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. 2021 Jan 14;16(1):e0245543.
doi: 10.1371/journal.pone.0245543. eCollection 2021.

Hand(y) hygiene insights: Applying three theoretical models to investigate hospital patients' and visitors' hand hygiene behavior

Susanne Gaube  1 , Peter Fischer  1 , Eva Lermer  2   3
Affiliations

Hand(y) hygiene insights: Applying three theoretical models to investigate hospital patients' and visitors' hand hygiene behavior

Susanne Gaube et al. PLoS One. .

Abstract

Background: Improving hand hygiene in hospitals is the most efficient method to prevent healthcare-associated infections. The hand hygiene behavior of hospital patients and visitors is not well-researched, although they pose a risk for the transmission of pathogens. Therefore, the present study had three aims: (1) Finding a suitable theoretical model to explain patients' and visitors' hand hygiene practice; (2) Identifying important predictors for their hand hygiene behavior; and (3) Comparing the essential determinants of hand hygiene behavior between healthcare professionals from the literature to our non-professional sample.

Methods: In total N = 1,605 patients and visitors were surveyed on their hand hygiene practice in hospitals. The employed questionnaires were based on three theoretical models: a) the Theory of Planned Behavior (TPB); b) the Health Action Process Approach (HAPA); and c) the Theoretical Domains Framework (TDF). Structural equation modeling was used to analyze the data. To compare our results to the determinants of healthcare workers' hand hygiene behavior, we searched for studies that used one of the three theoretical models.

Results: Among patients, 52% of the variance in the hand hygiene behavior was accounted for by the TDF domains, 44% by a modified HAPA model, and 40% by the TPB factors. Among visitors, these figures were 59%, 37%, and 55%, respectively. Two clusters of variables surfaced as being essential determinants of behavior: self-regulatory processes and social influence processes. The critical determinants for healthcare professionals' hand hygiene reported in the literature were similar to the findings from our non-professional sample.

Conclusions: The TDF was identified as the most suitable model to explain patients' and visitors' hand hygiene practices. Patients and visitors should be included in existing behavior change intervention strategies. Newly planned interventions should focus on targeting self-regulatory and social influence processes to improve effectiveness.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Frequency distribution of self-reported hand hygiene behavior in hospitals.
Fig 2
Fig 2. TPB path models with standardized parameter estimates to predict hand hygiene behavior.
Note: * p < .05, ** p < .001, n(total patients) = n(used patients) = 286, n(total visitors) = 251, n(used visitors) = 248.
Fig 3
Fig 3. HAPA path models with standardized parameter estimates to predict hand hygiene behavior.
Note: * p < .05, ** p < .001, n(total patients) = 266, n(used patients) = 255, n(total visitors) = 264, n(used visitors) = 257.
Fig 4
Fig 4. TDF path models with standardized parameter estimates to predict hand hygiene behavior.
Note: * p < .05, ** p < .001, n(total patients) = 293, n(used patients) = 273, n(total visitors) = 245, n(used visitors) = 238.
See this image and copyright information in PMC

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