Development of a behaviour change intervention using a theory-based approach, Behaviour Centred Design, to increase nurses’ hand hygiene compliance in the US hospitals

Abstract

Background A behaviour change campaign is unlikely to be effective if its intervention is not carefully designed. While numerous frameworks are widely used to develop and evaluate interventions, the steps detailing how to create an intervention are not as clear because the process of linking behaviour analysis to the intervention design is seldom discussed. We document the application of the Behaviour Centred Design (BCD) approach to the development of an intervention to improve hand hygiene (HH) rates among nurses’ hospital units in the USA. Methods Intervention development is divided into the first three steps of the BCD approach: Assess, Build, and Create. The Assess step centres on understanding the target behaviour. The Build step expands the knowledge of the target behaviour and population through formative research which leads to a creative brief that explains the focus of the intervention. In the Create step, the creative brief guides the intervention design. Results Drawing from the main findings of the Asses and Build steps, a focal insight was developed positing that nurses can rediscover the meaning and purpose of their role as a nurse and thus as a caregiver by practicing HH; in the process of cleaning their hands, nurses are living up to their ideal nurse-self. The focal insight was linked linguistically into a theory and change. The outcome was a simple intervention, called the Mainspring Intervention, which consisted of three major parts: a self-affirmation exercise to reduce defensiveness, a message that challenged nurses’ perceptions about their HH practice, and an implementation intention activity to help nurses link HH behaviour to a cue. Conclusions We detailed the creation of an original HH intervention that used the BCD approach. The intervention is relatively simple compared to most HH initiatives in the literature, both in terms of having relatively few components to the intervention and relatively easy field implementation. This intervention will allow us to test how specific psychological processes contribute to the problem of low HH rates, how our proposed intervention changes these processes in the hospital setting, and how the expected change in nurses’ cognition transforms over time because of the intervention.

Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study

“…Because senior hospital staff plays a lasting and permanent role, the support and involvement of senior hospital staff, including physicians, may assist in removing barriers to hand washing practice. The fundamental concepts of behavioral patterns of hand hygiene must, however, also be emphasized in order to change individual attitudes toward hand hygiene ( 35 ).…”

Impact of a Multimodal Improvement Strategy to Promote Hand Hygiene at a Hospital in Mauritius

“…Decision makers at healthcare facilities can pick a set of multimodal strategies from the table based on the specific hurdles being faced at their location. Several institutions have found success in the application of particular tools like the Joint Commission Targeted Solutions tool, WHO's Multimodal Hand Hygiene Improvement Strategy, Continuous Quality Improvement processes and through the use of behavioral change theories like the Behaviour Centered Design and the Health Action Process Approach [5][6][7][8][9][10]. [11,12].…”

Process Evaluation of an Acute-Care Nurse-Centred Hand Hygiene Intervention in US Hospitals

“…In this paper, we describe a process evaluation nested within a multiple baseline design—called the Mainspring study—that took place in six acute care units in two medical-surgical teaching hospitals in the United States during 2016–2017. ( Sands & Aunger, 2020 , 2021 ).…”

“…The intervention was developed using the Behaviour Centred Design approach to behaviour change, and it centred on the use of threat to professional identity to prompt change ( Aunger & Curtis, 2016 ). The intervention, delivered via written text, included a message which explained that nurses are known to be less likely to perform HH at room entry than at room exit, drawing attention to the incongruity between the nurses’ current HH practice and their required practice (to protect not only themselves, after potential exposure to pathogens, but patients from exposure to the nurses themselves) ( Sands & Aunger, 2021 ). To increase openness to this potentially threatening message, a values affirmation exercise was included in the beginning ( Crocker et al, 2008 ).…”