Translating a theory-based positive deviance approach into an applied tool: Mitigating barriers among health professionals (HPs) regarding infection prevention and control (IPC) guidelines

Abstract

Background Although a wide range of intervention programs and methods have been implemented to increase health professionals’ (HPs) adherence with infection prevention and control (IPC) guidelines and decrease the incidence of healthcare associated infections (HAIs), a significant discrepancy remains between the guidelines and their implementation in practice. Objectives This study proposes an applied tool based on the integrated theoretical framework of the positive deviance (PD) approach for developing more effective interventions to mitigate this discrepancy. Methods A qualitative study guided by the PD approach based on data from two sources: (1) in-depth archival analysis of systematic review articles, and (2) integration and synthesis of findings based on an extensive empirical study we conducted, involving 250 HPs (nurses, physicians, support staff and cleaning staff) from three governmental hospitals in Israel, over 35 months (January 2017 to November 2020). Results The barriers faced by HPs were classified into four main categories: (1) individual-motivational, (2) social-cultural, (3) organizational, and (4) work environment and resource-centered. For each barrier, we constructed a set of questions based on the PD approach. For each question, we adapted and applied methodological tools (e.g., in-depth interviews, focus groups, social network maps, video clips and simulations) to help solve the problem. Conclusion Translating a theory-based approach into an applied tool that offers step-by-step actions can help researchers and practitioners adopt and implement the approach within intervention programs to mitigate barriers.

Advanced theoretical-applied model based on the PD approach in the light of healthcare-associated infections: what have we achieved so far?

“…Therefore, we saw great importance in the methodological applied expansion we conducted in our study, which can allow for more detailed insights into the study quality and degree of intervention implementation. A detailed description of the intervention methodology, with its applied steps and tools, may greatly assist researchers and professionals implementing similar studies in a variety of healthcare settings ( 12 ). This point was also raised in the article by Zingg et al ( 29 ) which presents the conclusions of 42 experts from the IPC field [Geneva infection prevention and control (IPC) – think tank 2017) who came together to develop an IPC vision, a plan on how to prevent antimicrobial resistance (AMR), and to agree on a road map for research and public health activities.…”

“…To handle this challenge, we translated the positive deviance approach to an applied methodological tool, proposing step-by-step actions to mitigate barriers and minimize the existing ambiguity between the written guidelines to the work in the field, among HPs. The methodological tool is used as tool kit to find applicable solutions for each barrier identified through interviews, focus groups, and observations, to promote the use of PD practices that are not found in the official IPC guidelines ( 12 ).…”

Tuberculosis infection prevention and control in rural Papua New Guinea: An evaluation using the Infection Prevention and Control Assessment Framework

“…For instance, among the low-income countries studied, only nine (45%) indicated having a national IPC program, four (20%) guidelines on implementation methods, and one (5%) monitored compliance with IPC practice (5). The global assessment showed that more efforts are needed to strengthen IPC strategies in low-income countries susceptible to disease outbreaks such as COVID-19 and tuberculosis (12).…”