Gaube, Susanne; (2021) Understanding the psychological factors influencing hospital patients' and visitors' hand hygiene behavior. Doctoral thesis (Ph.D), University of Regensburg.

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Abstract

Hundreds of millions of patients are affected by healthcare-associated infections (HAIs) worldwide. Action is needed to prevent the transmission of pathogens causing HAIs to reduce risks to patients’ health and burdens on healthcare systems. Hand hygiene is the most effective measure for infection prevention in hospitals. However, hand hygiene among healthcare workers and laypeople is insufficient. Little is known about the facilitators and barriers to patients’ and visitors’ hand hygiene practices. Therefore, the present research project aimed to identify the central determinants of laypeople's hand hygiene in hospitals. In Study 1, a total of N = 1,605 patients and visitors were surveyed about their hand hygiene practice in hospitals. Three questionnaires were deployed to test the theoretical models' (TPB, HAPA, and TDF) effectiveness to predict participants' self-reported hand hygiene behavior. Two clusters of variables surfaced as being essential determinants of behavior: self-regulatory and social influence processes. In Study 2, visitors’ hand hygiene behavior was observed, and they were asked why they did or did not use the hand-rub dispenser in an open-answer format. Overall, N = 838 visitors provided explanations, which were consequently coded according to the same theoretical models employed in Study 1. The critical facilitators and barriers were similar to Study 1, implying that future interventions should focus on (1) visibility and accessibility of cleaning products, (2) informing people about their role in infection prevention, and (3) leveraging social influence processes. In Study 3, we used the previous studies' insights to design and test an intervention to improve visitors’ hand hygiene behavior through persuasive messages. Evidence-based signs were displayed in a hospital lobby, which a total of N = 246,098 people entered or left during the field experiment. Two out of seven signs significantly increased visitors’ dispenser usage rate. In summary, Study 1 and Study 2 indicate that knowing about the importance of hand hygiene, having easy access to hand hygiene products, establishing a norm for practicing hand hygiene, and being reminded to practice hand hygiene are the critical drivers for good hand hygiene behavior. Study 3 showed that a simple and cost-efficient intervention using these insights could improve hand hygiene behavior in hospitals.

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