A gentle push towards improved hygiene and food safety through ‘nudge’ interventions

Most of the perishable food in low- and middle-income countries is sold in informal markets where
food handlers are not usually trained in good hygienic practices. There are different approaches to
improve food safety in those markets, some of which include capacity building. However, one-off
trainings are not usually sustainable as behaviours are deeply rooted and often lead to unconscious
practices that can increase risk of food contamination. Close follow-up is intense in terms of human
and financial resources. Nudges have been described to influence behaviour with varying results,
partly depending on whether they have been imposed on or co-created with the end-users. In
this study we describe the human-centred-design process from identifying critical control points
between slaughter and retail to co-creating nudges that could potentially lead to better compliance
of meat handlers in Uganda with good hygienic practices. Three of the WHO “Five Keys To Safer
Food” were selected as the target behaviours to improve. The qualitative research was implemented
in the greater Kampala area between October 2020 to December 2021 and involved 119 meat
handlers, pork joint customers, food safety and veterinary technical experts and over 20 project
stakeholders. Findings from the initial ‘explore’ phase generated a number of insights on meat
handlers’ perceptions and attitudes that were later used to generate ideas and solutions in cocreating nudges during the ‘experiment’ phase: 1) Meat handlers eat the pork they handle at work
and have low risk perception; 2) Meat handlers feel their practices are acceptable; 3) Meat handlers
see ‘broken windows’ which set the norm for unhygienic behaviour; 4) Meat handlers follow the
path of least resistance; 5) Meat handlers keep up appearances for customers; and 6) Owners want
to see returns on hygienic investments. Fourty-two early prototypes were co-created with potential
end users and after several iterations, two nudge kits emerged, e.g. the “Keep Clean Loop” and the
“Tricolour Kitchen”. In a subsequent pilot test we assessed if the nudges help reducing the burden
of foodborne pathogens and if behaviour of meat handlers changes sustainably.