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J Hosp Infect. 2018 Dec 28. pii: S0195-6701(18)30719-9. doi: 10.1016/j.jhin.2018.12.014. [Epub ahead of print]

Application of the Theoretical Domains Framework to identify factors that influence hand hygiene compliance in long-term care.

Author information

1
Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada.
2
Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada. Electronic address: kim.corace@theroyal.ca.
3
Department of Psychology, Queen's University, Kingston, ON, Canada.
4
Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

BACKGROUND:

Healthcare worker (HCW) hand hygiene compliance is key to patient safety; however, compliance is suboptimal. Nevertheless hand hygiene compliance is not well studied in the long-term care setting.

AIM:

To apply a behaviour change framework, the Theoretical Domains Framework (TDF), to identify modifiable facilitators and barriers for HCW hand hygiene compliance in long-term care settings.

METHODS:

HCW hand hygiene compliance facilitators and barriers were examined using a questionnaire for HCWs from long-term care homes in Ontario, Canada. The questionnaire was informed by the TDF, which is based on a synthesis of constructs from a number of relevant psychological theories of behaviour change.

FINDINGS:

Barriers identified from the questionnaire aligned with the TDF domain environmental context and resources (time pressure, workload, and environmental controls). Facilitators identified from questionnaire results aligned with the TDF domains social/professional role and identity (it is what is expected of HCWs), and beliefs about consequences (risk of transmission of micro-organisms to self or others).

CONCLUSION:

There are several barriers to hand hygiene compliance that persist in long-term care. A behaviour change theory-informed framework such as the TDF can be helpful to identify those barriers. This study identified several key behavioural constructs aligned with the TDF that can be targeted when developing novel hand hygiene interventions.

KEYWORDS:

Behaviour change theory; Compliance; Hand hygiene; Healthcare workers; Theoretical Domains Framework

PMID:
30594611
DOI:
10.1016/j.jhin.2018.12.014
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