Psychometric evaluation of a measure of factors influencing hand hygiene behaviour to inform intervention

Abstract

Psychometric Evaluation of a Measure of Factors Influencing Hand Hygiene Behaviour to Inform Intervention Background. Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained, or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the 'what' (the standards that must be met), but also the 'how' (guidance on how to achieve the standards). Aim. To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered, and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity through comparison with selfreported HH behaviour, and convergent validity through direct unit-level observation of HH behaviour. Methods. The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to Intensive Care Unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs. Findings. A total of 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including Capability, Opportunity, and Motivation, was a significant predictor of self-reported Behavioural intention (F(3,209) =22.58, p<0.001). However, the Opportunity factor was not found to make a significant contribution to the regression model. Conclusion. The COMB HH questionnaire is reliable and valid and provides data to support the development, and evaluation, of HH interventions that meet the needs of specific healthcare units.

Understanding hand hygiene behaviour in the intensive care unit to inform interventions: an interview study

“…The desire to perform HH to protect themselves was mentioned by a third of the interviewees in our study. The propensity towards prioritising the protection of oneself from infection has also been found in other studies of HH compliance [28,36,37], including observations carried out in the two ICUs from which the interviewees in our study worked [24]. In the observations carried out in the ICUs, the staff were 55% compliant before an aseptic technique, as compared to 89% compliant after patient contact [24].…”

“…The fact that healthcare workers believe that they have the requisite knowledge and skills to carry out HH has also been found in other studies [23]. However, observations of 335 moments of HH in the two ICUs at which the interviewees worked found an overall compliance of 64% [24]. This lack of concordance between selfreported and observed HH compliance has also been reported elsewhere [25].…”

“…This is the very reason we recognise the importance of taking a multi-methods approach to understanding HH behaviour. In fact, these interviews were conducted as part of a larger project exploring HH compliance in Irish ICUs in which other methods of assessing HH behaviour were also utilised [4,24,29,39].…”

Localization of the SureWash Pocket® mobile health app to Brazilian Portuguese

“…Conformity with this practice requires strict compliance at the five specific times during health care through the correct technique, time, and adequate products. Although this measure is considered simple, the behavior related to HH is complex and is not readily apprehended or changed, constituting a great challenge to patient and professional safety (3)(4) .…”

Washing our hands of the problem

“…Once compliance has been accurately measured, work can then be undertaken to improve it, the optimal approach to this remains elusive [21][22][23][24][25][26][27][28]. The importance of customizing messaging and interventions: "One size does not fit all" was highlighted in this special edition last year [29] and has been embraced by Salmon et al in the context of the effect of messaging on different healthcare professions [30].…”