Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review

Fang

et al. 2020

IJERPH

Objective: Hand washing and sleep hygiene are two important health behaviors. The purpose of the current study was to identify the motivational and volitional antecedents of college students' hand washing and sleep hygiene behaviors based on an integrated model of behavior that combined social-cognition constructs from the Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA). Methods: Using a prospective design, college students (N = 1106) completed a survey assessing the motivational constructs of action self-efficacy, attitudes, subjective norm, perceived behavioral control, intentions, and behaviors of hand washing and sleep hygiene at Time 1. Demographic variables were also collected. One month later, at Time 2, college students (N = 524) self-reported on their volitional factors of maintenance self-efficacy, action planning, coping planning, and behaviors of hand washing and sleep hygiene. A further 2 months later, at Time 3, college students (N = 297) were asked to self-report on their hand washing and sleep hygiene behaviors over the past month. Findings: Data were analyzed using variance-based structural equation modelling. Results showed significant direct effects of attitudes, subjective norm, and perceived behavioral control on intentions; significant direct effects of action self-efficacy on maintenance self-efficacy; and significant direct effects of maintenance self-efficacy on action planning and coping planning. Significant direct effects of intention on action planning (sleep hygiene only), and significant direct effects of intention, maintenance self-efficacy (hand washing only), action and coping planning on behavior were also observed. Action planning also moderated the intention-behavior relationship, but only for hand washing. There were also significant total indirect effects of action self-efficacy on behavior mediated by maintenance self-efficacy, action planning, and coping planning for both behaviors, and significant total indirect effects of subjective norm and perceived behavioral control on behavior mediated by intention for sleep hygiene. When past behavior was included in the integrated model predicting all the psychological variables and behavior, all of the structural relations were attenuated. Discussion: Current findings indicate that college students' hand washing and sleep hygiene behaviors are a function of both motivational and volitional factors. Findings also indicate that the TPB and HAPA pathways might differ for the two health behaviors. Implications of the current findings for future health interventions aimed at improving college students' hand washing and sleep hygiene are discussed.

Section: Introductionmentioning

confidence: 99%

Predicting Hand Washing and Sleep Hygiene Behaviors among College Students: Test of an Integrated Social-Cognition Model

Fang

et al. 2020

IJERPH

“…Hand hygiene is a complex behaviour with a myriad of motivators and barriers. [1,4] While the basic behavioural aspects surrounding HH practices in hospital settings have been widely researched, there remain gaps in the literature regarding effective psychological promotion of hand hygiene compliance (HHC). [4] Psychological frameworks have been shown to lead to behaviour change in a wide variety of contexts, especially in the behaviour of healthcare workers (HCWs).…”

Section: Introductionmentioning

confidence: 99%

“…[1,4] While the basic behavioural aspects surrounding HH practices in hospital settings have been widely researched, there remain gaps in the literature regarding effective psychological promotion of hand hygiene compliance (HHC). [4] Psychological frameworks have been shown to lead to behaviour change in a wide variety of contexts, especially in the behaviour of healthcare workers (HCWs). [5] Therefore, focusing on determinants of behaviour change and employing psychological behaviour change models can better inform HH improvement strategies.…”

Section: Introductionmentioning

confidence: 99%

Determinants of hand hygiene compliance among nurses in US hospitals: A formative research study

Sands

Aunger

2020

PLoS ONE

Hand hygiene is the simplest and most effective measure for preventing healthcareassociated infections. Despite the simplicity of this procedure and advances made in infection control, hospital health care workers' compliance to hand hygiene recommendations is generally low. Nurses have the most frequent patient care interactions, and thus more opportunities to practice hand hygiene. As such, it is important to identify and understand determinants of nurses' reported compliance. Formative research was undertaken to assess the potential impact of several unexamined factors that could influence HH among nurses: professional role and status, social affiliation, social norms, and physical modifications to the work environment (as well as institutional factors like safety climate). A survey questionnaire was developed primarily to inform the creation of a behaviour change intervention. The survey looked at how these factors influence HH among nurses and sought to identify barriers and levers to reported hand hygiene. It was administered to a survey panel of acute care nurses, working in US hospitals, with a year or more of experience. Multivariate regression modelling suggested that reported hand hygiene compliance was most likely to be a function of a hospital management's communication openness, perceived performance by peers, increased interactions with patients and other staff members, and the reduction in stress, busyness, and cognitive load associated with role performance. A powerful, effective intervention on HH among nurses therefore could be directed at improving communication openness, consider the impact of perceived performance by peers, increase interactions with patients and staff, and determine how to reduce the stress and cognitive load associated with role performance.

Applied Psych Health & Well

“…Accumulating research, however, points to a substantial intention-behavior gap which challenges the idea that behavior is mainly the result of deliberative behavior regulation (Gardner, de Bruijn, & Lally, 2011;Sheeran, 2002;Sheeran & Webb, 2016). In the field of hospital hand hygiene, deliberative behavior regulation remains largely unquestioned and dominates empirical work, although mostly without referring to psychological theory (Srigley et al, 2015). The most prominent deliberative construct addressed in this field is knowledge (Erasmus et al, 2010;Huis et al, 2012).…”

Section: Introduction Hand Hygiene Considered From a Dual-process Permentioning

confidence: 99%

On the Role of Habit in Self‐Reported and Observed Hand Hygiene Behavior

Diefenbacher¹,

Pfattheicher

Keller³

2019

Background The present contribution tests the main ideas that (a) hand hygiene behavior is associated with habit, and (b) this association is robust when deliberative constructs (i.e. knowledge and intention) are controlled for, indicating an automatic component in hand hygiene behavior. Methods Two correlational studies using different operationalisations of hand hygiene behavior are reported. In Study 1, hand hygiene was assessed in the context of food preparation; data were measured using the Day Reconstruction Method in a sample of the general population. Study 2 considered hand hygiene compliance of healthcare workers applying video observation by body cameras and additionally self‐reported behavior. In both studies, habit was assessed using the Self‐Report Behavioral Automaticity Index. Results Both studies found the expected positive association between habit and hand hygiene (0.271 < r < 0.570). Habit was further analyzed in combination with knowledge and intention (Study 2), and emerged as a significant predictor of observed hand hygiene, while knowledge and intention were marginally significant. No significant interactions were found. Conclusions The present work provides evidence that hand hygiene behavior is reliably related to habit. The findings speak to the notion that addressing the automatic route to hand hygiene behavior when designing interventions can be fruitful.