An else-if ladder in JavaScript checks multiple conditions one by one. The program starts by checking the first condition. If it is true, it runs that block and skips the rest. If false, it moves to the next condition. This continues until a true condition is found or all conditions fail. If none are true, the else block runs as a default. In the example, num is 15. The first condition 'num < 10' is false, so it moves to 'num < 20' which is true. It prints 'Between 10 and 19' and stops checking further. This way, only one block runs. If num was 25, both conditions would be false, so the else block would print '20 or more'. This structure helps choose between many options clearly and efficiently.