Background Hand hygiene is crucial to avoid healthcare‐associated infections and the transmission of COVID‐19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social‐cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers’ adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID‐19 pandemic. Methods In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods ( pre‐COVID‐19 pandemic , heightened awareness , and strict precautions ). In addition, 115 healthcare workers answered questionnaires regarding social‐cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations. Results Adherence to hand hygiene recommendations increased from 47 per cent pre‐COVID‐19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self‐efficacy was associated with the intention to sanitise hands (β = .397, p < .001). Coping self‐efficacy mediated the association of intention with hand hygiene adherence. Conclusions Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID‐19 pandemic. To further improve interventions, social‐cognitive determinants should be considered, especially intention and (coping) self‐efficacy.

Background: Patient safety is a key target in public health, health services and medicine. Communication between all parties involved in gynecology and obstetrics (clinical staff/professionals, expectant mothers/patients and their partners, close relatives or friends providing social support) should be improved to ensure patient safety, including the avoidance of preventable adverse events (pAEs). Therefore, interventions including an app will be developed in this project through a participatory approach integrating two theoretical models. The interventions will be designed to support participants in their communication with each other and to overcome difficulties in everyday hospital life. The aim is to foster effective communication in order to reduce the frequency of pAEs. If communication is improved, clinical staff should show an increase in work satisfaction and patients should show an increase in patient satisfaction. Methods: The study will take place in two maternity clinics in Germany. In line with previous studies of complex interventions, it is divided into three interdependent phases. Each phase provides its own methods and data. Phase 1: Needs assessment and a training for staff (n = 140) tested in a pre-experimental study with a pre/post-design. Phase 2: Assessment of communication training for patients and their social support providers (n = 423) in a randomized controlled study. Phase 3: Assessment of an app supporting the communication between staff, patients, and their social support providers (n = 423) in a case-control study. The primary outcome is improvement of communication competencies. A range of other implementation outcomes will also be assessed (i.e. pAEs, patient/treatment satisfaction, work satisfaction, safety culture, training-related outcomes). Discussion: This is the first large intervention study on communication and patient safety in gynecology and obstetrics integrating two theoretical models that have not been applied to this setting. It is expected that the interventions, including the app, will improve communication practice which is linked to a lower probability of pAEs. The app will offer an effective and inexpensive way to promote effective communication independent of users' motivation. Insights gained from this study can inform other patient safety interventions and health policy developments.

COVID‐19 restrictions such as lockdowns or quarantines may increase the risk for social isolation and perceived loneliness. The mechanisms can be modeled by Cacioppo's Evolutionary Theory of Loneliness (ETL), which predicts that a lack of perceived social connectedness may lead, in the long‐term, to mental and physical health consequences. However, the association between COVID‐19 pandemic distress, mental health, and loneliness is not sufficiently understood. The present longitudinal study examined the relationship between distress and depression, and the mediating effects of anxiety and loneliness in a German rehabilitation sample ( N = 403) at two timepoints (≤6 weeks pre‐rehabilitation; ≥12 weeks post‐rehabilitation; mean time between T1 and T2 was  52 days). Change scores between T1 and T2 were examined for the variables COVID‐19 Peritraumatic Distress Index (CPDI), anxiety, loneliness, and depression. The results of the serial mediation analysis indicated that anxiety and loneliness were able to explain the relationship between distress and depression with 42% of variance in depression accounted for. Findings extend research on the relationship between COVID‐19 and mental health by considering anxiety and loneliness as sustaining factors of depressive symptoms, thus, successfully applying the ETL. Results stress the necessity to consider anxiety and loneliness in the treatment or prevention of depression.

Patient safety is an important objective in health care. Preventable adverse events (pAEs) as the counterpart to patient safety are harmful incidents that fell behind health care standards and have led to temporary or permanent harm or death. As safe communication and mutual understanding are of crucial importance for providing a high quality of care under everyday conditions, we aimed to identify barriers and facilitators that impact safe communication in obstetrics from the subjective perspective of health care workers. A qualitative study with 20 semi-structured interviews at two university hospitals in Germany was conducted to explore everyday perceptions from a subjective perspective (subjective theories). Physicians, midwives, and nurses in a wide span of professional experience and positions were enrolled. We identified a structural area of conflict at the professional interface between midwives and physicians. Mandatory interprofessional meetings, acceptance of subjective mistakes, mutual understanding, and debriefings of conflict situations are reported to improve collaboration. Additionally, emergency trainings, trainings in precise communication, and handovers are proposed to reduce risks for pAEs. Furthermore, the participants reported time-constraints and understaffing as a huge burden that hinders safe communication. Concluding, safety culture and organizational management are closely entwined and strategies should address various levels of which communication trainings are promising.

(1) Background: Obstetric work requires good communication, which can be trained through interventions targeting healthcare providers and pregnant women/patients. This systematic review aims to aggregate the current state of research on communication interventions in obstetrics. (2) Methods: Using the PICOS scheme, we searched for studies published in peer-reviewed journals in English or German between 2000 and 2020. Out of 7018 results, 71 studies were included and evaluated in this synthesis using the Oxford Level of Evidence Scale. (3) Results: The 63 studies that included a communication component revealed a positive effect on different proximal outcomes (i.e., communication skills). Three studies revealed a beneficial effect of communication trainings on distal performance indicators (i.e., patient safety), but only to a limited extent. Most studies simultaneously examined different groups, however, those addressing healthcare providers were more common than those with students (61 vs. 12). Only nine studies targeted expectant mothers. Overall, the evidence level of studies was low (only 11 RCTs), with 24 studies with an evidence level I-II, 35 with level III, and 10 with level IV. (4) Conclusions: Communication trainings should be more frequently applied to improve communication of staff, students, and pregnant women and their partners, thereby improving patient safety.

Zusammenfassung Hintergrund Soziale Isolation ist ein Risikofaktor für Einsamkeit und damit für gesundheitliche Beeinträchtigungen. Veränderungen im Zusammenhang mit der Coronapandemie in Deutschland gilt es besser zu verstehen. Fragestellung Ziel der Studie war es, Einsamkeit und assoziierte Faktoren vor und während der Coronapandemie in Deutschland systematisch zu untersuchen. Die Fragestellungen waren: 1. Wie einsam fühlen sich Menschen vor und während der Coronapandemie? 2. Wie viele Menschen fühlen sich seit Beginn der Coronapandemie einsamer? 3. Wie viele Menschen berichten über gesundheitliche Belastungen während der Coronapandemie? Material und Methoden Im Jahr 2019 (vor der Coronapandemie) wurden 1003 und im Jahr 2020 (während der Coronapandemie) 1050 Erwachsene online befragt (51 % Frauen; 18–90 Jahre). Ergebnisse Es fühlten sich 10,8 % vs. 26,6 % der Befragten vor bzw. seit der Coronapandemie mehrfach pro Woche oder täglich einsam. Alleinlebende, Frauen und Jüngere fühlten sich häufiger einsam. Seit der Coronapandemie fühlten sich 30,8 % einsamer, v. a. Jüngere. Von starken gesundheitlichen Belastungen berichteten 18,9 %, dies hing mit jüngerem Alter, verschiedenen Sorgen/Ängsten und Einsamkeit zusammen. Diskussion Die höhere Ausprägung der Einsamkeit und Sorgen während der Coronapandemie sollte bei verhaltensbezogenen Maßnahmen zur Prävention der psychischen und körperlichen Beeinträchtigungen sowie behördlichen Maßnahmen berücksichtigt werden. Jüngere Menschen und Alleinlebende könnten profitieren, indem sie zu gezielten Bewältigungsstrategien (z. B. angemessener Nutzung digitaler Medien) ermutigt werden.

Identifying modifiable correlates of older adults’ preventive behaviors is contributable to the prevention of the COVID-19 and future pandemics. This study aimed to examine the associations of social-cognitive factors (motivational and volitional factors) with three preventive behaviors (hand washing, facemask wearing, and physical distancing) in a mixed sample of older adults from China and Germany and to evaluate the moderating effects of countries. A total of 578 older adults (356 Chinese and 222 German) completed the online cross-sectional study. The questionnaire included demographics, three preventive behaviors before and during the pandemic, motivational factors (health knowledge, attitude, subjective norm, risk perception, motivational self-efficacy (MSE), intention), and volitional factors (volitional self-efficacy (VSE), planning, and self-monitoring) of preventive behaviors. Results showed that most social-cognitive factors were associated with three behaviors with small-to-moderate effect sizes (f2 = 0.02 to 0.17), controlled for demographics and past behaviors. Country moderated five associations, including VSE and hand washing, self-monitoring and facemask wearing, MSE and physical distancing, VSE and physical distancing, and planning and physical distancing. Findings underline the generic importance of modifiable factors and give new insights to future intervention and policymaking. Country-related mechanisms should be considered when aiming to learn from other countries about the promotion of preventive behaviors.

Background Because the clinical patterns and symptoms that persist after a COVID-19 infection are diverse, a diagnosis of post-acute COVID-19 syndrome (PACS) is difficult to implement. The current research project therefore aims to evaluate the feasibility and the practicability of a comprehensive, interdisciplinary, and cross-sectoral treatment program consisting of a low-threshold online screening and holistic assessment for PACS. Furthermore, it aims to evaluate digital interventions and the use of so-called personal guides that may help to facilitate the recovery of PACS. Methods This German study consists of a low-threshold online screening for PACS where positively screened participants will be supported throughout by personal pilots. The personal pilots are aimed at empowering patients and helping them to navigate through the study and different treatment options. Patients will then be randomly assigned either to an intervention group (IG) or an active control group (ACG). The IG will receive a comprehensive assessment of physiological and psychological functioning to inform future treatment. The ACG does not receive the assessment but both groups will receive a treatment consisting of an individual digital treatment program (digital intervention platform and an intervention via a chatbot). This digital intervention is based on the needs identified during the assessment for participants in the IG. Compared to that, the ACG will receive a more common digital treatment program aiming to reduce PACS symptoms. Importantly, a third comparison group (CompG) will be recruited that does not receive any treatment. A propensity score matching will take place, ensuring comparability between the participants. Primary endpoints of the study are symptom reduction and return to work. Secondary outcomes comprise, for example, social participation and activities in daily life. Furthermore, the feasibility and applicability of the online screening tool, the holistic assessment, digital trainings, and personal pilots will be evaluated. Discussion This is one of the first large-scale studies to improve the diagnosis and the care of patients with PACS by means of empowerment. It is to be evaluated whether the methods utilized can be used for the German and international population. Trial registration ClinicalTrials.gov Identifier: NCT05238415; date of registration: February 14, 2022