Abstract
BackgroundA theoretical approach to assessing the barriers and levers to evidence-based practice (EBP) with subsequent tailoring of theoretically informed strategies to address these may go some way to positively influencing the delay in implementing research findings into practice. Hand hygiene is one such example of EBP, chosen for this study due to its importance in preventing death through healthcare associated infections (HCAI). The development of an instrument to assess barriers and levers to hand hygiene and to allow the subsequent tailoring of theoretically informed implementation strategies is reported here.MethodsA comprehensive list of barriers and levers to hand hygiene were categorised to the Theoretical Domains Framework (TDF) in a Delphi survey. These items formed the basis of an instrument that was tested to establish validity and reliability. The relationship between self-reported compliance with hand hygiene and barriers and levers to hand hygiene was also examined along with compliance according to where the barriers and levers fit within the domains of the TDF framework.ResultsA 33-item instrument that tested well for internal consistency (α = 0.84) and construct validity (χ2/df = 1.9 [p < 0.01], RMSEA = 0.05 and CFA = 0.84) was developed. The relationship between self-reported compliance with hand hygiene moderately correlated with barriers identified by participants (total barrier score) (r = 0.41, n = 276, p <0.001). The greater the number of barriers reported, the lower the level of compliance. A one-way between groups multivariate analysis of variance was performed to investigate differences between those adopting high or low compliance with hand hygiene. Compliance was highest for this sample of participants among practitioners with high levels of motivation, strong beliefs about capabilities, when there were positive social influences, when hand hygiene was central to participants’ sense of professional identity and was easier to remember to do.ConclusionsThis study has produced encouraging findings suggesting the potential for improved hand hygiene and resulting effects on the human and financial costs of healthcare associated infection. This study identifies a further potential use for the TDF.
Highlights
Introduction to psychometric designRoutledge Kegan & Paul; 1986. 29
100 barriers and levers to hand hygiene practice were identified, which were compiled into statements for use in Step 2; for example, where a respondent said that confidence in their ability was a lever to hand hygiene, the statement produced was ‘I am confident in my ability to carry out hand hygiene.’
Construct validity, the relationship between barriers and levers, and compliance with hand hygiene and test-retest reliability The purpose of the second round of instrument testing was construct validation, to see if the specific items of the instrument fitted within the domains of the Theoretical Domains Framework (TDF)
Summary
Introduction to psychometric designRoutledge Kegan & Paul; 1986. 29. Ping RA JrOn assuring valid measures for theoretical models using survey data. The development and/or selection of interventions to implement changes in practice often appears to be done on the basis of intuition rather than theory [5,6,7], and this has led to a call for a different approach. This approach involves: the accurate assessment of barriers and levers to implementation [4,8], and the subsequent tailoring of implementation strategies [4,9]; and a theoretical basis for this assessment of barriers and levers to change, and the tailored implementation interventions [10]. Behaviour change theory provides a sound theoretical basis for addressing issues of implementation [11]
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