Improving Hand Hygiene Behavior Using a Novel Theory-Based Intervention During the COVID-19 Pandemic

Abstract

Background Promoting the adoption of personal hygiene behaviors known to reduce the transmission of COVID-19, such as avoiding touching one’s face with unwashed hands, is important for limiting the spread of infections. Purpose We aimed to test the efficacy of a theory-based intervention to promote the avoidance of touching one’s face with unwashed hands to reduce the spread of COVID-19. Methods We tested effects of an intervention employing imagery, persuasive communication, and planning techniques in two pre-registered studies adopting randomized controlled designs in samples of Australian (N = 254; Study 1) and US (N = 245; Study 2) residents. Participants were randomly assigned to theory-based intervention or education-only conditions (Study 1), or to theory-based intervention, education-only, and no-intervention control conditions (Study 2). The intervention was delivered online and participants completed measures of behavior and theory-based social cognition constructs pre-intervention and one-week postintervention. Results Mixed-model ANOVAs revealed a significant increase in avoidance of touching the face with unwashed hands from pre-intervention to follow-up irrespective of intervention condition in both studies, but no significant condition effects. Exploratory analyses revealed significant effects of the theory-based intervention on behavior at follow-up in individuals with low pre-intervention risk perceptions in Study 2. Conclusions Results indicate high adoption of avoiding touching one’s face with unwashed hands, with behavior increasing over time independent of the intervention. Future research should confirm risk perceptions as a moderator of the effect theory-based interventions on infection-prevention behaviors.

Curb the spread: Leveraging intensive longitudinal data to unravel within- and between-person processes in adherence to nonpharmaceutical interventions during COVID-19.

“…We also observed a main effect for momentary regulations (e.g., mandatory mask-wearing indoors), which is perhaps less surprising but at the same time supportive of the notion that regulations in addition to self-regulated motivation (“personal responsibility,” for a comment, see Reicher et al, 2022) can increase the adherence to recommended NPIs. Interventions to increase individual motivation for hygiene show small and inconsistent effects at best (Smith et al, 2022) and would likely profit from supporting regulatory measures.…”

Curb the spread: Leveraging intensive longitudinal data to unravel within- and between-person processes in adherence to behavioral guidelines during Covid-19

“…We also observed a main effect for momentary regulations (e.g., mandatory mask-wearing indoors), which is perhaps less surprising but at the same time supportive of the notion that regulations in addition to self-regulated motivation ("personal responsibility," for a comment, see Reicher, Michie, & West, 2022) can increase the adherence to recommended NPIs. Interventions to increase individual motivation for hygiene show small and inconsistent effects at best (Smith, Hagger, Keech, Moyers, & Hamilton, 2022) and would likely profit from supporting regulatory measures.…”

Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills: protocol for a single-arm pilot trial of Living Well After Stroke

“…Power was set at 0.80, alpha was set at 0.01 (adjusted to protect from inflation of type I error rate due to multiple tests), and the correlation between repeated measures set at 0.70, which was based on previous research that observed strong correlations between repeated measures of behaviour in a HAPA-based behaviour change intervention. 76 The analysis yielded a total minimum required sample size of 118.…”

“…The effect size was set to Cohen’s f=0.10 to detect a conservatively small effect,75 which was chosen due to the lack of previous research on HAPA-based behavioural interventions among survivors of stroke which could inform the expected effect size. Power was set at 0.80, alpha was set at 0.01 (adjusted to protect from inflation of type I error rate due to multiple tests), and the correlation between repeated measures set at 0.70, which was based on previous research that observed strong correlations between repeated measures of behaviour in a HAPA-based behaviour change intervention 76. The analysis yielded a total minimum required sample size of 118.…”