The use of behaviour change theory for infection prevention and control practices in healthcare settings: A scoping review

Abstract

Background Infection prevention and control (IPC) practices performed by healthcare workers are key to the prevention and management of infections. Compliance with IPC practices is often low, they are therefore commonly the focus of improvement interventions. Designing interventions that are based on behaviour change theories may help to improve compliance to practice. The aim of this review is to synthesise the evidence on the application of behaviour change theories to interventions to improve IPC practice in healthcare settings. Methods A scoping review was conducted following the Joanna Briggs Institute methodological framework. The theories of focus were the Theoretical Domains Framework (TDF), Capability, Opportunity, Motivation, Behaviour (COM-B) and Behaviour Change Wheel (BCW). Studies which applied these theories to any IPC practice were included. Results Eleven studies were identified which met the inclusion criteria. The IPC behaviours investigated were hand hygiene (7), antimicrobial stewardship (3), and MRSA screening (1). Nine studies explored barriers and facilitators to existing IPC practice; three used their findings to design a behaviour change intervention or tool. Domains of ‘beliefs about consequences’, ‘environmental context/resources’, and ‘social/professional role and identity’ were identified as key across all three IPC behaviours. Discussion This review has demonstrated the use of behavioural theories to understand determinants of behaviour related to IPC practice. Currently, there are few published examples of interventions to improve IPC practice that have been underpinned by behavioural theory. Practitioners in IPC should consider the use of these methods to enhance the efficacy of strategies to change healthcare worker behaviour.

Describing capability, opportunity, and motivation for food safety practices among actors in the Cambodian informal vegetable market

“…Since their creation, however, these models have been used in a variety of fields and have been applied most often in research regarding the promotion of health-related behaviors (e.g., dental hygiene, sexual health, weight management, exercise, hand hygiene, smoking cessation, etc. ; Cowdell and Dyson, 2019;Buchanan et al, 2021;Greene and Wilson, 2022). The COM-B model and TDF have also been applied, albeit to a much more limited extent, to research on food safety behavior change.…”

Applying the behaviour change wheel to assess the theoretical underpinning of a novel smartphone application to increase physical activity in adults with spinal cord injuries

“…At the core of the wheel is the capability, opportunity, motivation, and behaviour (COM-B) model (59,66), which postulates that changing behaviour is reliant upon three components: physical and psychological capability, physical and social opportunity, and reflective and automatic motivation (67,68). A mid ring on the BCW incorporates nine intervention functions (69,70), and the outer ring comprises seven policy options (71,72), which can support the delivery of the intervention functions (73). The BCW links influences on behaviour identified by the COM-B to potential intervention functions and policy categories (64).…”

Perspectives on research needs in healthcare epidemiology, infection prevention, and antimicrobial stewardship: what’s on the horizon—Part I

“…The latter opens up an entire field of research, the behavioral science of infection prevention. 29 Notably, to our knowledge, most institutions do not provide specific training for proper PPE donning and doffing procedures outside of the use of N95 respirators, which occurs in the form of "fit testing." Default gowning and gloving for contact precautions are meant to make things easy; however, not every patient interaction requires the use of a gown (it may only be necessary when in immediate physical contact with the patient).…”

“…Future research should engage behavioral science to understand how the IPC expert can be an "influencer" and modify healthcare worker behavior. 29,55 Simulation and hands-on learning should be studied more extensively as should novel ways of delivering education content (e.g., the "room of horrors" approach to identifying medical errors in a mock patient room 56 ). Moreover, the concept of "change management" has been used in the pharmaceutical industry for decades but has become more commonly heard in healthcare only recently; it deserves being applied to IPC endeavors, too.…”