ReviewClimbing the Intervention Ladder to handwashing compliance: A review and directions for future research

- Poor handwashing compliance is a pervasive problem in food service.
- The Intervention Ladder is a framework of behavior change strategies.
- An updated model to benefit researchers and food service providers is proposed.
- New avenues for future hand hygiene research are explored.

Proper handwashing is a simple, cost effective means for reducing the risk of foodborne disease transmission. Low compliance rates are often observed among food handlers, and a wide range of interventions have attempted to increase compliance, often with little success. Promoting lasting behavior change is difficult, and theoretical models like the Intervention Ladder developed by the Nuffield Council on Bioethics function as useful paradigms to help guide and promote behavior change.While the Intervention Ladder was developed to address issues like infectious disease, obesity, and drug use, it is applicable to the food industry with regards to promoting food safety practices like handwashing. The aim of this review is to expand on the Intervention Ladder and describe its application in the food industry. We believe the Intervention Ladder can serve as a model to benefit food industry stakeholders through providing strategies to promote handwashing compliance. We have modified the original model to include various levels of employee freedom that might impact which strategy is most appropriate depending on the circumstances. Limitations for each strategy are also considered, and directions for future research are included to help guide and expand the knowledge base of food safety behavior change strategies.