What distinguishes positive deviance (PD) health professionals from their peers and what impact does a PD intervention have on behaviour change: a cross-sectional study of infection control and prevention in three Israeli hospitals.

R Cohen,A Singhal,A.E Moses,S Benenson,A Gesser-Edelsburg

doi:10.1017/s0950268820002484

Abstract

Past studies using the positive deviance (PD) approach in the field of infection prevention and control (IPC) have primarily focused on impacts on healthcare-associated infection rates. This research aimed to determine if health professionals who exhibit PD behaviours have distinctive socio-cognitive profiles compared to non-PD professionals, and to examine the impact of a PD intervention on healthcare professionals' (HPs) behavioural changes in maintaining IPC guidelines. In a cross-sectional study among 135 HPs, respondents first filled out a socio-cognitive characteristics questionnaire, and after 5 months were requested to complete a self-reported behavioural change questionnaire. The main findings indicate that socio-cognitive variables such as external locus of control, perceived threat and social learning were significant predictors of a person exhibiting PD behaviours. Almost 70% of HPs reported behavioural change and creating social networks as a result of the PD intervention in maintaining IPC guidelines, 16.9% of them are a 'PD boosters' (a new group of HPs who have adopted the positive practices of PDs that were originally identified, and also added additional practices of their own). Social networks can contribute to internalizing and raising personal accountability even among non-PD professionals, by creating a mind map that makes each person believe they are an important node in the network, regardless of their status and role. Health intervention programmes should purposely make visible and prominent social network connections in the hospital system.

Highlights

Rising healthcare-associated infections (HAI), resulting in high morbidity and mortality, represent a critical issue of investigation in global public health [1]
A total of 135 healthcare professionals’ (HPs) responded to the questionnaire (Table 1), 38 (28%) of the respondents were identified as positive deviance (PD)
Locus of control (LOC): PDs did not attribute the acquired infections to external causes that depend on the system, with OR 0.65

Summary

Introduction

Rising healthcare-associated infections (HAI), resulting in high morbidity and mortality, represent a critical issue of investigation in global public health [1]. Hand hygiene compliance is reported to be suboptimal, HAI infection rates are high and often rising, and there is extensive resistance to change [3, 4]. Over the past three decades, while multiple intervention programmes have focused on increasing knowledge and awareness about reducing HAIs, the more innovative and effective ones have focused on behaviour models [5,6,7]. Srigley et al [6] in their review emphasised that behavioural models are more effective in raising compliance with infection prevention and control (IPC) guidelines, compared to interventions which only addressed knowledge and awareness. There is a great need to integrate behavioural theory-based interventions with existing programmes to identify factors that motivate health care workers to adhere to IPC guidelines

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