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

Dyson, Judith; Lawton, Rebecca; Jackson, Cath; Cheater, Francine

Abstract

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 (χ 2 /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. © 2013 Dyson et al.; licensee BioMed Central Ltd.

Citation

Dyson, J., Lawton, R., Jackson, C., & Cheater, F. (2013). Development of a theory-based instrument to identify barriers and levers to best hand hygiene practice among healthcare practitioners. Implementation science IS, 8(1), Article ARTN 111. https://doi.org/10.1186/1748-5908-8-111

• Journal Article Type: Article
• Acceptance Date: Sep 18, 2013
• Online Publication Date: Sep 23, 2013
• Publication Date: 2013-12
• Deposit Date: Nov 9, 2017
• Publicly Available Date: Dec 15, 2017
• Journal: Implementation Science
• Print ISSN: 1748-5908
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 8
• Issue: 1
• Article Number: ARTN 111
• DOI: https://doi.org/10.1186/1748-5908-8-111
• Keywords: Evidence-based practice, Implementation, Hand hygiene, Instrument, Barriers and levers, Psychological
• Public URL: https://hull-repository.worktribe.com/output/456415
• Publisher URL: https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-8-111
• Contract Date: Nov 9, 2017