TY - JOUR
T1 - Application of a theoretical framework for behavior change to hospital workers' real-time explanations for noncompliance with hand hygiene guidelines
AU - Fuller, Chris
AU - Besser, Sarah
AU - Savage, Joanne
AU - McAteer, John
AU - Stone, Sheldon
AU - Michie, Susan
PY - 2014/2/1
Y1 - 2014/2/1
N2 - 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.
AB - 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.
KW - Behavioral theory
KW - Noncompliance
UR - http://www.scopus.com/inward/record.url?scp=84895068791&partnerID=8YFLogxK
U2 - 10.1016/j.ajic.2013.07.019
DO - 10.1016/j.ajic.2013.07.019
M3 - Article
C2 - 24355490
AN - SCOPUS:84895068791
SN - 0196-6553
VL - 42
SP - 106
EP - 110
JO - American Journal of Infection Control
JF - American Journal of Infection Control
IS - 2
ER -