower participation rate in a PHI job (compared to their male counterparts) it may be likely that they have lower degrees of interest and motivation to succeed in this type of job due to a variety of reasons including cultural, traditional and other grounds. Had this been true, it could have explained the low participation rate for females. However, this notion is not supported by the analysis of the dependence of motivation on gender (see below in this Chapter), which did not reveal any significant differences in motivation by gender. Therefore, it is possible to conclude that the low participation rate for female PHIs is more associated with the current restrictions on females to obtain the required qualifications of an undergraduate Diploma in Food Safety. This proposition is further corroborated by the dominant representation of female PHIs in other countries (Pham, et al., 2010; Johnson, et al., 2014).
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Table 5.3.1 Respondents gender and age
Information N %
Gender
Male 259 86.0
Female 40 13.3
Prefer not to answer 2 0.7
Age group
18 – 29 75 24.9
30 – 39 192 63.8
40 – 49 29 9.6
50 – 59 4 1.3
Prefer not to answer 1 0.3 **N: Cell count. (N = 301 response rate 60%).
Respondents were also asked about their years of experience as a public health inspector and their qualifications. Most inspectors had between six and ten years of experience equalling
42.9% (n=129) of participants. This was followed by 23.9% (n=72) who had between 11 and
20 years of experience. In terms of qualifications, 68 respondents (22.6%) held a technical college (undergraduate) diploma and 127 (42.2%) had a secondary school diploma for health inspection, which is, on average, notably lower than in other developed and developing countries (Johnson, et al, 2014; Maldonado-Simán, et al, 2019). Table 5.3.2 below displays the years of experience and qualifications. The consequences of the presented distributions of the
PHI cohort in terms of their work experience and qualifications are discussed in more detail in the next section. Additionally, years of experience was used instead of age group in most of the conducted analysis and comparisons, because those with more experience were generally older so the age group effect is largely captured by years of experience.
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Table 5.3.2 Years of experience and qualification, Public Health Inspectors
Information N %
Years of experience
0 – 2 years 47 15.6
3 – 5 years 32 10.6
6 – 10 years 129 42.9
11 – 20 years 72 23.9
20+ years 10 3.3
Prefer not to answer 11 3.7
Qualification
Middle school 0 0
Secondary school 7 2.3
Secondary diploma (Health inspection) 81 26.9
Technical college diploma 127 42.2
Bachelor 68 22.6
Post-graduate 4 1.3
Other 14 4.7 **N: Cell count. (N = 301 response rate 60%).
The comparison of the percentage distributions of PHIs over the three categories of work experience [0–5 years (86 participants), 6–10 years (187 participants), and t 11 years (17 participants)] for the three different categories of education / formal qualification were conducted using the F2-test (Fig. 5.2). Significant differences between the considered distributions (Fig. 5.2) were indicated, with p < 0.001. In particular, participants with the lowest level of formal qualification (Secondary School) are characterized by the highest proportion of
PHIs with extended work experience (t 6 years – Fig. 5.2). This is probably because of the
Page | 127 lower past requirements for formal qualifications for PHIs. The significant number of participants (88, which is around 30%) with low formal qualifications in the considered sample further supports the expectation of a possible bias based on the Dunning-Kruger effect and
‘unconscious incompetence’ (Kruger & Dunning, 1999; Flowers, 1999; Simons, 2013), when the evaluation of the participants’ knowledge and skills in food safety inspections is considered—see below the Discussion section.
Figure 5.2 Percentage distributions of PHI participants over the three indicated work experience categories, by education/qualification
Note: Middle / Secondary School: 88 participants; Secondary / College Diploma: 195 participants; and Bachelor / Postgraduate: 18 participants.
In terms of participant workplace, a large proportion of respondents at 40.5% (n=122) chose not to answer this question (Table 5.3.3). This was probably caused by their fear of being identified or because of other related issues. Of those that did answer the question, 26.6%
(n=80) worked within the general department of environmental health. Table 5.3.3 that follows shows the breakdown according to the inspectors’ workplace.
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Table 5.3.3 Public Health Inspectors’ workplace (municipality)
Workplace N %
Municipality
General Department of Environment Health (GDEH) 80 26.6
Other departments 99 32.9
Prefer not to say 122 40.5
**N: Cell count. (N = 301 response rate 60%).
5.3.3. Knowledge and Skills
Table 5.3.4 shows the inspectors’ confidence in nine areas of knowledge. For seven of the nine knowledge areas, most of the inspectors reported that they were either confident or very confident. The area in which the inspectors were the most confident is in communicating inspection results where 80.8% (n=243) were confident or very confident in their knowledge.
The two areas in which less than half of the inspectors reported being confident were: Hazard analysis and critical control point (HACCP) guideline and food sampling techniques. The table below provides the results regarding each category of knowledge the participants were questioned about and their responses.
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Table 5.3.4 Inspectors’ confidence in nine areas of knowledge
Very Not Not Not at all confident Confident Sure confident confident
Area N (%) N (%) N (%) N (%) N (%)
62 Food safety laws and regulations+ 69 (22.9) 155 (51.5) (20.6) 12 (4.0) 3 (1.0)
Hazard analysis and critical control 104 point (HACCP) guideline- 40 (13.3) 104 (34.6) (34.6) 34 (11.3) 19 (6.3)
62 Inspection techniques+ 87 (28.9) 130 (43.2) (20.6) 15 (5.0) 7 (2.3)
91 Food sampling techniques- 51 (16.9) 74 (24.6) (30.2) 53 (17.6) 32 (10.6)
Communication about inspection 40 results+ 126 (41.9) 117 (38.9) (13.3) 10 (3.3) 8 (2.7)
57 Sanitation and hygiene+ 96 (31.9) 115 (38.2) (18.9) 24 (8.0) 9 (3.0)
98 Food microbiology+ 54 (17.9) 99 (32.9) (32.6) 34 (11.3) 16 (5.3)
79 Pest control+ 60 (19.9) 117 (38.9) (26.2) 27 (9.0) 18 (6.0)
93 Scientific research+ 57 (18.9) 96 (31.9) (30.9) 28 (9.3) 27 (9.0) +Areas in which majority (50%) of the inspectors reported being confident or very confident. -Areas in which less than majority (50%) of the inspectors reported being confident or very confident; N: Cell count. (N = 301 response rate 60%).
The inspectors were also asked about their level of confidence regarding the specific skills required to perform their job. The respondents felt most confident in their ability to communicate, with 78% (n=235) feeling either confident or very confident. The participants were the least confident regarding their English-speaking skills, with only 30.9% (n=93) being confident or very confident (Table 5.3.5). The table below shows all the skill areas that the inspectors were asked about and their corresponding responses.
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Table 5.3.5 Inspectors’ confidence in twelve areas of skills
Very Not Not at all confident Confident Not Sure confident confident
Area N (%) N (%) N (%) N (%) N (%)
Assessing compliance with food safety laws and regulations+ 77 (25.6) 138 (45.8) 56 (18.6) 22 (7.3) 3 (1.0)
102 Evaluation of HACCP system- 40 (13.3) 103 (34.2) (33.9) 39 (13.0) 17 (5.6)
Inspection techniques+ 84 (27.9) 125 (41.5) 62 (20.6) 18 (6.0) 12 (4.0)
Using inspection devices+ 80 (26.6) 106 (35.2) 76 (25.2) 20 (6.6) 19 (6.3)
103 Food sampling techniques- 57 (18.9) 84 (27.9) (34.2) 34 (11.3) 23 (7.6)
Assessing compliance with best practices in sanitation and hygiene+ 80 (26.6) 114 (37.9) 75 (24.9) 24 (8.0) 8 (2.7)
Assessing methods of microorganism control- 44 (14.6) 96 (31.9) 96 (31.9) 42 (14.0) 23 (7.6)
Assessing pest control+ 51 (16.9) 103 (34.2) 89 (29.6) 35 (11.6) 23 (7.6)
Conducting research and collecting evidence- 53 (17.6) 96 (31.9) 90 (29.9) 34 (11.3) 28 (9.3)
Communication skill+ 122 (40.5) 113 (37.5) 39 (13.0) 17 (5.6) 10 (3.3)
Reading English- 34 (11.3) 74 (24.6) 99 (32.9) 52 (17.3) 42 (14.0)
Speaking English- 29 (9.6) 64 (21.3) 86 (28.6) 57 (18.9) 65 (21.6) +Areas in which majority (50%) of the inspectors reported being confident or very confident. -Areas in which less than majority (50%) of the inspectors reported being confident or very confident; N: Cell count. (N = 301 response rate 60%).
The comparison of the percentage distributions of PHI responses to the questions about the level of confidence in their reading and spoken English skills was conducted for male and female PHIs using the F2-test (Figs. 5.3a, b). There was not a significant difference between the distributions of responses by male and female PHIs with regard to their spoken English
Page | 131 skills (Fig. 5.3b, p = 0.72). At the same time, there was a significant difference in the confidence of male and female participants regarding their reading English skills (Fig. 5.3a, p = 0.001).
Figure 5.3 Language confidence, by gender, reading English, and speaking English
Note: From 1 (‘Very confident’) to 5 (‘Not at all confident’) for male and female PHIs to the survey questions about the level of confidence in their skills in: (a) reading English; and (b) spoken English.
Interestingly, around 48% of females expressed lack of confidence in their reading
English skills (as opposed to around 30% of males), whereas around 40% of females expressed confidence in their reading English skills (as opposed to around 34% of males) – Fig. 5.3a. As these assessments are based on perception it is difficult to know whether there are real differences in reading skills between males and females (Morse, 1994; Creswell, 1998;
DeFanzo, 2011).
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Further, it is also important to investigate the effects of other demographic variables (in addition to gender) on skills in reading and spoken English, which were found to be the most problematic for both male and female PHIs (Table 5.3.5 and Fig. 5.3). To do this, multiple regression models was developed in which levels of confidence of the participants in their reading and speaking skills in English were considered as the dependent variables measured on the Likert scale from 1 (‘Very confident’) to 5 (‘Not at all confident’). The considered independent variables were gender, participant age, qualifications, and years of work experience.
The results suggest that only PHIs with 6-10 years of experience had some evidence of significantly worse skills (by 0.39 on average on the Likert scale from 1 to 5; p = 0.061) in reading English compared to the participants from the two other work experience categories
(0-5 years, and t 11 years). All other variables and categories did not have any significant effects on skills in reading English.
This finding could be explained as follows. PHIs with less extensive work experience
(0-5 years) completed their qualifications recently, and they should be on average younger than those PHIs with 6-10 years of experience. This sub-cohort of participants grew up in an environment with a greater prevalence of English (with a more extensive access to information in written English through media, Internet, etc.). In addition, younger generations are likely to have a better education in English, and these factors are likely to cause greater confidence in reading English skills among PHIs with less work experience. On the other hand, PHIs with the longest work experience (t 11 years) are more likely to gain greater skills in reading English by virtue of their food inspection work (including reading labels, instructions, regulations, etc. in English) over very long periods of time. As a result, they are also more confident in their reading English skills compared to PHIs from the 6-10 years of experience category. Thus, there may be a gap in training/skills for those with 6-10 years of work experience and these
Page | 133 could be a group to focus on for training programs aiming to overcome any deficiencies in reading English skills.
The results from the multiple linear regression for speaking English skills were somewhat different, with a trend suggesting that participants with Bachelor/Postgraduate qualifications had higher confidence in spoken English skills (by 0.57 on average on the Likert scale from 1 to 5; p = 0.098) compared to the other two qualification categories
(Middle/Secondary School, and Secondary/College Diploma). All other variables and their categories did not have significant effects on skills in speaking English. A plausible explanation of this effect could be straightforward—PHIs with higher formal qualification had more opportunities to encounter spoken English and were taught English better and more extensively.
It is also important to note that the outcomes shown in Tables 5.3.4 and 5.3.5 should be treated with a degree of caution. As further explained and discussed in the Discussion section, these outcomes could be exaggerated and biased (towards overconfidence) by the self- evaluating nature of the survey instrument and because of the significant proportion of PHIs having low levels of education and qualification (Table 5.3.2 and Fig. 5.2). This is likely to cause false confidence and lack of critical assessment of the personal abilities/skills by PHIs
(Kruger & Dunning, 1999; Flowers, 1999; Simons, 2013).
5.3.4. Training and Professional Development
Training and professional development represent one of the major aspects for growing confident, professional and efficient PHIs, and particularly in the currently rapidly developing
World with continuously emerging new threats to food safety, and new foods (including those
from different cultures) appearing on the market (Wallace & Oria, 2010). The conducted survey
revealed that around 60.8% (n=183) of Riyadh PHIs had received training during their careers,
and about 50.8% (n=153) of participating PHIs stated that the content of the training was
Page | 134 helpful (Tables 5.3.6 and 5.3.7). At the same time, about 51.8% (n=156) had not received any training and 27.2% (n=82) had received training only once in the last 12 months (Table 5.3.8).
Rather large proportions of the surveyed PHI cohort indicated that they had never received any training or that training was not helpful (39.2% and 10% – Tables 5.3.6 and 5.3.7, respectively).
These numbers are significantly concerning, as they reflect current deficiencies in the arrangements of PHI training in new emerging food safety treats and/or new inspection techniques.
Table 5.3.6 Received training about food safety since started working as a PHI
Answer N %
Yes 183 60.8
No 118 39.2
total 301 100
**N: Cell count.
Table 5.3.7 Helpfulness of training content
Answer N %
Yes 153 50.8
No 30 10.0
total 183 60.8
**N: Cell count.
Table 5.3.8 Training attendance in the last 12 months
Attending N %
Never 156 51.8
Page | 135
One time 82 27.2
Two times 20 6.6
More than two times 18 6.0
Not applicable 25 8.3
Total 301 100.0 **N: Cell count.
A large majority of the study participants 88.4% (n=266) indicated that they would attend professional development training even in the absence of any incentives (Table 5.3.9).
Although this finding should not be read as if there should be no incentives to attend training, it is a significant indication that the majority of PHIs are so interested in professional training that they are even prepared to disregard the absence of real incentives for attending such training.
Table 5.3.9 Intention to attend a training course even if there is no reward
Answer N %
Yes 266 88.4
No 35 11.6
total 301 100 **N: Cell count.
The survey instrument also asked if the inspectors themselves managed their own professional development and 86% (n=259) stated that this was the case (Table 5.3.10). They were then asked what new skills/knowledge had they learned over the past month. About 14%
(n=42) of PHIs stated that they did not learn anything new that contributed to their professional development.
In this regard, it is necessary to emphasise that self-management of own’s professional development is not a controllable or reasonable approach to the issue of training. Self- management is prone to lack of consistency, missing important points and other mishaps that
Page | 136 do not offer confidence in its efficiency. This is further confirmed by Table 5.3.11 showing that 14% of all study participants did not learn anything useful in the last month during their professional self-development. Although self-management of professional development could provide better flexibility, it should not be relied upon without any control mechanism by the industry and public food safety, and systematic (possibly, mandatory) training should be part of PHI’s professional development and qualification (Newbold et al., 2008).
Table 5.3.10 Management of your own professional development (e.g., training, reading scientific articles)
Answer N %
Yes 259 86.0
No 42 14.0
total 301 100
**N: Cell count.
Table 5.3.11 Number of times PHIs learnt about something new that has contributed to their professional development
Times N %
Never 42 14.0
One time 92 30.6
Two times 28 9.3
More than two times 77 25.6
Not applicable 62 20.6
Total 301 100.0 **N: Cell count.
Regularity of training and professional development is a very important issue that needs to be addressed, as typically training is required as soon as new developments and techniques in food safety emerge (Wallace & Oria, 2010). The obtained outcomes (Table 5.3.8)
Page | 137 demonstrate a lack of regular training in food safety in Riyadh, with nearly 52% of the surveyed
PHIs not receiving professional training over the last 12 months. This concern is further enhanced by the significant number of participants (42.8% - Table 5.3.12) indicating that professional training was not available to them.
Table 5.3.12 Agreement level with statements related to training and education
Strongly Agree Not sure Disagree Strongly I don’t agree N N (%) N (%) N (%) disagree N know N (%) (%) (%)
Training is usually 47 58 57 63 66 (21.9) 10 available for me (15.6%) (19.3%) (%18.9) (20.9%) (3.3%)
I will complete my 100 71 79 30 (10%) 13 (%4.3) 8 (2.7%) studies even if my (33.2%) (23.6%) (%26.2) employer does not give me the opportunity
My qualification 104 113 49 21 (7%) 12 (4%) 2 (0.7%) program prepared me (43.6%) (37.5%) (16.3%) well for my Job **N: Cell count. (N = 301 response rate 60%).
To further understand and analyse the availability of professional training of PHIs, ordinal logistic regression was used to examine the association between frequency of training attendance in past 12 months (Table 5.3.13) and years of experience, qualification, gender, municipality and motivation, skill and knowledge. The averaging of 12 skills items (question
2 in Appendix L) and 9 knowledge items (question 1 in Appendix L) to obtain the skills and knowledge latent variables, respectively, was possible because of the good internal consistency of the items constituting these latent variables. Reliability analyses were performed for the nine knowledge items and twelve skill items. The obtained Cronbach’s alphas (0.875 for the skill and 0.915 for the knowledge items) indicated that both groups of items form reliable and consistent scales. Because of the consistency of the items with each other, it was possible to consider the skill latent variable (M = 3.49, SD = 0.74) and the knowledge latent variable (M
= 3.65, SD = 0.80), which were computed for each participant by taking averages of their
Page | 138 respective twelve and nine items. The two latent variables were reverse coded so that higher scores reflected higher levels of knowledge and skill, and then used as the latent (dependent or independent) variables in the multiple regression analyses. Motivation was also reverse coded with a higher score reflecting a higher level of motivation.
Table 5.3.13 Ordinal logistic regression predicting frequency of attending training the in past 12 months OR 95% CI p-value N Years of Experience (Ref: 0-5 years) 70 6-10 years 0.62 (0.34, 1.15) 0.129 129 11-20 years 0.58 (0.3, 1.13) 0.110 82 Qualification (Ref: Secondary diploma (Health Inspector) 186 Other 1.77 (0.62, 5.06) 0.285 15 Bachelor or above 1.62 (0.78, 3.34) 0.193 65 Gender (Ref: Male) 228
Female 1.44 (0.6, 3.48) 0.417 38 Municipality (Ref: GDEH) 74
Other 1.05 (0.56, 1.98) 0.875 87 Prefer not to say 1.32 (0.73, 2.41) 0.361 105 Motivation 1.21 (0.98, 1.49) 0.075 266 Skill 1.83 (1.05, 3.2) 0.034 266 Knowledge 0.90 (0.49, 1.66) 0.740 266 Note: General Department of Environment Health (GDEH); OR: Odds ratio; CI: Confidence interval; N: Cell count.
Results from ordinal logistic regression indicated that years of experience, qualification, gender, workplace (municipality), and knowledge were not associated with frequency of attending training in past 12 months. There was a trend that higher motivation was associated with a higher frequency of attending training, (OR = 1.21, 95% CI [0.98, 1.49], p = .075). This effect size could be considered as small. Skill was the only significant independent variables, and higher skill was associated with higher odds of attending training more frequently, OR = 1.83, 95% CI = [1.05, 3.20], p = .034. This suggests that each unit
Page | 139 increase in skill was associated with an 83% increase in odds of attending training more frequently. The effect size could be considered medium.
Another relevant question is about the likelihood of receiving professional training by
PHIs over the course of a food inspector career (question 3 in the survey instrument—Appendix
L). Table 5.3.14 shows the summary statistics of the likelihood of receiving training by PHIs over the duration of their careers by gender, qualification, years of experience, and municipality. It also includes the descriptive statistics of motivation, skill and knowledge by receiving training (question 15. F in Appendix L).
The χ2 analysis shows that receiving training was not associated with municipality, χ2(2)
= 2.98, p = 0.369, but was significantly associated with qualification, χ2(2) = 11.37, p = 0.003, years of experience, χ2(2) = 44.55, p < 0.001 and gender, χ2(1) = 21.09, p < 0.001 and higher level of skill, t(299) = 4.14, p < .001, and knowledge, t(4.10), p < .001. There was no significant difference in motivation between those who received and not received training (F(1, 299) =
0.26, p = 0.613).
Table 5.3.14 Prevalence of receiving training by gender, education level, years of experience, municipality, and the mean and standard deviation of motivation by receiving training
Received training Not received training
N % N % p-value
Gender
Male 170 65.60% 89 34.40% < 0.001
Female 11 27.50% 29 72.50%
Qualification .003
Secondary/ Technical college diploma 139 66.83% 69 33.17%
Bachelor or above 32 44.44% 40 55.56%
Other 12 57.14% 9 42.86%
Years of experience
Page | 140
0-5 years 28 35.40% 51 64.60% < 0.001
6-10 years 80 62.00% 49 38.00%
11+ years 71 86.60% 11 13.40%
Municipality
GDEH 52 65.00% 28 35.00% 0.226
Non-GDEH 131 59.30% 90 40.70%
Preferred not to answer 67 54.90% 55 45.10%
M SD M SD p-value
Motivation 2.17 1.25 2.10 1.19 0.613
Skill 3.64 0.73 3.26 0.84 < .001
Knowledge 3.79 0.66 3.44 0.81 < .001 **N: Cell count.
The multiple logistic regression analysis was used to estimate odds ratios for the dependent variable of receiving professional training (not receiving training since the beginning of PHI career was considered as the base category). The considered independent variables were gender, education level, years of experience, municipality and motivation
(question 15. F of Appendix L).
Table 5.3.15 Receipt of training over the course of PHI career, logistic regression OR 95% CI p-value Years of Experience (Ref: 0-5 years) 6-10 years 4.78 (2.35, 9.74) 0.000 11-20 years 15.79 (6.48, 38.48) 0.000 Qualification (Ref: Secondary diploma (Health Inspector) Other 1.19 (0.36, 3.97) 0.771 Bachelor or above 0.61 (0.27, 1.4) 0.243
Gender (Ref: Male) Female 0.28 (0.1, 0.81) 0.019
Municipality (Ref: GDEH) Other 0.96 (0.46, 2.01) 0.923
Page | 141
Prefer not to say 0.83 (0.41, 1.68) 0.608 Motivation 1.24 (0.95, 1.61) 0.112 Skill 2.05 (1.12, 3.75) 0.020 Knowledge 0.90 (0.47, 1.73) 0.762 Note: General Department of Environment Health (GDEH); OR: Odds ratio; CI: Confidence interval; N: Cell count.
Results from logistic regression indicated that years of experience (OR = 4.78, 95% CI
= [2.35, 9.74], p < .001 for 6-10 years and OR = 15.79, 95% CI = [6.48, 38.48], p < .001 for
11-20 years; Reference group: 0-5 years of experience) and higher skill level (OR = 2.05, 95%
CI = [1.12, 3.75], p = .020) were associated with receiving training over the course of PHI career, females were less likely to receive training, OR = 0.28, 95% CI = [0.10, 0.81], p = .019.
The effect size of years of experience and being female could be considered as large (OR =
4.78 and 0.28 respectively). The effect size of skill level could be considered as medium. In contrast to bivariate analysis from the t-test above, knowledge was not significantly associated with receiving training (OR = 0.90, 95% CI = [0.47, 1.73], p = .762), but this is likely due to the strong correlation between skill and knowledge (r = 0.79). The gender variable was not statistically significant for the probability for PHIs to receive professional training over the last
12 months (Table 5.3.14). At the same time, it was highly significant for the probability for
PHIs to receive professional training over the duration of their careers (with females having significantly lower probability of receiving further professional training – Table 5.3.15). It can be argued that this major difference might be caused by the significant changes in the Saudi
Arabian social structure and approaches to women. The recent attempts to incorporate women activities more widely in the social and economic structures may result in greater accessibility of further professional training for female PHIs, thus causing the observed lack of gender significance within the last 12 months (Table 5.3.14). On the other hand, the more stringent restrictions of the past on females still cause a backlog in the historical lack of training
Page | 142 availability. As a result, the outcomes of the professional training likelihood over the duration of PHI careers illustrate the significant gender differences (Table 5.3.15).
Once the lack of availability and efficiency of professional training has been identified
(Tables 5.3.8, 5.3.10 to 5.3.15), another important question that should be raised is about the specific barriers for PHIs to receiving professional training and development (Table 5.3.16).
The majority (52.2%) of the surveyed PHIs suggested that there were barriers preventing them from attending professional training (Table 5.3.16). The largest specific barrier identified by the participating PHIs was the lack of availability of training (34.6% - Table 5.3.17), which further corroborates the current critical lack of availability of the relevant professional training for PHIs in Riyadh.
Table 5.3.16 Presence of barriers that prevent professional training attendance
Answer N %
Yes 39 13.0
Sometimes 118 39.2
No 144 47.8
**N: Cell count. (N = 301 response rate 60%).
Table 5.3.17 Identification of potential barriers that prevent attendance of professional training (when answering yes or sometimes
Potential barriers N %
Not available 104 34.6
Not relevant to what I need 55 18.3
No incentive 43 14.3 **N: Cell count.
Page | 143
Also, regarding training, the participants were asked to select all topics that they would like further training in. The most common topic among the participants was risk-based
(modern) food safety inspection techniques with 85% (n=256) stating they would like training in this area. In addition, all other 10 proposed areas of training listed in the survey also attracted significantly more than 50% response rates (Table 5.3.18). In general, Chi-square analysis shows that there was no significant variation in these percentage across gender, years of experience, qualification and workplace (municipality). This demonstrates widespread perceptions among PHIs in Riyadh that comprehensive professional development and training programs are needed across a wide spectrum of areas and issues embracing all major aspects associated with food safety and health inspections at food providing shops and restaurants
(Table 5.3.18). The particular emphasis was on risk-based inspection techniques, English as language of communication, and investigation skills in food inspections (Table 5.3.18).
Table 5.3.18 Topics that the participants identified a desire for further training
Topics Frequency N (%)
Risk-based (modern) food safety inspection techniques 256 (85%)
Use of inspection devices contained in the Health Inspectors bag 200 (66.4%)
Understanding and application of Hazard Analysis and Critical Control 190 (63.1%) Point (HACCP) system
Causes of foodborne outbreaks and illnesses and how to prevent future 204 (67.8%) outbreaks
Emerging food safety issues 204 (67.8%)
Foods from different cultures 175 (58.1%)
Emerging foodborne pathogens 199 (66.1%)
Understanding best practices regarding sanitation and hygiene 182 (60.5%)
Sampling tools and techniques 169 (56.1%)
Page | 144
English language (e.g., oral, written) 220 (73.1%)
Investigation skills in food safety inspection 218 (72.4%)
**N: Cell count.
The PHIs were also asked to select two of what they believed would be the most effective strategies for receiving information regarding food safety. The majority of participants at 72.4% (n=218) believed that using WhatsApp Messenger would be the most effective way (Table 5.3.19), and only 15.6% (n=47) believed that using a website would be the best approach. These results are revealing as they demonstrate a significant inclination towards communicative hands-on tools, rather than less flexible and less personal information provision through fixed websites. This is seen as the modern development in the communication tools and techniques favouring person-to-person communications and information exchange.
Table 5.3.19 The most effective strategy for disseminating food safety information to PHIs
Strategy N %
E-mail newsletter 88 29.2
Website 47 15.6
Social media (e.g., twitter, Facebook) 55 18.3
WhatsApp messenger 218 72.4
Workshop/ Seminar 194 64.5 **N: Cell count.
At the same time, the rather traditional way of disseminating new information by way of workshops and seminars also attracted a very significant (the second largest) response rate of around 64.5% (Table 5.3.19). In general, Chi-square analysis showed that there was no
Page | 145 significant variation in endorsing each of these dissemination channels across gender, years of experience, qualification and municipality after adjusting for multiple comparisons.
Additionally, in another survey question about the usefulness of various resources of training and professional development for the role as a health inspector (Table 5.3.20), the
overwhelming majority of the study participants stated that regular meetings with inspectors
from other agencies were the most useful resource (93%; n = 280), with the second most useful
resource being seminars/workshops (92.7%; n = 279) (Table 5.3.20).
Table 5.3.20 Usefulness of various resources for training and professional development
Resources Very Useful N Neutral Useless Very No useful N (%) N (%) N (%) useless opinion (%) N (%) N (%)
Formal education 109 122 43 16 3 (1%) 8 (2.7%) (36.2%) (40.5%) (14.3%) (5.3%)
Seminars/workshops 178 101 12 (4%) 6 (2%) 1 (0.3%) 3 (1%) (59.1%) (33.6%)
E-mail newsletter 75 97 72 36 (12%) 13 8 (2.7%) (24.9%) (32.2%) (23.9%) (4.3%)
Web-based database for 120 109 53 7 (2.3%) 5 (1.7%) 7 (2.3%) food safety information and (39.9%) (36.2%) (17.6%) resources
Regular meetings with 203 77 9 (3%) 7 (2.3%) 2 (0.7%) 3 (1%) inspectors from other (67.4%) (25.6%) inspection agencies (i.e., SFDA, MoC) **N: Cell count.
5.3.5. Challenges and Obstacles
Challenges and obstacles represent specific barriers for the improvement of food safety and achieving more effective inspections to enforce food safety in Riyadh and broader Saudi
Arabia. Understanding, characterising, and properly addressing/overcoming these barriers is an essential goal in the development of food safety. This section presents the results regarding
Page | 146 the currently existing challenges and obstacles for PHIs and food safety in Riyadh, Saudi
Arabia.
One of the significant identified obstacles appeared to be the communication with food handlers who speak a different language. About 75.6% (n=228) of the study participants agreed or strongly agreed that it is difficult to communicate food safety information in situations where there is no common language between the food handler and the inspector (Table 5.3.21). Lack of such communication is a major drawback for the improvement and enforcement of food safety.
Table 5.3.21 Communication and clarity of food safety (Level of agreement on a six-point Likert scale)
Statements Strongly Agree N Not sure Disagree Strongly No agree N (%) N (%) N (%) disagree N opinion N (%) (%) (%)
Whenever I meet food handlers who speak a
different language from my own, I find it difficult 133 95 38 31 3 (0.9%) 1 (0.3%) to communicate food (44.1%) (31.5%) (12.6%) (10.2%) safety information to them
All Food safety laws and 83 93 62 38 20 (6.6%) 5 (1.6%) regulations are clear to me (30.8%) (20.5%) (12.6%) (27.5%) **N: Cell count. (N = 301 response rate 60%).
Another major identified barrier is the lack of clarity of the food safety laws and regulations, with almost a half of the study participants (41.3%) indicating that they were either
‘not sure’ about the clarity of the laws and regulations, or that these laws and regulations were
‘not clear’ to them (Table 5.3.21). Comparing this finding with the previously discussed level of understanding of the laws and regulations by the study participants, it can be concluded that, although more than 70% of PHIs are confident in their understanding of the food safety laws and regulations (see Table 5.3.4), only 58.3% of PHIs considered these laws and regulations sufficiently clear (see Table 5.3.21).
Page | 147
For further insight into these outcomes, the variable of whether or not the existing food safety laws and regulations are sufficiently clear (question 12.B, Appendix L) was categorised so that the responses ‘Strongly agree’ and ‘Agree’ (with the clarity of the laws and regulations) were considered as the base category ‘Clear’, and all other responses were considered as category 1 ‘Not clear’ (the categorical Clarity variable). This categorization was undertaken in accordance with the notion that the laws and regulations are not sufficiently clear to those who hesitated to respond ‘Strongly agree’ or ‘Agree’ to this question. The F2-test was then used to determine whether the categories ‘Clear’ and ‘Not clear’ were related to the responses to the question about the perceived knowledge of food safety laws and regulations (question 1.A,
Appendix L). Fig. 5.4 shows the outcomes of this test analysis, demonstrating visual correlations between the confidence in the knowledge of food safety laws and regulations and the perceived clarity of these laws. Put differently, PHIs with greater perceived knowledge in food safety laws and regulations are more likely to also perceive that the laws and regulations are clear (see Fig. 5.4; p < 0.001 from the F2-test). This is expected, as perceived knowledge of some aspects should be positively associated with the perceived clarity of those aspects.
To further confirm that the perceived clarity of the existing food safety laws and regulations is related to the perceived knowledge of these laws and regulations, and to provide better quantitative comparisons, multiple logistic regression, with the Clarity variable being considered as the dependent variable, was then used to determine any significant effects from the different response groups of PHIs. As a result, it was demonstrated that the perception of clarity of the existing food safety laws and regulations is significantly affected only by different answers to the question about the perceived knowledge of food safety laws and regulations
(question 1.A, Appendix L). The greater the confidence of PHIs in the perceived knowledge of food safety laws and regulations, the greater is their perception in the clarity of these laws and regulations (p d 0.075), which is fully consistent with Fig. 5.4. At the same time, inclusion of
Page | 148 any other demographic variables (such as gender, education, age, and years of experience) into the considered logistic regression did not result in any additional significant effects on the perception of clarity of the existing food safety laws and regulations is (p > 0.14). It could thus be concluded that the perception of clarity of the food safety laws and regulations is significantly dependent only upon PHIs’ level of confidence in the food safety laws and regulations.
Figure 5.4 Percentage distributions of PHI participants over the two categories of the Clarity variable ‘Clear’ and ‘Not clear’
Note: Derived from question 12.B, Appendix L) for the five different responses to the question about the perceived knowledge of food safety laws and regulations (question 1.A, Appendix L).
On the other hand, if the effects on the perception of clarity of the food safety laws and regulations are considered only from the demographic variables (and the question about the perceived knowledge of food safety laws and regulations (question 1.A, Appendix L) is not included), then the outcomes of the multiple logistic regression model are shown in Table
5.3.22. This model and Table 5.3.22 demonstrate the differences in the estimated odds ratios
Page | 149 for the perception that the laws and regulations are not clear between the different PHI groups
(Table 5.3. 22), and these groups are likely to have different perceived levels of confidence in the food safety laws and regulations (compare with the discussion in the previous paragraph).
In this case, the responses ‘Agree’ or ‘Strongly agree’ in question 12.B, (Appendix L) constituted the base category of the dependent variable evaluating whether the existing food safety laws and regulations were perceived by PHIs to be clear.
Table 5.3.22 PHI perception that the existing food safety laws and regulations are not clear, multiple logistic regression for the odds ratios (OR) Predictor Variable OR 95% CI p-value
Gender (base: Female) 0.42 (0.21, 0.86) 0.017
Experience (base: 0-5 years 1.97 (1.03, 3.79) 0.041
t 11 years years) 6-10 years 1.67 (0.92, 3.03) 0.089
Intercept 0.97 (0.44, 2.18) 0.95
Note: Responses ‘Undecided’, ‘Disagree’, ‘Strongly disagree’, or ‘No opinion’ in question 12.B, Appendix L). The table shows only independent demographic variable with significant (p d 0.1) effects on perception of clarity of the existing laws and regulation. The other demographic variables (including education level and municipality) were not significant. OR: Odds ratio; CI: Confidence interval; N: Cell count.
To provide a deeper insight into the relationships predicted by the developed model
(Table 5.3.22), Fig. 5.5 presents the graphical dependences of the predicted likelihood of the perception that the existing food safety laws and regulations are clear (responses ‘Agree’ or
‘Strongly agree’ in question 12.B, Appendix L).
Page | 150
Figure 5.5 The predicted dependences of the likelihood that PHIs would perceive the existing food safety laws and regulations as not clear
Note: The responses ‘Undecided’, ‘Disagree’, ‘Strongly disagree’, or ‘No opinion’ in question 12.B, Appendix L) for the different indicated categories of their gender and work experience. The error bars represent the 95% confidence intervals for the respective points.
In particular, it can be seen that the perception of the existing laws and regulations as
‘not clear’ decreases with increasing work experience for both males and females. This is to be expected, as longer work experience may enable PHIs to better familiarize themselves with the laws and regulations, as well as with their meaning and application to the practice of food safety inspections. Interestingly, female PHIs are significantly more likely to perceive the existing laws and regulations as ‘not clear’ (Table 5.3.22 and Fig. 5.5). This could be related to the overall lower level of perceived knowledge of female PHIs compared to their male counterparts
(see below) and lower probability to receive professional training over the duration of their
PHI careers (Table 5.3.15 and Fig. 5.5).
Challenges with evaluation and enforcement of safety regarding foods from different cultures were acknowledged by the majority of the surveyed PHIs. For example, around 73.1%
Page | 151
(n=220) of PHIs regularly or at least occasionally encountered foods from different cultures, and about 31.9% (n = 96) of PHIs stated that they did not know what to do when encountering such foods (Tables 5.3.23 and 5.3.24). This is a significant gap in the practical knowledge and skills of PHIs in Riyadh. Further Chi-square analyses showed that male PHIs reported significantly higher frequency of encountering food from other cultures and more likely to report knowing how to inspect food from other cultures. There was no significant difference across years of experience, qualification and municipality.
Table 5.3.23 The frequency of encountering food from other cultures during inspection
Answer N %
Regularly 28 9.3
Occasionally 192 63.8
Rarely 61 20.3
Never 20 6.6
Total 301 100 N: Cell count.
Table 5.3.24 When food from other cultures is encounter, possession of knowledge to inspect
Answer N %
Yes 65 21.6
Sometimes 132 43.9
No 96 31.9
Not applicable 8 2.7
Total 301 100 N: Cell count.
The level of satisfaction of PHIs at their workplace is an important aspect for their efficiency and motivation. Lack of PHI satisfaction could be regarded as a significant barrier
Page | 152 for the improvement of food safety. As can be seen from Table 5.3.25, for most of the considered job-related issues the majority of the surveyed PHIs remain neutral. However, regarding such issues as transportation services, motivation at workplace, and support and security, the majority of the surveyed PHIs expressed dissatisfaction (Table 5.3.25). The only area in which the majority of participants were satisfied or very satisfied was the diploma curriculum for training health inspectors.
Table 5.3.25 Satisfaction level, job-related issues
Topic Very Satisfied N Neither N Dissatisfied Very satisfied N (%) (%) N (%) dissatisfied (%) N (%)
Food safety laws and 18 (6%) 121 84 (27.9%) 59 (19.6%) 19 (6.3%) regulations (40.2%)
Equipment in Health 14 (4.7%) 71 (23.6%) 79 (26.2%) 75 (24.9%) 62 (20.6%) Inspector’s bag
Field work system 28 (9.3%) 72 (23.9%) 84 (27.9%) 63 (20.9%) 54 (17.9%) (Raqeb)
The criteria of annual 26 (8.6%) 55 (18.3%) 92 (30.6%) 70 (23.3%) 58 (19.3%) performance report
Transportation service 32 (10.6%) 61 (20.3%) 37 (12.3%) 58 (19.3%) 113 (37.5%) provided by my department
Motivation at my 16 (5.3%) 38 (12.6%) 40 (13.3%) 87 (28.9%) 120 (39.9%) workplace
Support and security 22 (7.3%) 46 (15.3%) 44 (14.6%) 74 (24.6%) 115 (38.2%) provided by the management
The diploma 44 (14.6%) 127 61 (20.3%) 40 (13.3%) 29 (9.6%) curriculum for training (42.2%) health inspectors N: Cell count.
Satisfaction of each of these domains was analysed by gender, qualification, years of experience and municipality. Since each domain was coded from 1 ‘Very dissatisfied’ to 5
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‘Very satisfied’, t-test and ANOVA were used. There was no significant variation by gender, qualification and municipality in all domains after adjusting for multiple comparison. For some of the domains, inspectors with less experience reported higher satisfaction.
Finally, the participants were asked about the areas of their job they wanted to improve or found difficult (Table 5.3.26). Dealing with food handlers and business owners was the priority area that was most difficult, according to the majority of the participants (67.4%; n=203). Food safety laws and regulations came up as the area with the second largest response rate of 54.2%, which is consistent with the previous findings about the lack of clarity of, and satisfaction with, the food safety laws and regulations (Tables 5.3.22 and 5.3.25).
Table 5.3.26 Areas of PHI’s they find difficult or want to improve
Areas N %
Food safety law regulations 163 54.2
Food safety assessments 150 49.8
Dealing with food handler and business owner 203 67.4 N: Cell count. (N = 301 response rate 60%).
5.3.6. Education and Qualification
As can also be seen from Table 5.3.25, the majority of the surveyed PHIs were satisfied with the diploma curriculum for training health inspectors (question 7.C, in Appendix L). This is consistent with the previous findings presented in Tables 5.3.12 and 5.3.20. For example,
Table 5.3.12 shows that around 81.1% of the surveyed PHIs indicated that their qualification program prepared them well for the job, and Table 5.3.20 further suggests that around 76.7% of the surveyed PHIs agreed that their formal education was a useful resource for their training and professional development. To gain further insights into PHI groups perceiving that their qualification program prepared them well (or otherwise) for the job, this variable (question 7.C, in Appendix L) was categorised so that the responses ‘Strongly agree’ and ‘Agree’ constituted
Page | 154 the base (reference) category, and other responses (including ‘Not sure’, ‘Disagree’ and
‘Strongly disagree’) constituted category 1. Multiple logistic regression model was developed for this dependent variable and the following independent variables: age, gender, level of education, years of experience, municipality, difficulties with different languages (question
12.A, Appendix L). However, the analysis identified no significant independent variables (p >
0.1).
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5.4. Further Association Between the Variables
5.4.1. Correlation Between Skill and Knowledge in Nine Areas
This section considers correlations between the knowledge and skills variables in order to characterize the relationships between them and establish how perceived knowledge of specific items relevant to food safety and food safety inspections translates into the respective perceived skills of PHIs. Table 5.4.1 shows the correlation between nine individual knowledge items (question 1 of the survey instrument – Appendix L) and the respective nine individual skills items (question 2 – Appendix L). All the correlations were statistically significant (with p < 0.001). At the same time, the respective correlation coefficients appeared rather moderate
– between 0.48 and 0.63 (Table 5.4.1). This means that the percentage of the shared variance for the respective pairs of knowledge items and skills varied between 23% and 40%, respectively. This demonstrates that the knowledge items and the respective skills perceivably possessed by the study participants are rather moderately related to each other. In other words, only about R2 | 23% - 40% of variance of a perceived skill variable can be described by the perception of the corresponding knowledge by the PHIs participating in the study. The remaining 60% - 77% of the skills variance depends upon other parameters and factors. This might be explained by the potential lack of solid links between the background knowledge gained by the study participants during their formal education and training and the realities of the food safety inspection in the field, requiring somewhat different practical skills.
Table 5.18.1 Table 5.18.2 Table 5.18.3 Table 5.4.1 Correlation between individual knowledge variables and the corresponding skill variables
Knowledge variables Correlation (r) with the p-value corresponding skill variables
Food safety laws and regulations 0.48 < 0.001
Hazard analysis and critical control point guideline 0.63 < 0.001
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Inspection techniques 0.56 <0. 001
Food sampling techniques 0.58 < 0.001
Communication about inspection results 0.60 < 0.001
Sanitation and hygiene 0.59 <0 .001
Food microbiology 0.50 < 0.001
Pest control 0.52 < 0.001
Scientific research 0.54 < 0.001
As previously discussed (see Section 5.3.4), reliability analyses were performed for the nine knowledge items and twelve skill items. The obtained Cronbach’s alphas (0.875 for the skill and 0.915 for the knowledge items) indicated high level of reliability and internal consistency of the skills and knowledge scales. This enabled introduction of the two latent variables characterizing the general skills and knowledge of PHIs by way of averaging over the 9 knowledge items (the latent knowledge variable— question 1 in Appendix L) and 12 skills items (the latent skills variable—question 2 in Appendix L). An interesting question arising from here is whether the general skills and knowledge of PHIs, characterized by the respective latent variables correlate with each other in the same or similar way as the individual knowledge and skills items. It has been found that the latent knowledge and skills variables correlate better than any of the individual items. The corresponding correlation coefficient is
0.79 (p < 0.001), which means that up to ~ 62% of the variance of the averaged skills can be explained by the averaged knowledge items. This significant improvement in the R2 coefficient
(compared to any pair of the corresponding individual knowledge and skill) means that the overall relationship between perceived skills and perceived knowledge of PHIs is significantly stronger than for any of the individual knowledge items and skills.
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5.4.2. Association Between Gender, Education, Years of Experience and Municipality and Skills and Knowledge
Table 5.4.2 shows the descriptive statistics for the latent skill and knowledge variables for the groups of participants with different gender, education level, years of experience, and municipality. ANOVA was used to compare between different demographic groups of PHIs regarding their perceptions of skills/knowledge in food safety inspections. In particular, the results indicated that females reported significantly lower mean levels of knowledge (p =
0.002) and skill (p = 0.021) than males. Interestingly, the latent variables of knowledge and skills were not significantly associated with other demographic variables, except for years of experience, in which case there is a significant (under 10%) difference between the levels of perceived knowledge in the three groups of PHIs with the typical work experience duration of
0-5 years, 6-10 years, and t 11 years (with p = 0.094 – Table 5.4.2).
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Table 5.4.2 Mean and standard deviation of knowledge and skill by gender, education level, years of experience and municipality
Knowledge Skill
Variables M SD p-valuea M SD p-valuea
Gender
Male 3.71 0.74 0.002 3.53 0.80 0.021
Female 3.32 0.64 3.22 0.70
Qualification
Secondary/Technical college 3.51 0.79 0.437 3.69 0.72 0.418 diploma
Bachelor degree or above 3.39 0.81 3.55 0.79
Other 3.59 0.77 3.66 0.77
Years of experience
0-5 years 3.67 0.77 0.094 3.52 0.82 0.150
6-10 years 3.58 0.71 3.39 0.78
11+ years 3.80 0.70 3.61 0.80
Municipality
General department of environment 3.71 0.74 0.685 3.46 0.81 0.894 health
Other 3.61 0.73 3.49 0.81
Preferred not to answer 3.65 0.75 3.51 0.78 aThe p-value was calculated based on comparison across different level of each of the variables using ANOVA. M: Mean; SD: standard deviation.
Table 5.4.3 shows the results of multiple regression analyses, with knowledge and skill
regressed on gender, education level, years of experience, and municipality. The set of
variables explained 4.6% and 3.2% of variance in knowledge and skill, respectively. Like the
results from ANOVA, only gender was significantly associated with knowledge, b = 0.41, SE
= 0.16, p = 0.011. There was a trend that gender was associated with skill (p = .073) (Table
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5.4.3). As a result, females reported significantly lower levels of knowledge compared to males. The effect was moderately small, partial η2 = 0.029. All other variables were statistically non-significant. For more discussion of this see the Discussion Chapter below.
Table 5.4.3 Regression analyses predicting knowledge and skill
Knowledge Skill
Years of Experience (Ref: 0-5 years) b 95% CI p-value b 95% CI p-value
6-10 years -0.08 (-0.28, 0.12) 0.440 -0.11 (-0.34, 0.11) 0.332
11-20 years 0.09 (-0.13, 0.32) 0.411 0.06 (-0.19, 0.32) 0.615
Qualification (Ref: Secondary diploma (Health Inspector)
Other 0.12 (-0.23, 0.47) 0.489 0.20 (-0.19, 0.59) 0.324
Bachelor or above 0.06 (-0.19, 0.31) 0.637 0.02 (-0.26, 0.3) 0.889
Gender (Ref: Male)
(-0.72, - Female -0.41 0.09) 0.011 -0.32 (-0.67, 0.03) 0.073
Municipality (Ref: GDEH)
Other -0.05 (-0.26, 0.17) 0.661 -0.02 (-0.26, 0.22) 0.893
Prefer not to say -0.03 (-0.24, 0.18) 0.767 0.02 (-0.21, 0.26) 0.838 **b: Regression coefficient; CI: Confidence interval.
To evaluate the sensitivity of the previous regression analysis, knowledge and skill latent variables were categorised into two categories with the scores < 4 and t 4. This category selection ensured reasonably similar numbers of participants in each category. In addition, scores 4 and 5 on the original (reversed) Likert scale corresponded to ‘Very confident’ and
‘Confident’ with regard to the respective knowledge and skills items (questions 1 and 2 in
Appendix L). As a result, the selected categories reflected whether PHIs perceive confidence in their general professional knowledge and skills Table 5.4.4 shows the results of logistic regression with the same variables as in Table 5.4.3. Possible interactions between the
Page | 160 considered independent variables were investigated, but all appeared to be statistically insignificant. As can be seen, the conducted logistic regression analysis (Table 5.4.4) leads to similar conclusions as for the multiple linear regression model (Table 5.4.3) with the only difference being that gender is a significant predictor of both knowledge and skill (Table 5.4.4).
That is, female inspectors were more likely to have lower levels of knowledge (OR = 0.18,
95% CI (0.05, 0.61), p = 0.006) and skill (OR = 0.11, 95% CI (0.02, 0.54), p = 0.006).
Table 5.4.4 Logistic regression analysis predicting knowledge and skill
Knowledge Skills
Years of Experience OR 95% CI p- OR 95% CI p-value (Ref: 0-5 years) value
6-10 years 0.65 (0.34, 1.24) 0.190 0.79 (0.38, 1.61) 0.507
11-20 years 1.07 (0.54, 2.12) 0.853 1.30 (0.62, 2.72) 0.480
Qualification (Ref: Secondary diploma (Health Inspector)
Other 1.40 (0.47, 4.21) 0.545 1.64 (0.52, 5.2) 0.397
Bachelor or above 1.58 (0.74, 3.39) 0.235 1.76 (0.82, 3.82) 0.149
Gender (Ref: Male)
Female 0.18 (0.05, 0.61) 0.006 0.11 (0.02, 0.54) 0.006
Municipality (Ref: GDEH)
Other 0.74 (0.37, 1.46) 0.380 0.86 (0.41, 1.79) 0.685
Prefer not to say 0.80 (0.41, 1.54) 0.504 1.06 (0.52, 2.14) 0.874 Note: General Department of Environment Health (GDEH); OR: Odds ratio; CI: Confidence interval; N: Cell count.
5.4.3. Association Between Motivation and Gender, Education, Years of Experience and Municipality
Motivation of PHIs at their workplace is one of the major factors for the successful improvement of food safety and enforcement of safe practices in the food retail industry in
Riyadh. Table 5.4.5 shows the comparative statistics for PHI motivation for groups of
Page | 161 participants differing by their gender, education level, years of experience, and municipality.
ANOVA was again used to examine the bivariate associations between mean motivation levels in the considered groups. Results from these analyses indicated that motivation was not associated with gender (p = 0.456) or education level (p = 0.134), but it was significantly (under
10%) associated with municipality (p = 0.093 – Table 5.4.5). Motivation was also significantly associated with years of experience, p < 0.001. Participants with 6-10 years of experience (M
= 1.87, SD = 1.10) and 11+ years of experience (M = 1.93, SD = 1.09) reported significantly lower level of motivation than those with 0-5 years of experience (M = 2.70, SE = 1.30) (with p < 0.001 – Table 5.4.5).
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Table 5.4.5 Mean and standard deviation of motivation by gender, education, years of experience and municipality
Motivation
Variables M SD p-valuea
Gender
Male 2.12 1.24 0.456
Female 2.28 1.13
Qualification
Secondary/Technical college diploma 2.14 1.27 0.998
Bachelor or above 2.14 1.13
Other 2.14 1.15
Years of experience
0-5 years 2.70 1.30 < 0.001
6-10 years 1.87 1.10
11+ years 1.93 1.09
Municipality
Non-GDEH 2.18 1.10 0.093
GDEH 1.90 1.08
Preferred not to answer 2.28 1.22 aThe p-value was calculated based on comparison across different level of each of the variables using ANOVA. M: Mean; SD: standard deviation.
Table 5.4.6 shows the results for the relationship between motivation (dependent variable) and gender, education level, years of experience, and municipality. Pair-wise interactions between the independent variables were checked and none were statistically significant (all p > 0.1). The model explained 10.4% of variance in motivation and showed that participants with 6-10 years (b = -0.81, 95%CI = [-1.14, -0.49], p < .001) and 11+ years of
Page | 163 experience (b = -0.72, 95% CI = [-1.09, -0.36], p < .001) reported lower levels of motivation compared to those with 0-5 years of experience. This is an interesting outcome demonstrating the notable increase of the level of dissatisfaction among PHIs with their growing work experience in Riyadh. This represents a moderately large effect size (Cohen’s D = 0.66 and
0.59 for those with 6-10 years and 11-20 years of experience respectively).
Table 5.4.6 Regression analysis predicting motivation
Years of Experience (Ref: 0-5 years) b 95% CI p-value
6-10 years -0.81 (-1.14, -0.49) 0.000
11-20 years -0.72 (-1.09, -0.36) 0.000
Qualification (Ref: Secondary diploma (Health Inspector)
Other -0.13 (-0.7, 0.44) 0.650
Bachelor or above -0.21 (-0.62, 0.19) 0.301
Gender (Ref: Male)
Female 0.35 (-0.16, 0.85) 0.176
Municipality (Ref: GDEH)
Other 0.20 (-0.15, 0.55) 0.263
Prefer not to say 0.29 (-0.05, 0.63) 0.091 **b: Regression coefficient; CI: Confidence interval.
Since motivation was measured on the Likert (numerical) scale, the above analysis was also repeated with the categorised motivation variable (motivated versus not motivated), in order to assess the sensitivity of the results to the categorization used. Motivation was categorised into two categories with the motivation scores < 4 (the base category) and t 4
(category 1). This category selection also ensured a reasonably similar number of participants in each category. In addition, scores 4 and 5 on the original Likert scale for Motivation
(question 15 in Appendix L) corresponded to ‘Very satisfied’ and ‘satisfied’ with motivation at workplace. The multiple logistic regression was then used to determine the odds ratios for
Page | 164
PHIs to fall within one of the considered motivation categories. The outcomes of the logistic regression model are shown in Table 5.4.7. These outcomes are consistent with those from the multiple regression analysis (Table 5.4.6). In particular, compared to PHIs with 0-5 years of experience, participants with 6-10 years and 11+ years of experience were significantly more likely to report much lower levels of motivation, after adjusting for other variables in the model:
OR = 0.24, 95% CI (0.07, 0.84), p = 0.0025 and OR = 0.17, 95% CI = [0.03, 0.84], p = 0.030.
All other variables were statistically non-significant (Table 5.4.7).
Table 5.4.7 Logistic regression predicting motivation
Years of Experience (Ref: 0-5 years) OR 95% CI p-value
6-10 years 0.24 (0.07, 0.84) 0.025
11-20 years 0.17 (0.03, 0.84) 0.030
Qualification (Ref: Secondary diploma (Health Inspector)
Other 0.71 (0.08, 6.68) 0.764
Bachelor or above 0.42 (0.07, 2.7) 0.361
Gender (Ref: Male)
Female 0.71 (0.06, 8.93) 0.792
Municipality (Ref: GDEH)
Other 2.01 (0.35, 11.65) 0.438
Prefer not to say 3.00 (0.6, 14.87) 0.179 **OR: Odds ratio; CI: Confidence interval.
5.4.5. Association Between Gender and Municipality and Association Between Subjective Feeling About Preparedness for Inspector Job and Education Level
Table 5.4.8 shows the association between municipality and gender. χ2 analysis shows that municipality was not significantly associated with gender, χ2(1) = 2.02, p = 0.155. Table
5.4.9 shows the descriptive statistics of the item ‘My qualification program prepared me well for a real life health inspector job’ by education level .ANOVA shows that there was a significant difference in the item ‘My qualification program prepared me well for a real life
Page | 165 health inspector job’ across education level, F(2, 296) = 0.3.30, p = 0.038. However, post-hoc comparison indicated that none of the pairwise comparisons were statistically significant.
Table 5.4.8 Association between gender and municipality
Male Female
Municipality N % N % p-value
GDEH 73 91.25% 7 8.75% 0.341
Non-GDEH 85 85.86% 14 14.13%
Preferred not to 101 84.17% 19 15.83% answer **N: Cell count.
Table 5.4.9 Mean and standard deviation of the item ‘My qualification program prepared me well for a real-life health inspector job’ by education level
M SD p-value
Other 3.85 0.81 0.038
Secondary/ Technical college diploma 4.02 0.97
Bachelor/ postgraduate 3.65 1.35 **M: Mean; SD: Standard deviation.
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5.5. DISCUSSION
5.5.1. Introduction
This section discusses in further detail the results of the PHIs online survey (Phase 2
Figure 3.4). Results are discussed first on the demographics of participants (Section 5.5.2). And secondly on the results of the PHIs' general perception about their knowledge and skills in section (5.5.3). Followed by discussion of the survey outcomes associated with training and professional development (Section 5.5.4). Section (5.5.5) discusses the findings in relation to
PHIs job challenges and obstacles. In section (5.5.6) there is some discussion about the PHIs education and qualification followed by a conclusion (5.5.7).
5.5.2. Demographics
The demographics of the respondents presented in Table 5.3.1 indicate that most of the
PHIs (86%) are males. The observed gender disparity is consistent with the employment demographics in the country (Al-Bakr et al., 2017; Al-Asfour et al., 2017; Syed et al., 2018).
The high number of males is a result that, in Saudi Arabia, the Diploma of food safety degree
—the qualification requirement for PHI— is only available to males (Conditions for admission to the diploma program, 2019). Therefore, female participants in this study (13.3%) are more likely to have a different educational background (e.g., nursing or nutrition), and they were responsible for inspecting only women’s businesses due to cultural reasons (Alsaleh, 2015). In a similar study conducted in another region in Saudi Arabia, female PHIs constituted only 3.6% of the overall study cohort (Alsaleh, 2015). This further confirms the significant gender disparity with regard to the PHI profession and these two study cohorts.
Another important characteristic of the study participants was the large representation by young people. Around 88.7% of the study participants were between 18 and 39 years of age
(see Table 5.3.1), which closely resembles the national age demographics where 69.2 % of the entire population is aged 39 years and below (General Authority of Statistics, 2018). This
Page | 167 proportion of young PHIs is significantly higher than in Western developed countries. For example, the proportion of young (below 35 years) PHIs in the study by Johnson, et al (2014) conducted in the state of Indiana, USA, was only 21.3% and in another study in the state of
Ontario, Canada, (below 39 years) was under 50% (Pham, et al, 2010). The observed young age of the participants in the current study provides some explanation as to why the majority of the assessed PHIs (53%) had between three and ten years of experience.
The qualification requirements for the PHI profession in Saudi Arabia underwent significant changes in recent decades. Prior to 2005, the educational prerequisite to become a
PHI was a Secondary diploma (Health Inspection), which was obtained after three years of studies in health inspections, and it was equivalent to the level of a high school diploma. After
2005, the required level of qualification for a PHI became a 2-year undergraduate diploma
(Technical College Diploma) including a 3-month field-training course (Conditions for admission to the diploma program, 2019). It can be argued that Saudi Arabia has raised the required level of qualifications for the PHI profession to match other developing and developed countries. These recent changes are probably the main reason that only 28.6% of the study participants have a Technical College Diploma (undergraduate diploma) or higher (Table
5.3.2). The study participants were enrolled from the existing pool of PHIs in Riyadh, Saudi
Arabia, which includes a number of PHIs who qualified for this job prior to raising the qualification prerequisites in 2005. This has resulted in a significantly higher proportion of lower qualified PHIs compared to, for example, more than 75% of all PHIs in the state of
Indiana, USA, having a Bachelor degree or higher (Johnson, et al, 2014), and around 86% of
PHIs at import entry ports in Mexico having a college degree (Maldonado-Simán, et al., 2019).
Also, in some developed countries such as Canada and Australia, the minimum qualification requirement to be a PHI is a Bachelor’s degree (enHealth, 2009; Butler-Jones, 2008; Raphael
& Briant, 2006; Seed et al., 2013).
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Out of all study participants who chose to disclose their place of work, approximately equal numbers (26.6% and 32.9%) were working in the General Department of Environment
Health (GDEH) and other departments (municipalities) (see Table 5.3.3). Interestingly, around
40% of the participants did not disclose their place of work, which could be because of possible fear of being identified. Results must be therefore interpreted cautiously due to the risk of the presence of reporting bias.
5.5.3. Knowledge and Skills
General Comments About Knowledge and Skills
It is important to note here that, because of the relatively low levels of qualification of
PHIs in Riyadh (see the previous section), the responses of the surveyed PHIs could be biased.
This is because of the so-called Dunning-Kruger effect (Kruger & Dunning, 1999; Simons,
2013) and ‘unconscious incompetence’ (Flower, 1999), which tend to cause a cognitive and perceptual bias among less-skilled performers and people with lower levels of education and qualification towards overconfidence and overestimation of their abilities. Such people often simply do not understand their lack of abilities, knowledge and skills, and do not recognise this deficit (Kruger & Dunning, 1999; Flowers, 1999; Simons, 2013). It is also important to note that the Dunning-Kruger effect and unconscious incompetence are gender-neutral; therefore, they equally affect male and female. In addition, the Dunning-Kruger effect and unconscious incompetence could have an impact on the outcomes of any survey with the self-evaluating nature, if the perceptions of skills and knowledge are evaluated. While there are other methods to evaluate the participants knowledge and skills such as direct observation, it was not feasible due to the limited resources available to the researcher (Mills et al., 2009).
It has been found that, on the one hand, the surveyed PHIs had typically high levels of confidence in their risk-based knowledge and skills, whereas, on the other hand, the majority of them would like additional training in the same areas associated with their food inspection
Page | 169 activities (see section 5.5.4). One of the possible reasons for this inconsistency is that a general consensus was identified among the participants that there was a significant lack of training opportunities and if found, they did not target their real needs in food safety inspection (see section 5.5.4), and this recognised lack resulted in their high expression of the need for additional training in all listed areas.
Another potential reason for this inconsistency is that most of the surveyed PHIs might be at the levels of Remembering and Understanding in Bloom’s taxonomy knowledge pyramid
Figure 5.6 (Bloom, 1956). The PHI participants might not be fully confident with applying their knowledge in the practice of food safety inspections. Therefore, they might be ‘confident’ in their knowledge and skills in food safety inspections. However, they simultaneously feel deficiencies in their abilities to apply their knowledge to the practical situations emerging during food inspection, which is a possible reason for their perception of the need for further training, and expressing their willingness to attend such training. This interpretation, in addition to the Dunning-Kruger effect and unconscious incompetence, could be the cause for inconsistency between the finding of high levels of confidence of the surveyed PHIs in their knowledge and skills within specific areas in risk-based food safety inspection, and their expression of the need for further training in these knowledge and skills areas.
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Figure 5.6 The Bloom’s taxonomy knowledge pyramid representing the increasing depth of knowledge and skills resulting from a learning process (Armstrong, 2016)
Demographics and Knowledge and Skills
Group comparisons were conducted using the one-way ANOVA approach in order to evaluate any differences between the characteristic demographic groups within the cohort of
PHIs from Riyadh regarding to their average knowledge and skills (Table 5.4.2). The only statistically significant difference (with p < 0.05) was identified between male and female PHIs, with males displaying significantly higher levels of confidence in their knowledge and skills
(Table 5.4.2). This difference might be explained by the limitations on females who are not allowed to obtain Technical College (PHI qualification diploma) in food safety in Saudi Arabia.
As a result, female PHIs have different educational backgrounds in food safety, and this naturally resulted in lower levels of knowledge and skills of female PHIs compared to their male counterparts (Conditions for admission to the diploma program, 2019). This finding was further confirmed by the multiple regression analyses using linear regressions (Table 5.4.3) and logistic regressions with the categorized variables of average knowledge and skills (Table
5.4.4). Both types of regression models confirmed that the only significant (under 5%) variable
Page | 171 was gender of participants, and that males PHIs were significantly more confident in their knowledge and skills in food safety inspections, compared to their female counterparts.
The lack of significant effects of years of experience and the different levels of qualification on perceived knowledge and skills of PHIs (Tables 5.4.3 and 5.4.4) is likely to be caused by the overall low level of formal education among the Saudi PHIs, compared to other developed and developing countries (Hobbs et al., 2002; Crim et al., 2014; Butler-Jones, 2008;
Raphael & Briant, 2006; Seed et al., 2013; Maldonado-Simán, et al. , 2019). In addition, the lack of significant effects of municipality (workplace) on knowledge and skills variables
(Tables 5.4.3 and 5.4.4) is likely to be an illustration of the relative uniformity of the PHI workforce over different municipal regions and organisations.
Food Safety Laws and Regulations
In any country, food safety inspection must be conducted on the foundation of, and in accordance with, the legal and legislative framework of the existing laws and regulations (FAO,
2015). As argued by Cerit (2015), there is a need for the PHIs to hold a sound knowledge of the existing food laws and regulation since they form the basis upon which the inspection process is undertaken. FAO (2015) further noted that the absence of a good understanding of law and regulation among PHIs negatively affects their ability to carry out risk-based food inspection.
According to the results presented in Table 5.3.4, most of the PHIs in Riyadh are
‘confident’ (51 %) while 22.9 % are ‘very confident’ about their knowledge of food safety laws and regulation. Similarly, around 71.4% of the study participants are ‘very confident’ or
‘confident’ in their investigative skills in assessing compliance with food safety laws and regulations, as opposed to 8.3% who are ‘not confident’ or ‘not confident at all’. This shows the high level of knowledge and skills among Riyadh PHIs in performing their tasks specific
Page | 172 to food safety laws and regulations. At the same time, the significant numbers of participants who are ‘not sure’ about their knowledge in food safety laws and regulations and ‘not sure’ about assessment of compliance with these laws and regulations (20.6% and 18.6%, respectively—see Tables 5.3.4 and 5.3.5) also demonstrate the available opportunities for further improvement of knowledge and skills of PHIs in this important area. Cerit (2015) argued that, the awareness of safety laws among the PHIs determines effective the identification of the food safety issues and the prevention of foodborne illnesses (FBIs).
Because more than 70% of PHIs are confident in their knowledge of the food safety laws and regulations (Table 5.3.4), and only 58.3% of PHIs consider these laws and regulations sufficiently clear (Table 5.3.21), there is some contradiction between the claimed good level of knowledge of the laws and regulations by the study participants and the perceived lesser clarity of these laws and regulations. This conflict could be explained either by the exaggerated perceptions of the participants regarding their level of understanding of the laws and regulations (see above for the discussion of the Dunning-Kruger effect and its application to the obtained outcomes), or by the actual flaws in the existing laws and regulations. It is argued that the second explanation is more likely and particularly for this area of knowledge. This is due to the participants’ responses to another related survey item ‘What areas of your job do you find difficult or want to improve?’ (see Table 5.3.26) and where more than half (54.2%) of the PHIs participants responded that they wanted to improve food safety laws and regulations.
This further confirms that the food safety inspection laws and regulations in Riyadh, Saudi
Arabia need to be revised and clarified.
According to a similar study conducted in Canada, the lack of clarity in law and regulation has resulted in a lack of consistency, with different health departments and PHIs having different interpretations of the existing food safety laws and regulations (Pham, 2010).
As was discussed in the literature review (see Chapter 2), the need for food safety laws and
Page | 173 regulations and their detailed knowledge are paramount in empowering PHIs and their inspection activities (FAO, 2015). It is also recognised that revision of the current legislations and regulations in Riyadh is also important to ensure that they are consistent with the risk- based approach to food safety inspection (FAO, 2015).
Hazard Analysis and Critical Control Point (HACCP)
According to the FAO framework, the understanding of HACCP principles is fundamental to the implementation of risk-based food inspection (FAO 2015). Hutter and
Amodu (2009) argued that there is need for the PHIs to have adequate knowledge and skills in
HACCP for them to effectively identify and evaluate food safety hazards during restaurant inspection. Also, HACCP knowledge and skills areas were recognised in several university course accreditation guidelines for food safety inspectors in the developed countries that have risk-based inspection system in place (CIPHI, 2018; enHealth, 2009).
Given that 52.2% of the PHIs participants were ‘not sure’ or ‘not confident’ or ‘not confident at all’ in their HACCP knowledge (see Table 5.3.4) demonstrates that the majority of PHIs in Riyadh have insufficient knowledge of the HACCP guidelines. Essentially the same response rate was also observed with their skills in HACCP evaluation, with around 52.5% of all participants indicating that they are either ‘not sure’ or ‘not confident’ or ‘not confident at all’ (see Table 5.3.5). In terms of the difference between PHI groups, linear regression analysis for the dependent variable of PHI confidence in their knowledge of the HACCP guidelines
(question 1.B, Appendix L) showed that this variable significantly depends on gender (p <
0.001). Female PHIs have significantly lower confidence in their knowledge of HACCP (by
0.78, p < 0.001) on average on the Likert scale from 1 ‘Very confident’ to 5 ‘Not confident at all’. There is no significant dependence of this dependent variable on any other demographic variables including age (p > 0.28), qualification (p > 0.4), years of experience (p > 0.21), and municipality (p > 0.32).
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The lack of confidence among PHIs in their knowledge and skills in HACCP principles is a potential impediment to the implementation of a risk-based inspection. This is because a good understanding of its principles enables the PHIs to carry out a thorough and effective risk- based inspection to better prevent FBIs (FSIS, 2015). Also, developed countries such as the
US, Australia that implement risk-based inspections require the food safety inspectors to have a good understanding of HACCP (Crim et al., 2014; Loader & Hobbs, 1998; enHealth, 2009).
Further, 63.1% of all participants identified the need for further training in HACCP (Table
5.3.18), and there was no significant variation in this percentage across demographic variables.
This demonstrates the need for effective training of all PHI to raise their level of knowledge and skills in this area.
Inspection Techniques, Using Devices and Sampling
Inspection techniques and analytical toolkits for identification and evaluation of specific risks to food safety are another essential element of the risk-based inspection (FAO,
2008). These issues were addressed by five different questions in the survey, related to current knowledge in ‘Inspection techniques: observation, inspection, measuring, testing, questioning’, current skills in ‘Inspection techniques: observing, inspecting, measuring and testing’ and ‘Using of inspection devices (e.g., calibrated thermometer in testing food)’, and need for further training in ‘Use of inspection devices contained in the Health Inspectors bag’ and ‘Sampling tools and techniques’. Around 72.1% of all participants responded that they have confidence in their knowledge of ‘Inspection techniques: observation, inspection, measuring, testing, questioning’ (Table 5.3.4). A similar response rate of confidence (69.4%) was associated with the current professional skills in implementation of such techniques by
PHIs (Table 5.3.5). Around 61.8% of PHIs participants were also confident about using the available inspection devices (Table 5.3.5). At the same time, the majority of PHI participants without significant difference among the groups were still feeling the need for further training
Page | 175 in using inspection devices (66.4%), and in sampling tools and techniques (56.1%) (Table
5.3.18).
Food sampling techniques are integral to the issue of inspection techniques and devices because sampling is undertaken by using specific techniques and devices designed and used for food sampling and the determination of its safety. At the same time, the issue of food sampling also has its own important aspects, such as, handling of food samples, their transportation to a testing lab. Therefore, food sampling has been considered separately from inspection techniques and devices. The outcome of the study indicated that only 41.5 % of the
PHIs in Riyadh are confident in their knowledge of food sampling techniques (see Table 5.3.4).
Similarly, when referring to the skills in food sampling techniques, only 46.8 % of PHIs are confident (see Table 5.3.5). This showed a lack of confidence among the other part of the PHIs that may negatively affect the current inspection practices as well as the implementation of a risk-based approach. As indicated in the FAO framework, (2008) and the Canadian Food
Inspection Agency, (2015), food sampling techniques constitutes one of the essential steps in the identification of hazards and FBI control, which is important in the implementation of a risk-based approach. The PHIs cannot carry out effective product testing without having the required skills and knowledge in food sampling techniques. Thus, there is a need to enhance the PHIs’ knowledge and skills through training in food sampling techniques as a means of enhancing the integrity of food safety inspections. This is further confirmed by the previously indicated perceived need for further training in sampling tools and techniques, which was highlighted by 56.1% of all study participants (see Table 5.3.18).
Sanitation and Hygiene, Food Microbiology and Pest Control
Sanitation and hygiene are another essential part of the risk-based food safety
inspection and in which PHIs must be knowledgeable and able to convey this knowledge to
restaurant management and employees (FAO, 2008). The findings regarding the knowledge on
Page | 176 sanitation and hygiene showed that most of the PHIs in Riyadh (70.1 %) are confident (see
Table 5.3.4). This finding is supported by the findings related to their skills in the assessment of adherence to sanitation and hygiene, which indicated that most of the PHIs (64.5 %) are confident (see Table 5.3.5). Further, more than a third of the PHI participants were ‘not sure’ or ‘not confident’ or ‘not at all confident’ in their knowledge and ability to assess compliance with sanitation and hygiene practices. This identified a significant gap in an important area of knowledge and skills among the PHIs in Riyadh. The failure to observe hygiene practices (e.g., handwashing among food handlers) is one of the major causes of FBIs and is associated with
FBI outbreaks (Afifi et al., 2012; Michaels et al., 2004; Pham, 2010). It is therefore important for PHIs to have a good understanding of sanitation and hygiene to assure compliance of restaurants and food handlers with the best practices to prevent FBIs and to better protect the
community’s health. In comparison to the PHIs in Riyadh, less than 3% of PHIs in the province
of Ontario, Canada, were not sure or not confident with their knowledge of sanitation and
hygiene (Pham, 2010).
Additionally, in another survey question related to the sanitation and hygiene which
requested that the PHI participants list their priority areas for further professional training, the
need for training in ‘Understanding best practices regarding sanitation and hygiene’ was
indicated by more than half of the surveyed Riyadh PHIs (see Table 5.3.18).
Another important area of risk-based inspection knowledge and skills is food
microbiology. PHIs must be knowledgeable about food microbiology in order to effectively
conduct risk-based inspections and focus the inspection on issues that may cause FBIs (Cheng
& Sun, 2015; FAO, 2008). Almost half of all study participants (49.2%) were ‘not sure’ or ‘not
confident’ or ‘not at all confident’ about their knowledge in food microbiology (see Table
5.3.4). Further, more than half of the participants (53.5%) were ‘not sure’ or ‘not confident’ or
‘not at all confident’ about their skills in assessing methods of microorganisms (see Table
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5.3.5) demonstrating a general lack of confidence in this area. This also provides a potential implication for the above discussed issue and that is, the ability of the PHIs to conduct adequate sanitation and hygiene assessments. Marriott and Gravani (2006) argued that understanding the role of microorganisms in FBIs is important in understanding the principles of food sanitation and hygiene. Therefore, PHIs’ lack of knowledge and skills in microbiology will negatively affect conducting effective sanitation and hygiene assessment. This calls for urgent rectifying measures in the form of specially targeting training programs and food microbiology courses for PHIs.
Pest control is another area of knowledge and skills that the PHIs should possess when examining pest control application in restaurants, as exposure to pests could make food unsafe and contaminated with toxins and dangerous pathogens (FAO, 2008). The majority of the study participants were confident about their knowledge and skills in this area, with 58.8% and 51.1% of the respective response rates (see tables 5.3.4 and 5.3.5). Nonetheless, almost 50% of all participants were ‘not sure’ or ‘not confident’ or ‘not at all confident’ about their knowledge and skills in this area. This identified lack of confidence constitutes a matter for concern that should be addressed through training. In a different study, the proportion of PHIs who were not confident with their knowledge about pest control was significantly lower (only 1.3%) compared with PHIs in the current study (Pham, 2010).
Communication and English Language Skills
The FAO framework recommended that PHIs should possess good communication skills to effectively communicate with the stakeholder and adequately convey important technical and regulatory information (FAO, 2008). This is an essential part of any successful food inspection, including identification of any food safety issues and correctional actions to prevent future food FBIs by way of a risk-mitigating plan and regulatory measures (Hutter &
Amodu, 2009). As argued by Wallace and Oria (2010), PHIs should be trained in improving
Page | 178 their communication ability so the transfer of their knowledge and communication with restaurant workers will be effective.
As outlined in the results, the majority of PHIs in Riyadh are confident about their knowledge in ‘Communication about inspection results’ (80.8%) and in their ‘Communication skills’ (78.0%) (Tables 5.3.4 and 5.3.5). These outcomes are consistent with each other and demonstrate the strongly prevalent perception among PHIs about their high level of communication knowledge and skills in general. However, these results should be taken with a degree of caution, because in another area of knowledge and skills ‘English language’
(needed for better communication skills) and the respective items in the survey demonstrate rather low rates of confidence in this area, with only 35.9% of participants being confident in their reading English skills, and 30.9% being confident in their speaking English skills (see
Table 5.3.5). Thus, although the perceptions about current PHI knowledge and skills in general communication are high, there is a recognised need for improvement in English language communication skills. Once again, this does not mean that other communication skills are of lesser importance—they should be equally addressed. The PHIs in Riyadh need to have a good command of the English language (as a commonly shared language) since in most cases, workers from non-Arabic backgrounds who rarely understand the native language in Saudi
Arabia are employed in restaurants. The inability of an inspector to adequately communicate with food handlers due to language constraints will result in difficulties in conducting effective food safety inspection (Pham, 2010).
Scientific Research
Although, scientific research was not identified clearly in the FAO framework as a key area of knowledge and skills required by PHIs to conduct a risk-based inspection, it has been suggested that increasing complexity in the food supply chain requires a more specialised PHI workforce, with different inspections specialising in their narrower areas of expertise (e.g., use
Page | 179 research methods to inform evidence-based decision-making in food safety) (CIPHI, 2018;
Wallace & Oria, 2010). Therefore, the PHIs’ knowledge and skills in research and collecting evidence were considered in the current survey. Further, the aim of the related survey question was to get a sense of the PHIs’ general understanding in scientific research rather than investigating their detailed knowledge and skills in this area.
Almost half of the PHIs participants were ‘very confident’’ or ‘confident’ about their knowledge (50.8%) and skills (49.5%) in scientific research and collecting evidence. This is a unexpected result given that most of the participants (71.4%) hold relatively low qualification
(secondary diploma or below), and that scientific research is a complex topic that requires appropriate skills in qualitative and quantitative methods of data collection, analysis, research design. It is also possible that this high level of confidence among the participants was due to misinterpretations of this particular survey item (i.e., scientific research and collecting evidence) and this could be considered as a general term that the PHIs participants were not certain about. Therefore, this area of knowledge and skills may need further detailed investigation.
5.5.4. Training and Professional Development
Training and professional development has been partly considered in the above sections, as this helped to better understand and analyse the responses of the study participants with regard to their knowledge and skills. At the same time, a more systematic and detailed discussion of the survey outcomes associated with training and professional development of
PHIs in Riyadh is useful for further understanding of the existing issues associated with the
training and development of the PHI workforce in Riyadh. This is also important to identify
any potential barriers and facilitators to knowledge use within Knowledge to Action framework
(KTA) Figure 2.4 (Graham et al., 2006).
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Around 39.2% of all study participants indicated in their surveys that they never received any training about food safety since they started to work as a PHI (see Table 5.3.6).
Thus, they are systematically overlooking or missing new emerging food safety issues, techniques and procedures, emerging food pathogens. More than half of the study participants
(51.1%) indicated that they have not attended training for professional development in the last
12 months (see Table 5.3.8). This means that more than third of all participating PHIs do not receive any updates to their PHI qualification, and more than 50% of PHIs in Riyadh do not receive regular updates to their PHI qualification. Further, only 34.9% of all participants responded that ‘Training is usually available for me’ (Table 5.3.12). This demonstrates a major shortcoming in the overall arrangement with the availability of further training of Riyadh PHIs which is contrary to the best general practices in food safety adopted in other countries. For example, whereas the food safety guidelines and procedures at the federal and local levels in the US are subject to constant change, all inspection staff, regardless of their experience and years of practice, are required to undergo re-training in order to standardise their approach to food safety assessment procedures (Newbold et al., 2008).
Around 86% of the study participants indicated that they manage their own professional development. However, self-training may not guarantee sufficient levels of training in, and knowledge of, up-to-date information and new developments in food safety. This is further corroborated by the high rate of responses by the study participants that they would like to have further training in different food safety issues such as, ‘Emerging food issues’ (67.8%), ‘Foods from different cultures’ (58.1%), and ‘Emerging foodborne pathogens’ (66.1%) (see Table
5.3.18). Further, more than 50% of participants responded that they would like to have further training in each of the proposed areas of training, with the highest rate of positive responses
(85%) emerging for training in ‘Risk-based (modern) food safety inspection techniques’ (see
Table 5.3.18). In general, there were no significant variation in these results across gender,
Page | 181 years of experience, qualification and workplace. It could thus be said that there is a general consensus among the Riyadh PHIs that the currently existing training programs are insufficient and should be expanded on a more regular basis, taking into account all of the proposed major areas of further training highlighted in Table 5.3.18.
An interesting finding regarding gender differences when it relates to training availability. As was briefly discussed in the Results sections above, there was no difference in the probabilities for male and female PHIs to receive professional training over the last 12 months (Table 5.3.14). At the same time, the likelihood for female PHIs to receive professional training over the duration of their careers (i.e., since the time they started their PHI jobs) was significantly lower than for male PHIs (Table 5.3.15). It can be argued that this is an important finding demonstrating the recent changes in the attitude towards professional training of female
PHIs, with female PHIs currently having the same opportunities for their professional training as their male counterparts. It could also be argued that this is reflective of the recent trends in
Saudi Arabia that are aimed at the wider incorporation of women into the social and economic structures, and this has resulted in greater accessibility of further professional training to female
PHIs, thus causing a significant decline in gender significance within the last 12 months (Table
5.3.14). These trends are consistent with those in other developed and developing countries where women constitute a significant part of the PHI workforce. However, the fact that female
PHIs have had significantly lower opportunities for professional training over the duration of their careers (Table 5.3.15 and Fig. 5.5) could still cause a significant backlog of the past lack of training availability.
Furthermore, about 88% of all participants responded that they would attend further training even if there is no reward (Table 5.3.9). The municipal authorities should, therefore, take advantage of the willingness of the PHIs to introduce training programs and address any identified gaps in their knowledge and skills. As identified in Table 5.3.19, the two top tools
Page | 182 for disseminating food safety information to PHIs were WhatsApp messenger (72.4% of all participants) and Workshop/Seminar (64.5% of all participants). While the nature of WhatsApp messenger is suitable for fast dissemination of some group short text message and brief information, the second most preferred option—Workshop/Seminar—could be a better approach for knowledge dissemination especially when the aim is to improve practices (Tanner
& Hale, 2002). Table 5.3.20 confirms this by further showing that ‘Seminars/Workshops’ and
‘Regular meetings with inspectors from other inspection agencies (i.e., SFDA, MoC)’ were perceived as the most useful resources for further training and professional development. It is also noted that ‘Web-based database for food safety information and resources’ could also be a useful resource for food safety training (see Table 5.3.20).
5.5.5. Challenges and Obstacles
There are various job-related challenges and issues that should be considered for successful improvement of food safety inspection practices in Riyadh, Saudi Arabia. These issues such as motivation at the workplace and the criteria of the PHIs’ annual performance report were described by the participants in semi-structured interviews (Phase 1) as issues that negatively affected their job performance and the efficiency of food safety inspection visits.
Therefore, such issues were investigated in the current survey (Phase 2) and PHIs participants were asked to rate their satisfaction level about them.
As can be seen from Table 5.3.25 the results show that there is a high level of dissatisfaction among PHIs regarding some of the listed job-related issues. One of the major issues is the motivation at the workplace, where approximately (69%) of the participants were
‘dissatisfied’ or ‘very dissatisfied’ about the ‘motivation at their workplace’. This is high and concerning and could be a major impediment for PHIs’ effective job performance. To further investigate this sensitive issue, the difference between PHI groups was examined. The results show that the only significant effect on motivation comes from the group of PHIs with 0-5
Page | 183 years of work experience who have higher satisfaction levels (Tables 5.4.5 and 5.4.7). This could be expected, as an individual who starts in a new job often tends to have a higher level of motivation compared to those who have more years of experience (see, for example, Schulze
& Steyn (2013)). However, the fact that more than two-thirds of PHIs participants were dissatisfied about the motivation at their workplace raises many concerns. Evidence shows that poor worker motivation in health sectors can lead to poor job performance (e.g., failure to conduct proper food safety inspection, tardiness and absenteeism) (Van Lerberghe et al., 2002;
Freeman et al., 1998).
Furthermore, evidence from this study also indicates low satisfaction levels among
PHIs with their annual performance report criteria, transportation services, PHIs’ support and security (Table 5.3.25). There was no significant variation by gender, qualification and municipality among the PHIs groups, except with those PHIs with less experience reporting higher satisfaction levels. More discussion about the low satisfaction level with these job- related issues is presented in the integration chapter in conjunction with phase 1 findings (see
Chapter 6).
5.5.6. Education and Qualification
Results from the current survey showed that most of the PHIs (56.8 %) in Riyadh, Saudi
Arabia are satisfied with the diploma curriculum for training PHIs (Table 5.3.25). Evidence also indicates that most of the PHIs (81.1 %) are of the view that the PHI qualification program prepares them well for the job (Table .5.3.12). However, the findings regarding the quality of education and its effectiveness in preparing the PHIs to conduct risk-based inspection based on
HACCP principles needs to be interpreted based on the other findings discussed in this study, which indicate that the training process does not fully equip the learner for their professional roles. Further discussion about the education and qualification is presented in the integration chapter (see Chapter 6).
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5.5.7. Conclusion
In this phase of the sequential exploratory study, quantitative data were gathered through cross-sectional survey of PHIs who work across the eleven environmental departments
(municipalities) in Riyadh, Saudi Arabia. The perceptions of the PHIs about their knowledge and skills of risk-based food inspection, current training opportunities, and challenges and obstacles in their work environment that affect their job performance were examined.
The current study identified a lack of knowledge and skills among the PHIs in some areas such as HACCP, food sampling, English language as a communication tool, that are essential to conduct risk-based food inspection as outlined by the FAO knowledge and skills framework (see Section 2.7.2). Additionally, the study also identified deficiencies in the existing PHIs’ training approach and in the overall training arrangements. The training programs should be expanded on a more systematic and regular basis to facilitate the knowledge dissemination strategies within the KTA framework (Figure 2.4), thus meeting the identified needs of PHIs. This is to enable the PHIs as key players in the Health Protection
Domain (Figure 2.3) to conduct risk-based food safety inspection and to better protect the community’s health from FBIs.
The next chapter brings the qualitative and the quantitative findings (Phase 1 and Phase
2 Figure 3.4) together for additional exploration and to provide further insight into the issues under investigation.
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CHAPTER 6: INTEGRATIONS
6.1. Introduction
This chapter considers, compares and integrates the outcomes obtained from the qualitative and quantitative study (Phase 1 and Phase 2 Figure 3.4). Integration can strengthen the study outcomes, mutually complement the findings from the qualitative and quantitative approaches and highlight issues and questions for further study and analysis (Fetters et al.,
2013). In addition, the integration is the consideration of the possible alignment/agreement or otherwise of the collected databases, adopted qualitative and quantitative methods, and their outcomes (Fetters et al., 2013). This includes the determination of the extent to which the qualitative and quantitative findings cohere, interpretations and/or discussions of any agreements and disagreements. Such comparison and integration is essential in the current study, because it involves mixed methods, the outcomes of which should be discussed together and integrated where possible to identify, characterise and interpret any similarities and/or differences (Classen et al., 2007; Fetters et al., 2013; Guetterman et al., 2015).
Several levels of integration could be identified and used in the process of this research.
Firstly, this project was a sequential exploratory study, in which the qualitative data collection and analysis preceded and informed the development of the quantitative survey instrument, thus ensuring integration at the study design (Fetters et al., 2013). The collection and analysis of the qualitative data also informed the collection of the quantitative data through the
developed survey instrument, thus ensuring integration of the obtained data at the data and
methods level (Fetters et al., 2013). Finally, integration and interpretation at the reporting level
was achieved by the comparison and mutual interpretation of the qualitative and quantitative
findings, which are presented in this chapter.
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Furthermore, the integration of the findings provided further details about barriers and facilitators that could limit or prevent the target audience (PHIs) from using this knowledge; thus, informing the 'adapt knowledge’ and ‘assess barriers’ stages within the knowledge-to- action framework (Figure 2.4) (Graham et al., 2006). This Chapter in the next sections systematically presents and discusses the core issues and outcomes of this study. Chapter 7.4 then serves to brings these outcomes as a summary illustrating the application within the
Knowledge Translation Framework.
6.2. Knowledge and Skills
6.2.1. Laws and Regulations
Major qualitative findings of Chapter 4 included the following:
1. Lack of clarity of the existing laws and regulations.
2. Lack of existing laws and regulations with regard to specific food safety issues,
including foods from different cultures.
3. Many laws and regulations are not current and need to be updated. Municipal
authorities should influence the relevant the relevant government agency to develop
better food safety regulations to catch up with the actual needs of, and problems in,
the industry.
Major quantitative findings of Chapter 5 included the following:
1. About 40% of all study participants complained or expressed uncertainty about the
clarity of the existing laws and regulations.
2. More than 50% of the surveyed PHIs responded that they would like the existing
laws and regulations to be improved.
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Integration and comparison:
As identified in the FAO knowledge and skills framework (see Section 2.7.2), one of the major areas of general knowledge and skills of the PHI is the detailed knowledge of the existing food safety laws and regulations, including the ability to apply these laws and regulations in practice during a food safety inspection (FAO, 2008).
The obtained quantitative outcomes are consistent with the qualitative findings. About
40% of the surveyed PHIs expressed that the current food safety laws and regulations are insufficiently clear, and more than 50% of them desired improvements in the existing laws and regulations, which is consistent with the qualitative findings 1 – 3. This result appears to support the updating of existing laws and regulations and making them more appropriate for the practical needs of PHIs and their professional activities when conducting effective and efficient food safety inspections in restaurants. The indicated qualitative findings provide more specific emphasis on the current needs regarding the modification of the existing laws and regulations and indicate the specific areas of these desired improvements:
x Developing and introducing specific regulations about the handling of
particular foods with high risk of contamination or spoilage.
x Updating the regulations to reflect modern food inspection processes and
embrace new foods and foods from different cultures.
Thus, the complementary and mutually corroborating qualitative and quantitative outcomes of this study highlight the need for the implementation of specific practical recommendations to the food safety authorities in Riyadh. Additionally, any changes and developments in the local food safety laws and regulations should be consistent with the risk- based inspection approach to food safety.
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6.2.2. Hazard Analysis and Critical Control Point (HACCP)
Major qualitative findings of HACCP included the following:
1. The HACCP components were not part of the curriculum for the secondary diploma
(the PHI qualification prerequisite prior to 2005) and is being taught only
superficially and in basic terms within the undergraduate diploma (the current PHI
qualification prerequisite).
2. There appears to be a complete lack of any knowledge of HACCP among PHIs who
possessed the secondary diplomas.
3. Lack of detailed knowledge and skills among PHIs who possessed an undergraduate
diploma in food safety with regard to HACCP.
4. Many restaurants in Riyadh are implementing the HACCP system. However,
evaluating the HACCP system or inspecting restaurants based on HACCP
principles is not a current job requirement for the PHIs in Riyadh.
5. An Environmental Health Manager (EHM Falah #5) stated that ‘We’ve got
restaurants that apply the HACCP system, but the PHIs cannot evaluate it because
they are not qualified’. This statement was also supported by the PHIs participants.
Major quantitative findings included the following:
1. A substantial proportion (52%) of the surveyed PHIs responded that they are either
not sure or not confident about their knowledge and skills in HACCP.
2. Forty-eight per cent (48%) of the surveyed PHIs responded that they are confident
about their HACCP knowledge and its application in food inspections.
3. Sixty-three per cent (63%) of all participants identified the need for further training
in the HACCP.
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4. There is overwhelming acceptance (85%) of participants that they would like to
have further training in risk-based food safety inspection techniques.
Integration and comparison:
HACCP is a preventative method aimed at identifying any potential hazards to food safety, so that the causes of foodborne illnesses (FBIs) are avoided or effectively mitigated
(FAO, 2008). According to the FAO knowledge and skills framework Section 2.7.2, the
HACCP approach is risk-based, and its elements should be thoroughly understood by PHIs to conduct effective food safety inspection. The framework also recommended that even if the
HACCP system was not implemented in food establishments, the PHI may conduct the inspection utilising its elements and use the inspection visit as an opportunity to promote the application of HACCP to establishments.
As can be seen from the above findings, the major qualitative and quantitative outcomes are generally consistent with each other regarding the HACCP. It was not sufficiently represented during the diploma studies and also, PHIs are not qualified to evaluate the HACCP system as stated by the EHM. Further, it is not a job requirement to inspect restaurants based on HACCP principles, which is expected, as the current practices of food safety inspection in
Riyadh are generally based on the traditional approach (Al-Kandari & Jukes, 2009). The low level of knowledge and skills among PHIs (below 50%) established by the quantitative approach reflects the lack of systematic teaching of the HACCP components at the educational institutions and courses relevant to the PHI profession. This is particularly relevant to those
PHIs who gained their qualifications prior to 2005, at which time HACCP components were not part of the learning curriculum at all.
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Furthermore, there is some contradiction between the systematic indications from the qualitative data about the lack of qualification and reasonable in-depth training and knowledge in HACCP, and the quantitative outcomes showed that around 48% of the surveyed PHIs were confident in their HACCP knowledge and skills, and its application (overconfidence). The notion of this overestimate is further corroborated by the quantitative result which shows that around 63% of PHIs wanted to receive further training in HACCP. Thus, it could be argued that the unexpectedly large proportion of PHIs who are confident in their knowledge and skills with regard to the HACCP could be caused by false confidence, particularly in this area of knowledge and skills (Kruger & Dunning, 1999; Flowers, 1999; Simons, 2013). As was discussed in the previous chapter, the developed survey instrument was based on self- evaluation of the knowledge and skills of the participating PHIs. This may cause a bias towards overestimating the levels of knowledge and skills in the HACCP area that has not been properly studied and practised by the participating PHIs.
In this sense, the qualitative analysis has significantly added to the quantitative approach by corroborating the suspected reason for the relatively high (around 48%) and apparently overestimated proportion of PHIs who perceived (incorrectly) that they were confident in the knowledge and skills associated with the HACCP. This further reinforces the need for training specifically targeting the essential knowledge and skills in HACCP. This could be as a beginning stage to provide the foundation upon which the PHI can conduct risk- based inspections with an intention to prepare PHIs who are fully certified to evaluate the
HACCP systems in future. As mentioned in the FAO framework, ‘Ideally, food inspectors will have taken courses and been certified in the application of HACCP’ (FAO, 2008, p. 66).
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6.2.3. Communication Skills
Major qualitative findings included the following:
1. All PHIs during the interviews agreed that they experienced communication
difficulties caused by language barriers when they delivered food safety
information to the restaurant staff.
2. Particular difficulties arose from insufficient knowledge and skills of the English
language.
3. PHIs mentioned that a new method of communication should be developed to
overcome language barriers and to ensure that PHIs and restaurant staff and owners
are able to communicate effectively.
Major quantitative findings included the following:
1. Around 80% of the surveyed PHIs in Riyadh are confident in their knowledge and
skills in communication.
2. Around 30 – 35% of the surveyed PHIs are confident in their English reading and
speaking skills.
3. Around 73% of PHIs would like further training in written and oral English.
Integration and comparison:
As also identified in the FAO knowledge and skills framework (Section 2.7.2), PHIs
must have adequate communication skills that allow them to engage effectively with different
stakeholders including management, restaurant staff and owners (FAO, 2008).
A degree of inconsistency can be seen in these above findings. It is apparent that there
is a mismatch between the first quantitative finding which shows the very high level of
confidence of PHIs in their own communication skills, and the 2-3 quantitative findings
Page | 192 demonstrating the apparent recognition of the need for further training in English language as a communication skill. This inconsistency could be explained by accepting that the PHIs might be correct in saying that their general communication skills are very good, and their communication skills are only insufficient when they involve English, as described by the qualitative finding, number 2. Another possible reason for this inconsistency is that the study participants might not be relating significant language barriers to their personal communication skills, potentially assuming that overcoming such barriers is somebody else’s problem, e.g. the food business owner.
Repeated indications from the conducted interviews confirmed that insufficient skills in spoken and written English cause a variety of problems and issues for PHIs, including difficulties with reading food labels and any relevant instructions, communicating with restaurant workers from different language backgrounds, conveying messages and inspection outcomes to food managers and handlers, developing post-inspection efforts towards the improvement of food safety. These findings are clearly in line with the second and third quantitative findings identifying insufficient knowledge and skills in English as a widespread communication problem and the need for further training. One of the major consequences of the lack of English skills is the breakdown of communication between PHIs and restaurant workers, since many of them are from non-Arabic backgrounds who are more likely to not understand Arabic (the native language in Saudi Arabia). As a result, the restaurant workers may not receive reasonable explanations about, and have little knowledge of, the identified breaches of food safety and how any such breaches could be overcome, rectified and prevented.
This may result in a deadlock for the improvement of food safety and the prevention of foodborne illnesses that cannot be overcome other than through better verbal and written communication (including though English, which is regarded as a common communication tool).
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6.3. Training and Professional Development
Major qualitative findings included the following:
1. Further professional training is regarded by PHIs and their managers as one of the
major issues needed for the successful implementation of food safety inspection.
2. PHIs are dissatisfied with the variety and availability of opportunities for further
professional training.
3. Lack of relevance of the available training to PHI needs in the field.
4. Unwillingness on behalf of the management and the higher administration to
accommodate feedback from PHIs with regard to training programs.
Major quantitative findings included the following:
1. Almost 40% of the surveyed PHIs have had no additional training about food safety
since they started their job, and more than 50% did not attend any training in the
last 12 months.
2. Around 86% of the surveyed PHIs manage their own professional development.
3. Only around 35% of the surveyed PHIs agreed that training was generally available
to them.
4. More than 50% of the surveyed PHIs want more training, including in risk-based
food safety inspection techniques (around 85% of PHIs).
Integration and comparison:
These outcomes from the qualitative and quantitative analyses demonstrate the current importance of further professional training to the PHI workforce in Riyadh. The outcomes from both studies suggest that the participants perceived the currently existing training programs as requiring significant improvement and expansion. Training should be delivered on a more
Page | 194 regular basis to the PHIs, so that all PHIs receive an update to their qualifications, knowledge and skills at least once a year or whenever new developments and/or issues in the food safety and inspection fields emerge (Wallace & Oria, 2010). It could be said that due to the shortcoming in the current training programs, 86% of PHIs indicated that they manage their own professional development, which is a relevant and worrying finding. That is because self- learning is lacking input from trainers and may not guarantee sufficient levels of up-to-date information and new developments in food safety. This also highlights the needs for a significant overhaul of training programs.
The creation of an atmosphere of cooperation with PHIs is recommended along with inviting them to provide feedback regarding possible improvements to the training programs to (i) ensure training links to the real needs of PHIs in the field, and (ii) PHIs successfully inform the development of the food safety inspection practices in Riyadh and Saudi Arabia, based on modern risk-based food safety assessment techniques.
6.4. Education and Qualification
Major qualitative findings included the following:
1. As stated by the Diploma Coordinator, there has been no change or update to the
curriculum of the secondary diploma since its establishment in 1990 untill to 2005.
The first review of the curriculum occurred when the undergraduate diploma was
created in 2005 in order to prepare the new qualification diploma.
2. Lack of relevance of professional qualifications and education curriculum to the
PHI’s needs in the field.
3. Obsolete learning curriculum in food safety education.
Major quantitative findings included the following:
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1. Around 23% of the surveyed PHIs in Riyadh are not satisfied with the diploma
curriculum for training of PHIs.
2. Around 28% of the surveyed PHIs in Riyadh are not sure or disagree with the
statement that the qualification program prepared them well for the job as a PHI.
Integration and comparison:
The participants in the qualitative study made multiple comments with regard to the education curriculum during the semi-structured interviews. The resultant qualitative outcomes demonstrate the current deficiencies in the education curriculum and the qualifying process for
PHIs in Riyadh. The subsequent collection of the quantitative data and its analysis confirmed and complemented the concerns expressed by the PHI interview participants. For example, the quantitative results suggested that a significant proportion of PHIs were dissatisfied with their formal qualification and its relevance to their jobs, and this was clearly consistent with the qualitative findings about the lack of relevance of the curriculum to the practical situations and obsolete nature of the curriculum, as perceived by about a quarter of survey participants.
Further, an example of deficiency of the past and the currently existing education curricula for PHIs was the absence of consistent and in-depth training in HACCP as a risk- based inspection approach. For example, an ex-coordinator of the secondary diploma and the current coordinator of the undergraduate diploma made the following comment:
The HACCP principles never existed as course material for the secondary diploma, but
it has been added in later years. The secondary diploma curriculum wasn’t changed for
15 years from 1990 to 2005; however, the HACCP principles have now been simply
added to the current undergraduate diploma. (Khalid #7)
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There were no updates to the secondary diploma curriculum for 15 years which is a worrying matter, and even though the changes and updates to the curriculum were made after
2005, the HACCP elements were presented in the current undergraduate diploma superficially.
The subsequent quantitative analysis consistently demonstrated the lack of sufficient knowledge and skills in HACCP (discussed early in this chapter), which is consistent with the qualitative findings. The fact that around 48% of the survey participants indicated their confidence in the knowledge of HACCP does not contradict the qualitative findings about the deficiencies of the current qualification curriculum. As discussed early, the relatively large numbers of survey participants who were confident in their knowledge and skills in HACCP is most likely associated with the overestimation of their abilities (Kruger & Dunning, 1999;
Flower, 1999; Simons, 2013), caused by the actual lack of systematic knowledge of HACCP.
Therefore, it can be concluded that the assessment about the deficiencies of the current qualification curriculum for PHIs in Riyadh is supported by the conducted qualitative and quantitative analyses.
6.5. Challenges and Obstacles
Major qualitative findings included the following:
1. The electronic field system ‘Raqeb’ needs improvement to better assist PHIs in
performing their food safety inspection visits.
2. Annual evaluation reports of PHIs do not focus on the PHI’s effectiveness in field
and do not reward high productivity, efficiency, and good work.
3. Lack of laws and regulations sufficiently supporting and protecting the PHIs during
the performance of their professional duties. Including enabling enforcement of the
inspection procedures (e.g., access to all premises and services to be inspected).
4. Shortcoming in the current transportation services available to the PHI.
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5. PHIs expressed their lack of satisfaction about the inspection devices bag provided
to them.
Major quantitative findings included the following:
1. Thirty-eight per cent (38.8%) of PHIs were dissatisfied about the electronic field
system.
2. Approximately forty-three per cent (42.6%) of PHIs were dissatisfied about the
criteria of annual performance report.
3. More than 60% of PHIs were dissatisfied about the support and security provided
by the management to them.
4. About 57% of PHIs were dissatisfied about transportation service provided by the
department.
5. About forty-six per cent (45.5%) of PHIs were dissatisfied about the provided
inspection equipment in the PHI bag.
Integration and comparison:
Drawing on the above results the quantitative and qualitative findings about the issues
associated with the PHIs’ professional activities are largely complementary. In this regard, the
qualitative outcomes are useful, as they disclose the possible causes that negatively affect the
job performance of the PHIs in Riyadh. For example, both the qualitative and quantitative
analyses identified significant transportation service issues that correlate with significant
dissatisfaction of the study participants, with around 57% of the surveyed PHIs expressing their
concerns about lack and inadequacy of transportation services. Similarly, the equipment and
other contents of the inspection bag provided to PHIs also cause concerns among nearly 50%
of PHIs. The qualitative analysis provides further complementary information regarding the
inspection bag by suggesting the irrelevance of some of the devices that are not normally used
Page | 198 during the inspections, the lack of proper calibration, the obsolete nature of the provided instruments, and the lack of adequate training on how to use some of these devices. Concerns were raised that such equipment and lack of training causes inaccuracy and inefficiency when using them during the food safety inspection. In addition, it was also highlighted that the provided bags are inconvenient and too heavy to carry.
The following table presents quotation samples from participants in the qualitative study about the electronic field system, the criteria of annual performance report, the lack of legal protection and support for PHIs.
Table 6.1 Quotation samples from the qualitative study NO Issue Quotations
Electronic field system The electronic field system Raqeb needs to be improved, and they should take the inspector’s opinion into consideration. They didn’t 1 ‘Raqeb’ take our opinion when they first introduced it to us. Therefore, disadvantages appeared. It even sometimes hinders the inspector’s work.’ (PHI Fahd #2)
Annual evaluation of ‘The PHIs’ annual evaluation report has some problems that frustrate the PHIs. For instance, 80 per cent of the PHIs’ work is in 2 PHIs the field, but the annual report form criteria only focus on office work.’ (EHM Sami #6)
Lack of legal protection ‘Sometimes the restaurant owner impedes and prevents the PHIs from checking a certain room inside the restaurant because it has a 3 and support for PHIs tremendous number of food safety violations… The regulations have to be updated to solve such problems.’ (PHI Yasser #3)
‘Some PHIs work hard, but the fear of not being legally protected discourages them from doing their job. Two weeks ago, one of the PHIs had a problem with a restaurant owner. The owner swore at the PHI, and he submitted a lawsuit to the authorities…’ (EHM Sami #6)
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A high level of consistency can be seen from the above quotations and the related quantitative results 1 – 3. For instance, the obtained quantitative result identified that 42.6% of the PHIs were dissatisfied about the criteria of the annual performance report. The second quotation from the qualitative finding presented in Table 6.1 explained the issue with the PHIs’ annual evaluation report, that it is mainly focused on the PHIs’ office work, while the main
PHIs’ work is completed in the field. In this respect, the qualitative and quantitative findings clearly complement each other and provide additional information about the possible reason for this low level of satisfaction. It is logical that the annual report should primarily focus on
PHIs’ productivity and efficiency in the field, because the most important component of a
PHI’s work is the food safety inspection visit, which is completed in the field. Updates on the performance review process could be achieved by considering the needs of PHIs and the nature of their work. As argued by Nelson (2000), for a performance appraisal to be successful, it should consider the demands and expectations of the employee because this will generate a sense of fairness and motivate the employee to perform a better job and achieve maximum productivity.
Furthermore, the qualitative findings outlined a lack of legal protection provided by the administration to the PHI in performing his duties. Also, the quantitative findings highlighted that 60% of the surveyed PHIs were dissatisfied about the support and security provided to them. Both results demonstrate the lack of current legal protection provided to PHIs which is an alarming finding. This presents a challenge for the administration and suggests that the related regulations need to be revised to empower PHIs to ensure that they can perform their inspection duties without worrying about repercussions when they find any food safety
breaches.
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All of these challenges associated with the professional activities of PHIs are points of serious frustration for PHIs and should be eliminated or minimised by management and higher municipal administrations to enable Riyadh’s PHIs to conduct effective food safety inspections.
6.6. Conclusion
This chapter identified and discussed the major qualitative and quantitative findings of this thesis. As can be seen from the above discussions, the findings are closely aligned, either complementing or further expanding each other to provide more information, justifications and explanations for the conclusions drawn and the recommendations made. Such close integration of the qualitative and quantitative outcomes is a strength of the current sequential exploratory study. The outcomes and conclusions derived from the different methodological approaches corroborate or complement each other, providing more support for key results and insights into the existing major issues in the food safety inspection practices in Riyadh, Saudi Arabia.
Many of the issues identified in the separate sections have impacts on, and relevance to, issues from other sections. In other words, significant improvements in food safety and PHI performance can only be achieved when considering complex measures affecting the majority of the identified issues and concerns. This may be seen as a difficult task but, if successful, it should result in a major improvement in the current food safety inspection practices. Moreover, the integrated outcomes of this study are expected to facilitate the translation of the knowledge
into action (see Section 2.7.3 Knowledge-to-Action Framework) to better reach the targeted
users (PHIs) by identifying some possible barriers (e.g., lack of PHIs legal protection) and
facilitators (e.g., supportive law and regulations). Therefore, improving inspection practices,
facilitates the transition towards the risk-based food inspection approach. In addition, the
developed integrated outcomes are expected to be beneficial in the transitional period, as they
Page | 201 also identify the required changes and improvements that can provide immediate benefits even under the existing traditional food safety inspection approach.
The next chapter will provide conclusions, actionable recommendations and strategies based on the qualitative and quantitative findings to improve the inspection practices in Riyadh,
Saudi Arabia.
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CHAPTER 7: CONCLUSION
7.1. Introduction
As introduced in Chapter 1, safe food is essential to sustaining life and promoting community health and development. Access to safe food is the right of everyone as reflected in the Declaration of the World Food Summit, convened at the Food and Agriculture
Organization of the United Nations (FAO), Rome in November 1996 (FAO, 1996). According to the World Health Organisation (WHO, 2015), eating unsafe food causes more than 200 diseases ranging from diarrhea to cancers. Further, each year worldwide, unsafe food causes about 600 million cases of foodborne illness (FBI) and 420,000 deaths (WHO, 2015). In 2017, the United States (US) reported 841 FBI outbreaks and more than half of the outbreaks (489 outbreaks, accounting for 64%) were associated with eating unsafe food at restaurants (Mattson et al., 2017). The US is not alone in its struggle, as in Australia (AUS), there were 293 FBI outbreaks between 1995 to 2000, and restaurants were associated with the highest number of these outbreaks (60 outbreaks, accounting for 28%) (Gould et al., 2004). In Saudi Arabia, the number of reported FBI outbreaks has increased from 254 outbreaks in 2014 to 358 in 2018, and more than half of these outbreaks were associated with commercial sources (e.g., restaurants) (MOH, 2018).
An effective and modern food safety inspection system (i.e., policies and practices) is an essential element to prevent FBIs and protect public health (Hopper & Boutrif, 2007).
However, food inspection systems in the majority of the Gulf Cooperation Council (GCC) countries (including Saudi Arabia) are characterised by significant deficiencies and are best described as using a rather outdated ‘classic and traditional food inspection’ approach (Al- kandari & Jukes, 2009; FAO/WHO, 2007). This approach primarily has focused on establishing effective hygiene control and dealing with any associated food safety issues in a
Page | 203 reactive manner (Albersmeier et al., 2009; FAO, 2015). In contrast, the modern risk-based inspection approach (whose international adoption is recommended by the FAO) is more preventive and focuses on inspection practices and the risk factors that may cause FBIs. This can be argued will provide better health protection (see Section 2.6. for more comparisons)
(Albersmeier et al., 2009; Hoag et. al. 2007; Hopper & Boutrif, 2007; FAO, 2015; FSIS, 2015;
Sareen, 2014).
Considering the Health Determinants Model outlined in Chapter 5 (Figure 4.1), and the
Three Domains of Public Health Model (Figure 2.5. outlined in Chapter 2), policies and procedures play a key role in controlling infectious diseases and socioeconomic development
(Whitehead & Dahlgren, 1991; Griffiths et al., 2005; World Bank, 2018). For instance, the current food safety inspection policies and procedures in Saudi Arabia (as mentioned above) are traditionally based (less effective in FBI prevention and can hinder socioeconomic development) and can be improved by moving towards the risk-based inspection approach
(Buncic, 2006; FAO, 2008; Sareen, 2014). However, the Saudi Public Health Inspector (PHI), as a key role player in implementing these policies and procedures through the conduction of food safety inspection, has limited technical knowledge and skills in risk-based inspection techniques and tools (Henson & Caswell, 1999; FAO, 2008; Al-kandari & Jukes, 2009). This creates a significant hurdle for the improvement and transformation of the current inspection approach towards the contemporary and more effective risk-based approach.
Saudi Arabia with more than 34 million citizens is the largest economy among the GCC countries (General Authority of Statistics, 2018; Deloitte, 2016). For the benefit of its citizens and other neighbouring countries, it is important that the risk-based food inspection approach is adequately adapted and introduced in Saudi Arabia. In addition, the recently developed and adopted Saudi Vision 2030 roadmap for economic development until 2030 (Saudi Vision 2030, n.d.) constitutes an ambitious development plan for the Saudi economy and society to ensure
Page | 204 prosperity, safety, and harmonious development for the coming decade. Within the policy environment, Saudi Vision 2030 highlights Key Performance Indicators including at least two major points associated with food safety and public health protection (Saudi Vision 2030, n.d.):
1. An increase in the population satisfaction index with food safety
2. A decrease in public health incidents (e.g., FBIs)
These key indicators (outlined in Section 1.1.2) underpin and reflect the rapid development of the Saudi food industry, with approximately 52,000 facilities currently providing food distribution to Saudi consumers (Manafa, 2019), and an expected further increase in the number of restaurants and other food delivery outlets by nearly 50% by 2030
(Manafa, 2019; Saudi Vision 2030, n.d.). The development in the food industry is further
stimulated by other social transformations in Saudi society. For example, women’s engagement
in the labour market has increased from 14% in 1992 to 23% in 2018 (OECD, 2019; World
Bank, 2020). It is anticipated that these changes will further stimulate the rapid development of a diverse set of restaurants and other food delivery outlets, because women will have less time for in-home cooking and food preparation.
7.2. Significance and Strengths of the Study
The rapid changes in Saudi society and, in particular, the food industry are hindered by, and raise serious questions and concerns about, the traditional (and outdated) food safety inspection approach and lack of an effective food safety inspection system based on the modern principles of risk identification and management (Koutsoumanis & Aspridou, 2016; Manning
& Soon, 2013). This becomes particularly important in the environment of the growing complexity and diversity of food delivery to the end consumer, but the PHIs only have limited technical knowledge and skills in modern risk-based food inspection techniques and tools (Al-
Page | 205 kandari & Jukes, 2009). At the same time, little is known about the current issues faced by
PHIs in Saudi Arabia and, more specifically, in the capital city of Riyadh.
To understand how food safety can be improved, the current study focused on the
Riyadh cohort of PHIs working under the Ministry of Municipal and Rural Affairs, who are responsible for inspecting and enforcing food safety at the local level. The Riyadh cohort is not necessarily representative of the entire Saudi PHI workforce, yet it provides perspectives at both municipal service delivery and national policy levels. Although PHIs in Saudi Arabia are responsible for a variety of environmental health issues, the scope of this research was limited to one critical and significant area – knowledge, skills and other relevant issues associated with food safety inspection. The performance of PHIs (a key role player in the Health Protection
Domain, Figure 2.6) in this area of their responsibilities is particularly critical, as PHIs’ abilities to perform these duties can affect the health and safety of the wider community.
As described in Chapter 1, the major objectives of this thesis were (i) to evaluate the knowledge and skills of Riyadh’s PHIs in risk-based food inspection according to the FAO framework (see Section 2.7.2), (ii) to identify any barriers and issues that may influence the effectiveness of food safety inspections, and (iii) to develop evidence-based information to facilitate the intervention to improve the ability of Riyadh’s PHIs to conduct risk-based inspection. The current mixed methods study is significant because it provides a better understanding and appreciation of the current state of evaluation, control, and enforcement of food safety. The study identified and highlighted the major critical issues and barriers in
Riyadh, representing significant challenges and obstacles preventing or impeding improvements in food safety, effectiveness of food inspection, and transition of the food inspection towards risk-based safety evaluation techniques. The outcomes can also help inform implementation of the Saudi Vision 2030 roadmap (Saudi Vision 2030, n.d.) by identifying actionable research-based strategies and recommendations for policymakers to enhance and
Page | 206 modernise the current food safety inspection system which would facilitate the achievement of food safety related goals.
It is envisaged that the research outcomes will be particularly useful and significant in the current transitional period of the Saudi food industry, characterised by a rapid increase in the numbers of restaurants and other food delivery outlets in Riyadh (Manafa, 2019;
Vision2030.gov.sa). This research also provides actionable findings that can support implementation strategies for transition to the risk-based food safety inspections, which have been widely adopted, or are being adopted, in a number of developed and developing countries.
A key finding is that there are currently a number of significant gaps in the knowledge and understanding of the major existing challenges in food safety inspection processes and in the
PHI workforce in Riyadh. These gaps significantly hinder the projected rapid development of the food industry. These gaps have been particularly widened by the modern integration with other countries, resulting in rapid introduction of new foods and food producers/distributors from other cultures. These gaps are associated with heightened unknown risks of food contamination, new food pathogens, and new food management regulations with which the
Saudi PHIs may not be completely familiar. There is an urgent need to safely manage this situation on the basis of the best available food safety practices, techniques, and optimal organisation and support of food safety inspections and the associated PHI workforce in Riyadh
and the broader society of Saudi Arabia. This research has significantly contributed to filling
this knowledge gap by conducting systematic cross-validating analyses of the existing issues
and their causes in the food safety inspection system in Riyadh on the basis of the existing
perceptions of PHIs as frontline workers, their managers, and the related educational
institutions.
One of the strengths of the current study is the potential that these outcomes could be
generalisable (across Saudi Arabia and elsewhere e.g., Gulf States) in terms of knowledge and
Page | 207 skills of PHIs, laws and regulations (see Section 7.4.2). The results can be reasonably generalised because all PHIs across the country have the same qualifications, and the laws and regulations are centrally administered (nationally). However, any such generalisation should be approached with a degree of caution, as the local logistical problems and resulting issues associated with food safety inspections could differ in other administrative regions (see Section
7.5 for a more detailed discussion).
In addition, the study is important and useful for further large-scale population studies to determine and characterise other issues and needs (see Section 7.6) associated with the effective performance of PHIs to develop and improve food safety in Saudi Arabia and other neighbouring countries.
7.3. Methodological Aspects of the Study
This research was a sequential exploratory study design (Figure 3.4) involving qualitative (Phase 1) and quantitative (Phase 2) approaches. The role of the initial qualitative approach was two-fold. Firstly, the semi-structured interviews were conducted with PHIs,
Environmental Health Managers, and the Coordinator of the Food Safety Diploma in Riyadh.
During these interviews, major themes and sub-themes characterising the food safety inspection system in Riyadh were identified on the basis of two sources: (1) the existing literature on food safety in other countries including the FAO knowledge and skills framework, and (2) the common issues and concerns raised by the interviewees based on their professional experiences and intrinsic knowledge of the food safety inspection practices in Riyadh. The identified major themes and sub-themes were subsequently used for the development of the survey instrument to quantitatively evaluate the prevalence and importance of the formulated issues and resultant questions under the identified themes and sub-themes. From this point of
Page | 208 view, the qualitative analysis was used to inform the development of the valid quantitative instrument for surveying PHIs in Riyadh.
Secondly, the qualitative analysis was also used to understand, in more detail, the quantitative findings (see Chapter 6), and to expand these into the broader context of food safety in Riyadh and Saudi Arabia generally. From this point of view, the qualitative analysis was complementary to the quantitative analysis and enabled further validation, explanation, and expansion of the quantitative findings. Thus, the use of the sequential exploratory design
combining the qualitative and quantitative methodologies was particularly reliable and
productive in the current study, ensuring both the validity and reliability of the outcomes, as
well as in-depth analysis and interpretation.
7.4. Major Findings and Actionable Recommendations
7.4.1. Introduction
The findings and actionable recommendations were developed and guided by the knowledge-to-action (KTA) framework (Figure 2.4) to better reach the targeted users (Graham et al., 2006). As discussed in section 2.7.3, the scope of the current study covered the first 3 stages (see Figure 2.5) within the action cycle journey of KTA framework. These stages are (i)
Identify need and select knowledge, (ii) Adapt knowledge to the local context and, (iii) Identify barriers to knowledge use. See Figure 7.1. for linked and concrete examples.
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Figure 7.1 Example of outcomes linked to KTA framework
• Identify need > The knowledge and skills needed for PHIs to conduct risk-based food inspections. • Select knowledge > FAO knowledge and skills framework, see Stage 1: Identify need and select knowledge Section 2.7.2 (e.g., Communication skills area).
• Knowledge > Gaps were identified among the PHIs in communication skills. • Required adjustments to fill the gaps > English Language as a Stage 2: Adapt knowledge to local common communication tool with restaurants workers (from context non-Arabic background).
• Individual level: Barriers: insufficient skills in English language and lack of motivation among PHIs. Facilitators: up-to-date English skills - study identified that motivation can be enhanced through improving PHIs annual evaluation criteria. Stage 3: Identify barrier and facilitator • Organisational and system level: to knowledge use Barriers: lack of training programs - lack of motivation at workplace. Facilitators: appropriate training program - supportive annual evaluation criteria.
The following evidence-based 23 major findings and 12 recommendations and actionable strategies were developed to inform the authorities in Saudi Arabia and to facilitate the intervention by taking this evidence-based information to the implementation stages (stage
4 to 7) within the KTA framework action cycle.
7.4.2. The Following Summarises 23 Major Findings:
Demographic based findings
1. The overall gender composition of the PHI workforce in Riyadh, Saudi Arabia, is
significantly dominated by, or biased towards, male PHIs. This is different from other
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countries where the gender compositional trends are the opposite (Pham et al., 2010;
Johnson et al., 2014). These differences appear cultural in origin, an issue addressed by
Saudi Vision 2030. (see Section 5.5.2)
2. Female PHIs have significantly lower levels of knowledge and skills compared to their
male counterparts, which could be related to their different educational background
caused by the limited access for females to the food safety diploma (qualification
requirement of PHI profession) (tvtc.gov.sa, 2019). (see Section 5.5.2)
3. Female PHIs are also three times less likely to access further professional training in food
safety during their careers than males, which could be one of the causes of their lower
levels of knowledge and skills, and may constitute a significant risk to food safety.
Additionally, no difference was identified in the likelihood for male/female PHIs to
receive professional training over the last 12 months. (see Section 5.5.4)
4. The PHI workforce in Riyadh is dominated by relatively young PHIs (under 39 years of
age), which differs from the age composition of the PHI workforce in some developed
countries (Johnson et al., 2014; Pham et al., 2010). At the same time, PHIs in Riyadh
have approximately the same work experience in food safety as those in these developed
countries. (see Section 5.5.2)
5. The current qualification requirement of a specialised 2-year undergraduate diploma
(tertiary level) for the PHI profession has raised the qualification requirements in Saudi
Arabia closer to those in several other developed and developing countries (Raphael &
Briant, 2006; Butler-Jones, 2008; Seed et al., 2013; Johnson et al., 2014; Maldonado-
Simán et al., 2019) (see Section 2.5 for more details). However, prior to 2005 the
qualification requirement was only a secondary school diploma (nontertiary) which has
resulted in significantly lower levels of formal qualifications among the PHI workforce
in Riyadh. (see Section 5.5.2)
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6. For the secondary diploma qualification prior to 2005, the Hazard Analysis and Critical
Control Points (HACCP) elements were not part of the curriculum, and currently are
being taught only superficially and in basic terms within the current undergraduate
diploma. (see Section 4.3)
Knowledge and Skills based findings
7. Generally, the majority (>50%) of the PHIs reported being confident in different
knowledge and skills areas of risk-based food inspection (e.g., law and regulation and
communication). Areas in which the majority (<50%) were less confident include
HACCP, food sampling techniques and the English language as a communication tool
(further details below). (see Section 5.5.3)
8. Although around 48% of the PHIs were confident about their HACCP knowledge and its
application in food inspections, this is likely to be false confidence and confidence of the
ignorant (Dunning-Kruger effect) particularly with the HACCP knowledge and skills
area due to strong evidence from both studies (see Section 6.2.2 for further detail)
(Kruger & Dunning, 1999; Simons, 2013).
9. There are significant gaps in knowledge and skills in food sampling techniques as only
about 40% of the surveyed PHIs expressed confidence. (see Section 5.5.3)
10. There are risks in communication and using important information for decision making
as insufficient levels of proficiency in English (around 65 - 70% of the surveyed PHIs)
were identified by qualitative and quantitative data as one of the most significant issues
preventing or impeding communication with foreign (from non-Arabic background)
workers in restaurants, reading and evaluating labels and handling instructions. These
issues are of high importance, as labelling is often in English, and this is the common
language for communication with the many foreign workers in Saudi Arabia. (see Section
6.2.3)
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11. About 65% to 70% of the surveyed PHIs were confident with their knowledge and skills
on sanitation and hygiene. However, the fact that almost half of surveyed PHIs were not
sure or not confident with their knowledge and skills in food microbiology provides
potential implications for conducting adequate sanitation and hygiene assessments. This
is because understanding the role of microorganisms in FBIs is important for
understanding the principles of food sanitation and hygiene (Marriott et al., 2006). Poor
sanitation and hygiene practices are one of the leading causes of FBIs and the PHIs
should have adequate knowledge and skills to ensure compliance of food handlers with
best practices (Afifi et al., 2012; Michaels et al., 2004; Pham, 2010). (see Section 5.5.3)
12. Almost half of the surveyed PHIs were not sure or not confident about their knowledge
and skills in scientific research and collecting evidence. It should be noted that scientific
research is not a key area of knowledge and skills for conducting a risk-based inspection.
However, the increasing complexity in the food supply chain requires specialist PHIs in
narrow areas of expertise, such as using research methods, to inform evidence-based
decision-making in food safety (CIPHI. 2018; Wallace and Oria, 2010). (see Section
5.5.3)
13. PHIs desire further training. Around 60% of the surveyed PHIs would like further
training in emerging food safety issues, foods from different cultures, and emerging food
pathogens. Therefore, this should be one of the major foci of the required modifications
in the PHI training system in Riyadh. (see Section 5.5.4)
14. The majority of the surveyed PHIs need further training in how to use the inspection
devices provided to them (66%) and sampling tools and techniques (56%). (see Section
5.5.3)
15. More than 65% of surveyed PHIs expressed the need for further training in the causes
and prevention of foodborne outbreaks and illnesses. (see Section 5.5.4)
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Inspection, training system and work environment-based findings
16. Lack of clarity of existing food safety laws and regulations in Riyadh and the need for
their improvement, are also among the most significant concerns of the surveyed and
interviewed study participants (> 50%). (see Section 5.5.2)
17. About 38% of the PHIs were dissatisfied about the electronic field system ‘Raqeb’. It
was identified by the participants of the qualitative study that the system needs to be
updated based on the PHIs’ feedback and suggestions to increase its efficiency. (see
Section 6.5)
18. On-going professional development and training is lacking. Almost 40% of the surveyed
PHIs indicated that they had not received any professional training since they started
work as a PHI, and 86% of them indicated that they managed their own professional
development. This is a major concern demonstrating the lack of regular training,
upskilling and updates to the PHI qualifications, and is contrary to the basic principles
and best food safety practices in developed countries (Wallace & Oria, 2010). (see
Section 5.5.4)
19. High quality training is one of important aspects for growing confident, professional and
effective PHIs. However, poor availability of training is another major identified issue,
with only 35% of the surveyed PHIs being satisfied with training availability. (see
Section 5.5.4)
20. There was a general consensus among the Riyadh PHIs that (i) the currently existing
training programs are insufficient, (ii) should be expanded on a more regular basis and
(iii) involve a reward element for successful completion of any training courses.
However, the majority of the participants expressed their willingness to attend further
training even if there are no rewards. (see Section 5.5.4 and Section 6.3)
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21. The overwhelming majority (93%) of the PHIs stated that regular meetings with
inspectors from other agencies were the most useful resource for training and
professional development, with the second most useful resource being
seminars/workshops (92.7%). (see Section 5.3.4)
22. The two top strategies preferred by the PHIs for receiving information regarding food
safety were WhatsApp messenger (72.4%) and Workshop/Seminar (64.5%). (see Section
5.5.4)
23. A high level of dissatisfaction was found amongst the PHIs. The highest levels of
dissatisfaction were caused by:
a) motivation at workplace (69%)
b) lack of support and security provided by the management (63%)
c) the provided transportation service (57%)
d) the criteria of the PHI annual performance report (42%).
These are points of serious frustration for PHIs which could be seen as a significantly
impeding factors (barriers) for the improvement in food safety inspection practices. (see
Section 6.5)
7.4.3. Recommendations and Actionable Strategies Based on the Major Findings
Demographic based recommendations and strategies
1. Allow and support females to access the diploma training program in food safety, thereby
increasing the number of qualified PHIs. This recommendation aligns with the currently
promoted empowerment of women in Saudi Arabia (OECD, 2019; World Bank, 2020;
Saudi Vision 2030, n.d.), and would also increase female participation in the PHI
workforce, as in other developed and developing countries. (Based on findings 1 and 2)
2. Given the historic disparity in the access of further professional training in food safety
for females PHIs, it is recommended extending the initiatives which resulted in recent
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improvements, so this gap is closed. Prioritising the engagement of female PHI’s in
training to increase their level of knowledge and skills will continue the current positive
trend. (Based on findings 2 and 3)
3. It is also recommended that the PHI qualification curriculum be improved to meet the
knowledge and skills requirements for risk-based inspections. This includes in depth
training on HACCP principles since it provides important knowledge and skills necessary
to conduct a risk-based inspection. Curriculum development processes may also benefit
from the FAO knowledge and skills framework (see Section 2.7.2) which has been used
to develop the survey instrument for the current research. Other course accreditation
policies in developed countries that have implemented the risk-based inspection such as
the Australian Environmental Health Course Accreditation Policy (2014) and the
Canadian Institute of Public Health Inspectors Board of Certification Instructional
Objectives (2018) could also be considered. (Based on findings 5-8)
Knowledge and Skills based recommendations and strategies
4. It is recommended that the major areas of knowledge and skills for systematic
professional training of PHIs in Riyadh (Based on findings 6-11 and 13-16) focus on the
following identified areas:
a. Existing food safety laws and regulations, and any changes in this area
b. Principles of Hazard Analysis and Critical Control Points (HACCP)
c. Advanced training in written and spoken English as the common language for
communication with restaurants’ workers who don’t speak Arabic,
understanding food label information and handling instructions, and effectively
communicating any new information about food safety issues and techniques
d. Use of inspection devices provided in the PHI bag
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e. Training in food safety techniques relevant to food from different cultures
f. Training in food sampling techniques
g. New advances in microbiology, methods of microorganism control
h. Emerging food pathogens and causes and prevention of foodborne illnesses
and outbreaks.
5. It is recommended that, because of the ever-increasing complexity in food safety issues,
the PHI workforce be stratified to include PHIs that are specialised in particular areas of
food safety expertise such as using research tools and research analysis to inform
evidence-based decision making in food safety. This would be in line with the trends in
other countries (Wallace & Oria, 2010). (Based on finding 12)
Inspection, training system and work environment-based recommendations and strategies
6. It is necessary to update and improve the clarity and consistency of the laws and
regulations which are a crucial element of the inspection system (Based on finding 16).
The improvement of clear food safety laws and their detailed knowledge will be
paramount in empowering PHIS and their inspection activities (FAO, 2008). Therefore,
it is recommended that the following major two areas of improvements are addressed:
a. Development and introduction of specific regulations about handling of
particular foods with high risk of contamination or spoilage including foods
from different cultures
b. Development and introduction of new laws and regulations supporting and
protecting PHIs during the performance of their professional duties and
enabling enforcement of the inspection procedures and relevant punitive
actions. This will become even more important if more female PHIs are
employed due to the nature of the inspecting role.
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7. It is recommended that the future development of the food inspection system and its laws
and regulations are clearer, more structured and support the risk-based food inspection
approach. (Based on finding 16)
8. It is recommended to improve the current electronic field system ‘Raqeb’ taking into
consideration the PHIs’ opinions since they are the main users of the system. The issues
and obstacles associated with the system are of a ‘programming’ nature that affect the
efficiency of inspection performance, and it can be resolved through better cooperation
between the main user (PHIs), their managers and the system developer. (Based on
finding 17)
9. It is recommended to significantly modify and develop an effective professional training
system for PHIs. An evidence-informed strategy would include introducing a mandatory
regular training system. For example, the food safety guidelines and procedures at the
federal and local levels in the US are subject to constant change. All inspection staff,
regardless of their experience and years of practice, are required to undergo re-training
in order to standardise their approach to food safety assessment procedures (Newbold et
al., 2008). It is recommended that the same approach be adopted for PHIs in Saudi
Arabia. (Based on findings 18-22)
10. It’s recommended to provide a network of tangible rewards and incentives for the
successful completion of training courses. For example, linking the success of training
and high qualifications to the annual performance report, promotion schemes, salary
scales, and professional recognition (Kerr & Slocum, 1987; Ong & Teh, 2012; Munap et
al., 2013; Caza et al., 2015). (Based on findings 18-22)
11. A constructive atmosphere of cooperation between the management and PHIs should be
created, including inviting PHIs to provide feedback regarding improvements in the
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training programs to ensure they link to the real world needs of PHIs in the field. (Based
on findings 19 and 20)
12. The levels of motivation in the PHI work environment were low which could be seen as
a significant barrier/impeding factor for the improvement in the food inspection practices
in Riyadh (see, for example, Franco et al., (2002)). To enhance motivation, (Based on
findings 18- 23) it is recommended to:
a) improve the legal protection for PHIs to ensure that they can perform their duties
without worrying about repercussions when they find food safety violations in
restaurants regardless of the influence of its owners
b) improve the PHIs’ annual evaluation criteria taking into consideration the needs
of the PHIs and the nature of their work. This will generate a sense of fairness,
which is itself a significant motivator (DeNisi et al., 2006; Nelson, 2000)
c) improve the transportation service including car insurance and sufficient
allowances for fuel
d) develop a system of rewards for high achievements and qualifications
e) introduce sufficient stimuli to undertake further training (in addition to the
introduction of the compulsory training, as recommended above).
7.5. Study Limitations
The study design is subject to several limitations, the first phase of the study was limited to conducting semi-structured interviews with only seven participants (four PHIs, two
Environmental Health Managers, and the Coordinator of the Food Safety Diploma). The responses from the study participants, along with the FAO framework informed the development of the survey items (second phase). However, including only seven participants may have limited these findings.
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Another limitation of the current study was the self-evaluation nature of the developed survey instrument. Self-evaluation is based on subjective perceptions of the surveyed individuals and can introduce bias in the final quantitative outcomes (Mabe & West, 1982;
Faddar et al., 2018). It is also important to understand that any self-evaluating survey instruments may be subject to sampling bias, depending on the composition of the analysed cohort of participants (Mabe & West, 1982). For example, in the current study, the considered cohort of PHIs was heavily biased towards male PHIs. This was representative of the overall gender composition of the PHI workforce in Riyadh, Saudi Arabia. It could also be argued that the considered PHI cohort was adequate for addressing the existing workforce realities and the associated needs of PHIs in Saudi Arabia, apart, possibly, from the small number of female
PHIs with limited areas of responsibilities. Because of the significant dominance of the males in the study, the applicability of the obtained study outcomes to female PHIs, their needs and any associated issues could potentially be limited.
Although the potential generalisability of the obtained outcomes was described as one
of the significant strengths of the current study (see Section 7.2), logistical services and their
availability could differ in other administrative regions of Saudi Arabia and in other countries.
These differences could arise because each administrative region has its own budget and
management. This could create significant logistic differences depending on environmental
factors, the electronic field inspection system, transportation networks and communication.
Other limitations associated with the adopted analytical methodology include:
a. Possible selection/responder bias. All 502 PHIs in Riyadh (the complete sampling
frame) were invited to participate in the current study. However, only 301 (60%)
completed the survey instrument and participated in the study. As a result, the obtained
quantitative results may reflect selection bias in that the results do not take into account
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the perceptions and opinions of 201 (40%) PHIs in Riyadh who decided not to
participate in the study or were excluded from the study on the grounds of non-
completion of the survey. The reasons for non-participation are not known. It is not
possible to determine the extent of this potential bias as no information is available for
those who choose not to participate. Further, it is noted that 40.5% of participants did
not indicate the broad category of workplace, suggesting a caution of participants to
potentially identify themselves. The choice not to identify their workplace limits the
generalisation of the workplace comparisons. b. Potential measurement bias may be present by the method of delivery of the survey and
collection of the outcomes. The questionnaire was distributed electronically through
email and WhatsApp, and the responses were also collected electronically. This
approach favoured those who are confident and comfortable with electronic methods of
communication. Therefore, the study findings may be biased by not including the
opinions of those PHIs who decided not to participate in the study because of the
electronic method of survey delivery and response collection. c. Of the 201 PHIs in Riyadh who decided not to participate in the study, a total of 120
started the survey but decided not to complete it. This may indicate other possible
limitations associated with non-participation (in addition to the possible bias against
PHIs who were not comfortable with the electronic means of communication). Several
potential reasons for this non-participation include: (1) possible lack of willingness to
commit time to complete the survey (e.g., perception that the survey is long or too
difficult); (2) apathy and lack of motivation towards their profession and lack of
willingness to make a difference; (3) deterrence by some of the survey questions; (4)
fear of being identified. Each of these potential reasons creates additional possible
limitations of the current study, which are associated with the potential non-inclusion
Page | 221
of the interests and opinions of the PHI groups that might be characterized by these
reasons.
d. The reasons and limitations of sampling PHIs only from Riyadh have been described
earlier in Section 7.2.
7.6. Future Research
Several areas of future research were identified as a result of this study. For example, the conducted analysis was mainly relevant to the identification and characterisation of any issues associated with the implementation of food inspections in Riyadh. It would be useful and important in future to extend the data collection and analysis to involve other areas of Saudi
Arabia in order to identify, if any, differences in food safety activities and needs in different areas of Saudi Arabia. It would also be important to directly compare the quantitative outcomes in relation to food safety issues in Saudi Arabia with other countries to enable better understanding of any differences and to take them into account when applying the experience of other countries to Saudi Arabia.
Other proposed areas of future research include:
a. Further study about moving the current recommendations and the actionable strategies
to the implementation stages 4-7 of the KTA framework (see Figure 2.5) which include
how to put the strategies in place, ensuring the necessary financial and human resources,
monitoring the progress and evaluating the outcomes.
b. Study about the cost-effectiveness analysis or a Health Technology Assessment (HTA)
following the Canadian Model for HTA of Canada’s CADTH. HTA is an important
part of decision making in Saudi Arabia, where there a commitment to the efficient use
of public funds also consistent with Saudi Vision 2030.
Page | 222
c. Further study about possible improvements in the PHI qualification curricula that
would address existing national issues, while simultaneously reflecting the dominant
international trends in risk-based food safety inspections. Future research may consider
course accreditation policies such as The Australian Environmental Health Course
Accreditation Policy (2014) and The Canadian Institute of Public Health Inspectors
Board of Certification Instructional Objectives (2018).
d. Further study into the feasibility and benefits of stratification of the PHI workforce in
Saudi Arabia to address the rapidly increasing complexity in food safety issues and to
train and involve PHIs specialised in particular areas of food safety expertise. This
would be in line with the wider trends in other countries (Wallace & Oria, 2010).
e. Detailed study of the reasons for the demotivation of the PHI workforce, including any
potential differences in motivation levels among PHIs in different departments in
Riyadh, and identification of ways to boost motivation among PHIs in Riyadh.
f. Although this research focused on enhancing the inspection system for the network of
restaurants and other food outlets delivering food to the end consumer, further research
is recommended to involve other steps in the chain of ‘from farm-to-fork’ food
production, including food transportation, storage, and delivery (FAO 2008, p.10). This
has the potential to further strengthen the overall national food control system in Saudi
Arabia.
7.7. Conclusion
This thesis provided twenty-three major findings and identified thirteen actionable opportunities and recommendations guided by the KTA framework (see Section 2.7.3). This is to enhance the current inspection system and improve the knowledge and skills of the Saudi
PHIs to conduct risk-based food inspection based on the FAO framework (see Section 2.7.2).
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The thesis also described the significance and importance of the work and its numerous outcomes, which will be important for the successful development of the concept and practices of food safety inspection in Riyadh and Saudi Arabia generally, including the anticipated transition of the food safety inspection system towards the risk-based approach. The conducted research and findings of this thesis represent a significant contribution to strengthen the Saudi
National food control system, achieving the relevant Saudi Vision 2030 goals, providing safer food for consumers and protecting the community from FBIs.
Page | 224
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Appendices
Appendix A Ethical Approval- Queensland University of Technology
Note about participants confidentiality: All participants in this study were given pseudonyms except for the Food Safety Diploma Coordinator who agreed to mention his name and consent form was obtained.
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Appendix B Data Collection Approval- Ministry of Municipal and Rural Affairs, Saudi Arabia
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Appendix C Data Collection Approval – Saudi Arabia Cultural
Mission, Australia
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Appendix D Data Collection Confirmation – Environmental Health Department, Riyadh Main Municipality, Saudi Arabia
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Appendix E Course Coordinator Interview Approval, Technical and Vocational Training Corporation is a training institute, Saudi Arabia
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Appendix F Participants Invitation Message - English
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Appendix G Participants Invitation – Arabic
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Appendix H Participants Information Sheet – Arabic
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Appendix I Interview Document - Public Health Inspectors (PHIs)
Interview information
Date: Time: Location:
Interviewee: Gender: Position:
Prior to interview (expected duration 5-10 minutes)
x About the study I’d like to thank you once again for being willing to participate in the interview aspect of my PhD research. As I have mentioned to you before, my study seeks to investigate the knowledge and skills required of PHIs in Saudi Arabia for continuing the change in practices towards conducting of risk- based (modern) inspection at restaurants. The aim of this study is to enhance the existing food safety inspection practices and reducing foodborne illnesses. The study will also contribute to achieving one of the Ministry of Municipal’s objectives at the Saudi Vision 2030 (Objective no. 7 which requires the Ministry to provide a healthy local urban environment and decrease the foodborne outbreaks). I would also like to inform you that the outcome of this interview will be used in developing a survey questionnaire for the PHIs in Riyadh. Do you have any questions about the study? x Approvals This study has been reviewed and received ethics clearance from the Human Research Ethics Committee at Queensland University of Technology, Australia. Also, the study has obtained an approval from the Ministry of Municipal and Rural Affairs. Participation in the interview is completely voluntary and you may choose to withdraw from completing the interview at any time. All data will remain confidential and anonymous. Any reported results will not include information that would allow identification of participants.
x About the interview Our interview today will be audio recorded and will last for about one hour. I will ask you questions about your background, your experiences with food safety inspection with focusing on restaurants, professional development, changes and challenges in performing your duties and future considerations with regards to food safety inspection.
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During any stage of the interview you have the right to not answer any question if you do not wish to, without any explanation. In addition, you can withdraw from the study after the interview without explaining why. x Consent form I. If you are still happy to take part in this study, could you please read and sign the consent form? II. Before we begin the interview, do you have any questions? [Discuss questions] x If there are any questions arise at any point in this interview, feel free to ask them at any time. I would be more than happy to answer your questions. x Start audio recording.
Start Interview (expected duration 45-60 minutes)
x Introductory Questions (expected duration 5 minutes) 1. Briefly, would you please summarize your work history and education? (Props: qualification, years of experience, duties, achievements, training courses, differences if previously worked in other departments) 2. Do you like what you do?
x Food safety inspection (expected duration 10 -15 minutes) In terms of the food safety inspection, 3. In terms of the food safety inspection, could you please describe a typical inspection visit to restaurant? (Props: from office to the inspection site, preparation, proper equipment, inspection official document and reporting) Followed up by: a. Are there any specific criteria you follow to determine what restaurant you are going to inspect? If yes, what are they? b. Are there any specific criteria you follow to determine the inspection frequency? If yes, what are they? c. What do you generally check during restaurant inspection visit? d. What assessments you do? What questions do you ask? e. What are the most important issues or points that you focus on during the inspection? f. Do you think all the PHIs in Riyadh do the same? Why?
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4. How do you communicate with food handlers who don’t speak Arabic? (Props: provide advices, English language, difficulties) a. Could you please give me an example of a time when you were unable to successfully communicate? How did you handle that? 5. To what extent is the food safety responsibility is shared between the Inspector and operator/handlers/owners? (Props: PHIs’ responsibilities, food handler and operator’s and owner’s responsibilities, cooperation, compliance) 6. Do you know the Hazards and Critical Control Points (HACCP) system? If yes, Followed up by: a. How did you know about it? Do you utilize it? b. If the restaurant has a HACCP plan, do you check it? If no, why? 7. What do most PHIs think about the current inspection approach? Followed up by: a. Is that the way you feel too? Why? b. What do you like? What don’t you like? Why? x Changes and challenges (expected duration 10 -15 minutes) 8. What significant changes in inspection practice have happened in the last five years which have directly affected food safety? (Props: changes in legislation, inspection approach, role of the PHIs) a. How successfully do you think you have implemented these changes? a. Was there any resistance from anyone (e.g., PHIs, EHMs, business owner)? What happened? How did you deal with it? b. What is the most significant change? Why? 9. What challenges have you faced in restaurant inspection during the last five years? (Props: inspecting food from different culture e.g., sushi, compliance, communication, food handlers, business owners) a. Which one frustrates you the most? b. What do you usually do about it? 10. To what extent does existing food legislation (food law, regulations, standards) support or hinder food inspection? Why? 11. What are the most significant food safety issues related to restaurant nowadays? (Props: issues that cause foodborne outbreak) Followed up by: a. Why?
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b. What do you usually do about it? 12. In your opinion, how could the current food inspection approach at restaurant be improved? (Props: practices, proper equipment, official document and reporting) 13. If we want to change and develop the current food inspection practices, what barriers do you believe exist that prevent this development? x Education and professional development (expected duration 10-15 minutes)
In regard to the education and professional development aspects:
14. To what extent do you believe that the curriculum of the educational institute you’ve graduated from help you in your working life as PHI? (Props: knowledge, skills, practical, risk assessment and management, communication skills, critical thinking, food law, regulations, research methods) a. What subjects have been of most help in doing your job? b. Do you believe the qualification curriculum needs improvements? Why? What do you think is needed? What subjects could be added to the course? 15. In your current work, does the department keep you up to date with recent developments relating to food safety inspection? If yes, Followed up by: a. How? (Props: opportunities for continuous professional development, training programs content, hazards analyses, risk assessment and management, communication skills) 16. What training courses are not included in the program that you believe you and your colleagues may need? 17. Are there any obstacles that could hinder the professional development of you or your colleagues? If yes, what are they? x The future and the risk-based inspection (expected duration 10-15 minutes) 18. In the next 5 to 10 years, what do you consider the greatest threats for the PHIs workforce? Why?
(Note: the interviewee will now be given oral information about the risk-based inspection) then, will be asked the following questions: 19. What is your opinion about the risk-based approach? Why?
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20. Do you think that you and your colleagues will be confident in changing food inspection practice toward the risk-based approach? 21. What do you think that you and your colleagues need to change practice toward the risk-based approach? (Props: skills, knowledge, training, equipment and resources) 22. What changes need to be made in order to implement the risk-based approach? (Props: administration, equipment, training, technology, legislation) 23. What barriers do you believe will prevent the implementation of the risk-based approach? (Props: legislation, training, changing in inspection practice, using technology) x Concluding 24. Do you have any other thoughts or ideas you’d like to add? x Thanking the interviewee for the participation The end
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Appendix J Interview Document – Environmental Health Manager (EHMs)
Interview information
Date: Time: Location:
Interviewee: Gender: Position:
Prior to interview (expected duration 5-10 minutes)
x About the study I’d like to thank you once again for being willing to participate in the interview aspect of my PhD research. As I have mentioned to you before, my study seeks to investigate the knowledge and skills required of Public Health Inspectors (PHIs) in Saudi Arabia for continuing the change in practices towards conducting of risk-based (modern) inspection at restaurants. The aim of this study is to enhance the existing food safety inspection practices. The study will also contribute to achieving one of the Ministry of Municipal’s objectives at the Saudi Vision 2030 (Objective no. 7 which requires the Ministry to provide a healthy local urban environment and decrease the foodborne outbreaks). I would also like to inform you that the outcome of this interview will be used in developing a survey questionnaire for the PHIs in Riyadh. Do you have any questions about the study? x Approvals This study has been reviewed and received ethics clearance from the Human Research Ethics Committee at Queensland University of Technology, Australia. Also, the study has obtained an approval from the Ministry of Municipal and Rural Affairs. Participation in the interview is completely voluntary and you may choose to withdraw from completing the interview at any time. All data will remain confidential and anonymous. Any reported results will not include information that would allow identification of participants.
x About the interview Our interview today will be audio recorded and should last 45-60 minutes. I will ask you questions about your background, experiences and your expectations toward the performance of the PHIs on the food safety inspection. The interview will also focus on the professional development, changes and challenges that the PHIs face in performing their duties.
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During any stage of the interview you have the right to not answer any question if you do not wish to, without any explanation. In addition, you can withdraw from the study after the interview without explaining why. x Consent form I. If you are still happy to take part in this study, could you please read and sign the consent form? II. Before we begin the interview, do you have any questions? [Discuss questions] x If there are any questions arise at any point in this interview, feel free to ask them at any time. I would be more than happy to answer your questions. x Start audio recording
Start Interview (expected duration 40-60 minutes)
x Introductory Questions (expected duration 5 minutes) 1. Briefly, would you please summarize your work history and education? a. (Props: qualification, years of experience, duties, achievements, training courses, differences if previously worked in other departments)
x Food safety inspection (expected duration 10 -15 minutes) 2. In terms of the food safety inspection, what do you expect PHIs to do when conducting an inspection visit to a restaurant? (Props: from office to the inspection site, preparation, proper equipment, inspection, official document and reporting) 3. Do you believe that all PHIs conduct food safety inspections as you would expect? Why? 4. What are the most significant food safety issues related to the restaurants in the last decade? (Props: issues that may cause food poisoning) Followed up by: c. Why? a. What do you think the best way to handle it? 5. What skills do highly competent PHIs have? 6. If you think someone is less competent, what are they lacking? What do you think they need?
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7. What do you think are the most important skills and knowledge that a PHI needs to effectively conduct a food safety inspection at a restaurant? 8. When judging the performance of PHI, what factors or characteristics most important to you? Why? 9. What do you think most EHMs in Riyadh think of the current restaurant inspection approach? Followed up by: a. Is that the way you feel too? b. What do you like about the current approach? What don’t you like? Why? 10. In your opinion, how could the current food inspection approach be improved? a. What areas need improvement? Why? b. Do you believe any barriers exist that may prevent this development?
x Changes and challenges (expected duration 10 -15 minutes) 11. What are the significant changes made in your Department in the last decade which have directly affected the food safety inspection? (Props: changes in legislation, inspection approach, role of the PHIs) b. How successfully do you think you have implemented these changes? c. Was there any resistance from anyone (e.g., PHIs, EHMs, business owner)? d. What happened? How did you deal with it? e. What is the most significant change? Why? 12. What challenges have you faced with your PHIs in restaurant inspection during the last decade? (Props: PHIs’ inspection practice, inspecting food from different culture e.g., sushi, compliance, communication, food handlers, business owners) c. Which one frustrates you the most? d. What do you usually do about it? 13. To what extent does existing food legislation (food law, regulations, standards) support or hinder food inspection? Why? 14. What challenges do you think the PHIs are facing today? Why? x Education and professional development (expected duration 5 -10 minutes) 15. During the last decade, have you ever had newly graduated PHIs working in your department? If yes, a. To what extent do you believe that they have adequate knowledge and skills to perform their duties as PHIs?
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b. Why? Any identified gaps? 16. Do you keep the PHIs informed about what is going on in their profession? How? a. Are there any current training course programs for the PHI? If yes, b. What does it include? c. How did you determine the PHIs needs? d. Who designs the training courses? What are they based on? e. Who is involved in the development of the training course component? 17. Are there any obstacles that could hinder the professional development of PHIs? If yes, what are they? x The future and the risk-based inspection (expected duration 10 -15 minutes) 18. In the next 5 to 10 years, what do you see as the greatest threats for the PHIs? Why?
(Note: the interviewee will now be given oral information about the risk-based inspection approach) and will then be asked the following questions: 19. What is your opinion about the risk-based approach? Why? 20. Do you think that the PHIs will be confident in changing their practice toward the risk-based approach? 21. What do you think is needed for PHIs’ to change their practice and implement the risk-based approach? (Props: skills, knowledge, training, equipment and resources, administration, technology) 22. What barriers do you believe will prevent the implementation of the risk-based approach? x Concluding 23. Do you have any other thoughts or ideas you’d like to add? x Thanking the interviewee for the participation
The end
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Appendix K Interview Document for the Coordinator of the Food Safety Diploma at the Technical College of Riyadh
Interview information
Date: Time: Location:
Interviewee: Gender: Position:
Prior to interview (expected duration 5-10 minutes)
x About the study I’d like to thank you once again for being willing to participate in the interview aspect of my PhD research. As I have mentioned to you before, my study seeks to investigate the knowledge and skills required of Public Health Inspectors (PHIs) in Saudi Arabia for continuing the change in practices towards conducting of risk-based (modern) inspection at restaurants. The aim of this study is to enhance the existing food safety inspection practices. The study will also contribute to achieving one of the Ministry of Municipal’s objectives at the Saudi Vision 2030 (Objective no. 7 which requires the Ministry to provide a healthy local urban environment and decrease the foodborne outbreaks). I would also like to inform you that the outcome of this interview will be used in developing a survey questionnaire for the PHIs in Riyadh. Do you have any questions about the study? x Approvals This study has been reviewed and received ethics clearance from the Human Research Ethics Committee at Queensland University of Technology, Australia. Also, the study has obtained an approval from the Ministry of Municipal and Rural Affairs. Participation in the interview is completely voluntary and you may choose to withdraw from completing the interview at any time. All data will remain confidential and anonymous. Any reported results will not include information that would allow identification of participants. x About the interview Our interview today will be audio recorded and should last for about one hour. I will first ask you questions about your background before discussing the current curriculum of the Food Safety Diploma and the qualification requirements for PHIs. You have the right to not answer any question without explanation during the interview, and you can withdraw from the study after the interview without explaining why.
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x Consent form III. If you are still happy to take part in this study, could you please read and sign the consent form? IV. Before we begin the interview, do you have any questions? [Discuss questions] x If there are any questions arise at any point in this interview, feel free to ask them at any time. I would be more than happy to answer your questions. x Start audio recording
Start the Interview (expected duration 45-60 minutes) x Introductory Questions (expected duration 5-10 minutes) 1. Briefly, would you please summarize your work history and education? (Props: qualification, years of experience, duties, achievements, training courses, differences if previously worked in other departments) x Food Safety Diploma (expected duration 20 minutes) 2. Why was the qualification requirement of PHIs changed from a secondary diploma to the current high diploma in 2005? a. Who proposed the changes? b. What happened? c. What is your opinion about these changes? 3. In general, what are the differences between the previous secondary diploma and the current high diploma? (Props: admission requirement, staff, curriculums, teaching method) a. Why was this change undertaken? b. Has it made a difference? c. What is your opinion about these changes? 4. What changes have happened to the curriculum? a. What change has occurred in the subjects? b. Why were they changed? c. Have they made a difference? d. What is your opinion about these changes? 5. What knowledge and skills directly related to food safety inspection do you teach?
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(Props: practical, HACCP, risk assessment and management, communication skills, English language, critical thinking, food law, regulations, research methods) a. How do you incorporate ‘this’ into the teaching? b. To what extent do you incorporate ‘this’ into the teaching? 6. Could you please talk to me about the practical placement unit? a. What are the requirements to pass the unit? b. How do you assess the knowledge and skills of the trainee during the field training? c. What you assess? Who does the assessment? 7. Do you adjust the curriculum? If yes, a. How often? b. What mechanisms do you employ for making the adjustments? E.g., involving of stakeholder feedback (from students, graduates, professional bodies, employers and other interested parties) x Professional development (expected duration 5 minutes) 8. Do you have any cooperation with the Ministry of Municipal in the provision of training courses for current PHIs in Saudi Arabia? If yes: a. What does include? b. Based on what do you design the training course? c. Are PHIs involved or the Environmental Health departments involved in the development of the training course component? d. How did you determine the needs of current PHIs? x The future (expected duration 20 minutes) 9. Would you like to raise any issue regarding the current curriculum? If yes: a. What? b. How could this be improved in the future? 10. Is there any plan to change the curriculum and qualification in the nearest future? If yes: a. What are they? Why these changes? 11. Do you think there is a need for any change to the current curriculum for the next 5- 10 years? If yes: a. What are they? Why these changes? 12. Have you heard about the Saudi Vision 2030? If yes,
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a. Dose the vision has any objective related to Food safety Diploma? If yes, b. What are they? What you are going to do? x (Note: the interviewee will now be given oral information about the risk-based inspection) then be asked the following questions: 13. What is your opinion about the risk-based approach? 14. What changes to the current curriculum or qualification are needed to implement the risk-based approach? 15. What skills and knowledge do you think the student may need? 16. What barriers do you believe will prevent the implementation of these changes? x Concluding 17. Do you have any other thoughts or ideas you’d like to add? x Thank the interviewee for their participation
The end
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Appendix L Survey Questionnaire – English Language
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Food Safety Inspection Knowledge
Note: There is a similarity between Question 1 and 2. Question 1 is about your confidence in your knowledge, while Question 2 is about your confidence in your skills. Both questions allow you to select answer from the list of choices.
1. How confident are you about your current knowledge in the following areas?
1- Very confident| 2- Confident | 3 - Not Sure | 4 – Slightly confident | 5 – Not at all confident
1 2 3 4 5
A Food safety laws and regulations
Hazard analysis and critical control point (HACCP) guideline for B preventing a food safety hazard
Inspection techniques: observation, inspection, measuring, C testing, questioning
Food sampling techniques for collecting samples for bacterial and D chemicals testing
How to communicate inspection results E
Best practices in sanitation and hygiene F
Food microbiology (e.g., conditions required for growth of G potentially harmful microorganisms)
How pests are controlled H
Scientific research I
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Food Safety Inspection Skills
2. How confident are you about your current skills in the following areas? (this question allows you to select multiple answers from the list of choices)
1- Not at all confident| 2 - Slightly Confident | 3 - Not Sure | 4 - confident | 5 - very confident
1 2 3 4 5
A Assessing compliance with food safety laws and regulations
Evaluation of the hazard analysis and critical control point
B (HACCP) system
Inspection techniques: observing, inspecting, measuring and
C testing
Using of inspection devices (e.g., calibrated thermometer in
D testing food)
Food sampling techniques (e.g., aseptic techniques, handling for E transportation to a laboratory) Assessing compliance with best practices in sanitation and
F hygiene
G Assessing methods of microorganisms control
Assessing pest control (e.g., Identifying pests and providing
H advice on appropriate methods of control).
Conducting research and collect evidence (e.g., outbreak
I tracing, preventative strategies) Communication of (e.g., food safety information, inspection results) in a way that food handlers and business operators J understand Reading in English (e.g., ingredients presented in English
K language) Speaking in English language (e.g., delivering food safety L information to food handlers)
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Training and professional development
3. Have you received any training about food safety since you started working as a Health Inspector? o Yes o No (if chosen, it will automatically skip Q3-A to Q4 on the online survey) A- If yes, was the content helpful for your responsibilities in food safety inspection?
o Yes o No
4. In the last 12 months how many times have you attended training for your professional development?
1- Never| 2- One time | 3- Two times | 4- More than 2 times | 5 - Not applicable
5. Would you attend a training course even if there is no reward? o Yes o No
6. Do you manage your own professional development? (e.g., training, reading scientific articles)
o Yes o No if (if chosen, it will automatically skip Q6-A to Q7 on the online survey) A- If yes, in the last month how many times have you learnt about something new that has contributed to your professional development?
1- Never |2- One time | 3- Two times | 3- More than 2 times | 4- Not applicable
7. To what extent do you agree or disagree with the following statements:
1 - Strongly agree| 2 - agree| 3 – Not sure | 4 - Disagree | 5 - Strongly disagree
1 2 3 4 5 A Training programmes are usually available for me. I will arrange to complete my studies even if my employer does not B give me the opportunity. My qualification program prepared me well for a real-life Health C Inspector job.
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8. Are there any barriers that prevent you from attending professional training? o Yes o Sometimes o No if (if chosen, it will automatically skip Q8-A to Q9 on the online survey)
A- If yes or sometimes, what are the potential barriers that prevent you from attending professional training? Select all that apply. o Not available o Not relevant to what I need o No incentive
9. From the topics listed below, what would you like further training in? (check all that apply)
Topics
A Risk-based (modern) food safety inspection techniques
B Use of inspection devices contained in the Health Inspectors bag
C Understanding and application of Hazard Analysis and Critical Control Point (HACCP) system
D Causes of foodborne outbreaks and illnesses and how to prevent future outbreaks
E Emerging food safety issues
F Foods from different cultures
G Emerging foodborne pathogens
H Understanding best practices regarding sanitation and hygiene
I Sampling tools and techniques
J English language (e.g., oral, written)
K Investigation skills in food safety inspection
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10. Which of the following would you consider to be the most effective strategy for disseminating food safety information to health inspectors? (please select Two) o E-mail newsletter o Website o Social media (e.g., twitter, Facebook) o WhatsApp messenger o Workshop/ Seminar 11. In your opinion, how useful is each of the following resources in your role as a health inspector?
1 - Very useful | 2 - Useful | 3 - Neutral | 4 - Useless | 5 – Very useless|6 - No opinion
Resources 1 2 3 4 5
A Formal education (general education provided by government)
B Seminars/workshops
C E-mail newsletter
D Web-based database for food safety information and resources
Regular meetings with inspectors from other inspection agencies (i.e., E SFDA, MoC)
Challenges and obstacles 12. To what extent do you agree or disagree with the following statements:
1 - Strongly agree| 2 - agree| 3 - Undecided | 4 - Disagree | 5 - Strongly disagree | 6 – No opinion
1 2 3 4 5 6
Whenever I meet food handlers who speak a different language from A my own, I find it difficult to communicate food safety information to them
B All Food safety laws and regulations are clear to me
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13. How often during food inspections do you come across food from other cultures?
Regularly Occasionally Rarely Never
14. Do you know how to inspect those food from other cultures??
Yes Sometimes No Not applicable
15. How satisfied are you with the following?
1- Very satisfied |2- Satisfied |3- Neither |4- Dissatisfied |5- Very dissatisfied
1 2 3 4 5
A Food safety laws and regulations
B Equipment in Health Inspectors bag
C Field work system (Raqeb)
D The criteria of annual performance report
E Transportation service provided by my department
F Motivation at my workplace
G Support and security provided by the management
H The diploma curriculum for training health inspectors
16. What areas of your job do you find difficult or want to improve? (Select all that apply)
x Food safety law regulations x Food safety assessments x Dealing with food handler and business owner
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Demographic information
17. In which age category do you belong?
x 18 to 29 yrs x 30 to 39 yrs x 40 to 49 yrs x 50 to 59 yrs x 60 yrs or older x Prefer not to answer
18. What is your gender?
x Male x Female x Prefer not to answer
19. How long have you been employed as public health inspector?
x 0 to 2 yrs x 3 to 5 yrs x 6 to 10 yrs x 11 to 20 yrs x More than 20 yrs x Prefer not to answer
20. Are you currently employed as a Health Inspector in Riyadh?
x Yes x No
21. In which municipality do you work? Select from the list
x General Department of Environmental Health x Municipality of Olaya x Municipality of Batha x Municipality of the North x Municipality of Areegea x Municipality of Arqa x Municipality of Aziziyah x Municipality of Shmeisi x Municipality of Shifa x Municipality of Al Rawda x Municipality of Namar x Municipality of Deraia x Prefer not to answer
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22. What is the highest degree/level of education you have been awarded?
x Middle School x Secondary School x Secondary diploma in Health Inspection x Technical college diploma (Food and Environment technology) x Bachelor x Postgraduate x Other (Please specify)
23. Please provide any additional comments you would like to mention
Thank you so much for taking the time to complete the survey.
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Appendix M Survey Questionnaire – Arabic Language
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Appendix N Major Themes – Map
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