Application of a theoretical framework for behaviour change: Examining hospital workers real-time explanations for their non-compliance with hand hygiene guidelines

Fuller Chris, Sarah Jane Besser, McAteer John, Savage Joanne, Sheldon Stone, Susan Michie

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)
92 Downloads (Pure)

Abstract

BACKGROUND:

Insufficient use of behavioral theory to understand health care workers' (HCWs) hand hygiene compliance may result in suboptimal design of hand hygiene interventions and limit effectiveness. Previous studies examined HCWs' intended, rather than directly observed, compliance and/or focused on just 1 behavioral model. This study examined HCWs' explanations of noncompliance in "real time" (immediately after observation), using a behavioral theory framework, to inform future intervention design.

METHODS:

HCWs were directly observed and asked to explain episodes of noncompliance in "real-time." Explanations were recorded, coded into 12 behavioral domains, using the Theory Domains Framework, and subdivided into themes.

RESULTS:

Over two-thirds of 207 recorded explanations were explained by 2 domains. These were "Memory/Attention/Decision Making" (87, 44%), subdivided into 3 themes (memory, loss of concentration, and distraction by interruptions), and "Knowledge" (55, 26%), with 2 themes relating to specific hand hygiene indications. No other domain accounted for more than 18 (9%) explanations.

CONCLUSION:

An explanation of HCW's "real-time" explanations for noncompliance identified "Memory/Attention/Decision Making" and "Knowledge" as the 2 behavioral domains commonly linked to noncompliance. This suggests that hand hygiene interventions should target both automatic associative learning processes and conscious decision making, in addition to ensuring good knowledge. A theoretical framework to investigate HCW's "real-time" explanations of noncompliance provides a coherent way to design hand hygiene interventions.
Original languageEnglish
Pages (from-to)106-110
Number of pages5
JournalAmerican Journal of Infection Control
Volume42
Issue number2
Early online date17 Dec 2013
DOIs
Publication statusPublished - 1 Feb 2014

Keywords

  • behavioral theory
  • noncompliance

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