Development of a theory-based instrument to identify barriers and levers to best hand hygiene practice among healthcare practitioners

Implementation Science

Francine Cheater²  Cath Jackson⁴  Rebecca Lawton¹  Judith Dyson³ 

[1] Bradford Institute for Health Research, Duckworth Lane, Bradford, UK;School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK;Faculty of Health and Social Care, University of Hull, Cottingham Road, Hull, UK;Department of Health Sciences, University of York, Heslington, York, UK

关键词: Compliance;    Psychological theory;    Barriers and levers;    Instrument;    Hand hygiene;    Implementation;    Evidence-based practice;   

Others  :  813313
DOI  :  10.1186/1748-5908-8-111

 received in 2013-03-14, accepted in 2013-09-18,  发布年份 2013

【 摘 要 】

Background

A theoretical approach to assessing the barriers and levers to evidence-based practice (EBP) with subsequent tailoring of theoretically informed strategies to address these may go some way to positively influencing the delay in implementing research findings into practice. Hand hygiene is one such example of EBP, chosen for this study due to its importance in preventing death through healthcare associated infections (HCAI). The development of an instrument to assess barriers and levers to hand hygiene and to allow the subsequent tailoring of theoretically informed implementation strategies is reported here.

Methods

A comprehensive list of barriers and levers to hand hygiene were categorised to the Theoretical Domains Framework (TDF) in a Delphi survey. These items formed the basis of an instrument that was tested to establish validity and reliability. The relationship between self-reported compliance with hand hygiene and barriers and levers to hand hygiene was also examined along with compliance according to where the barriers and levers fit within the domains of the TDF framework.

Results

A 33-item instrument that tested well for internal consistency (α = 0.84) and construct validity (χ²/df = 1.9 [p < 0.01], RMSEA = 0.05 and CFA = 0.84) was developed. The relationship between self-reported compliance with hand hygiene moderately correlated with barriers identified by participants (total barrier score) (r = 0.41, n = 276, p <0.001). The greater the number of barriers reported, the lower the level of compliance. A one-way between groups multivariate analysis of variance was performed to investigate differences between those adopting high or low compliance with hand hygiene. Compliance was highest for this sample of participants among practitioners with high levels of motivation, strong beliefs about capabilities, when there were positive social influences, when hand hygiene was central to participants’ sense of professional identity and was easier to remember to do.

Conclusions

This study has produced encouraging findings suggesting the potential for improved hand hygiene and resulting effects on the human and financial costs of healthcare associated infection. This study identifies a further potential use for the TDF.

【 授权许可】

   
2013 Dyson et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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