1004. Hospital workers’ “real-time” explanations for their non-compliance with hand hygiene guidelines: application of a theoretical framework for behaviour change
Session: Poster Abstract Session: Hand Hygiene 2012
Friday, October 19, 2012
Room: SDCC Poster Hall F-H

Use of behavioural theory to understand healthcare workers’ (HCWs’) explanations for poor hand hygiene compliance is limited. Previous studies have not examined HCWs’ explanations in “real time” (i.e. shortly after the observed behaviour). This study examined HCWs’ “real time” explanations of non-compliance, using behavioural theory. 


During a hand hygiene intervention trial, HCWs were directly observed and asked to explain episodes of non-compliance. Explanations were coded into domains using a behavioural theory framework (the Theory Domains Framework) and further subdivided into themes.


A total of 207 explanations were coded into domains: 87 (42%) as ‘Memory/Attention/Decision Making’, 55 (26%) as ‘Knowledge’ and 18 (9%) as ‘Environmental Context/Resources’; 16 explanations (8%) were coded into other domains and 31 (15%) could not be coded. Within ‘Memory/Attention/Decision-Making’, three themes were identified: memory (n=40) ; loss of concentration (n=29) and distraction by interruptions (n=23). Within ‘Knowledge’, HCWs demonstrated ignorance of indications for hand-hygiene specifically around wearing gloves (n=18), and environmental contacts (n=17). Two themes were identified within ‘Environmental Context/Resources’: workload, and lack of resources (n=15).


Behavioural domains most commonly associated with poor hand hygiene compliance were ‘Memory/Attention/Decision Making’, ‘Knowledge’ and ‘Environmental Context’. Hand hygiene interventions should target conscious decision making and automatic processes as well as more conscious processes. These findings may not generalise to other settings or contexts, but the method of recording explanations for non-compliance in “real time” and coding these with a behavioural framework provides a theoretically coherent way to design hand hygiene interventions.

Christopher Fuller1, Sarah Besser2, Joanne Savage1, John McAteer3, Susan Michie1 and Sheldon Stone1, (1)University College London, London, United Kingdom, (2)King's College London, London, United Kingdom, (3)MRC Edinburgh, Edinburgh, United Kingdom


C. Fuller, None

S. Besser, None

J. Savage, None

J. McAteer, None

S. Michie, None

S. Stone, GOJO industries: Received research support funding from GOJO industries, Research support

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