Exploring Hand Hygiene Practices in Food Businesses Using the Capability, Opportunity, and Motivation for Behaviour Change (COM-B) Model

Introduction: Hand hygiene compliance in food service and manufacturing businesses is important to limit the risk of transmission of foodborne illness and to ensure the safety of the food produced for consumers. In many previous observational studies, malpractices regarding hand hygiene have been reported in food business establishments. Hence, there is a need for food handlers to comply with hand hygiene requirements recommended by international guidelines. To target a positive change in practices, factors such as capability, opportunity, and motivation may help facilitate or impede hand hygiene practices in food businesses.

Purpose: To explore capability, opportunity, and motivation factors that influence hand hygiene in food manufacturing and service settings.

Methods: A total of 23 qualitative semi-structured interviews were conducted with food service and manufacturing industry representatives. The interview schedule focused on the hand washing requirements, applied protocols and procedures, compliance assessment methods, and behavioural barriers within food business. The interviews were transcribed and thematically analysed in NVivo 21 using COM-B components of ‘Capability’, ‘Opportunity’, and ‘Motivation’.

Results: ‘Capability’ included psychological and physical components. For example, ‘Psychological Capability’ positively impacted hand hygiene and included “behaviour and culture”, “previous experience and knowledge", and “memory and attention”, whereas ‘Physical Capability’ such as “skin irritation” negatively impacted behaviours and compliance rate.

‘Opportunities’ that influence hand hygiene behaviours included ‘Physical Opportunities’ such as “education”, “monitoring”, “hand hygiene resources”, and “time constraints”, while ‘Social Opportunities’ involved considerations like “peer pressure”, “production pressure”, and “food safety culture”. Furthermore, aspects such as “reward and recognition”, “consequences”, and “reinforcement” were identified as important ‘Motivational’ factors for improving and maintaining hand hygiene standards.

Significance: Findings from this study give insights of the key opportunities that are necessary to increase food handlers’ capability of engaging in proper hand washing practices as well as what motivates them to maintain and improve these practices.