Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Implement Sci. 2012 Sep 14;7:92. doi: 10.1186/1748-5908-7-92.
Many strategies have been designed and evaluated to address the problem of low hand hygiene (HH) compliance. Which of these strategies are most effective and how they work is still unclear. Here we describe frequently used improvement strategies and related determinants of behaviour change that prompt good HH behaviour to provide a better overview of the choice and content of such strategies.
Systematic searches of experimental and quasi-experimental research on HH improvement strategies were conducted in Medline, Embase, CINAHL, and Cochrane databases from January 2000 to November 2009. First, we extracted the study characteristics using the EPOC Data Collection Checklist, including study objectives, setting, study design, target population, outcome measures, description of the intervention, analysis, and results. Second, we used the Taxonomy of Behavioural Change Techniques to identify targeted determinants.
We reviewed 41 studies. The most frequently addressed determinants were knowledge, awareness, action control, and facilitation of behaviour. Fewer studies addressed social influence, attitude, self-efficacy, and intention. Thirteen studies used a controlled design to measure the effects of HH improvement strategies on HH behaviour. The effectiveness of the strategies varied substantially, but most controlled studies showed positive results. The median effect size of these strategies increased from 17.6 (relative difference) addressing one determinant to 49.5 for the studies that addressed five determinants.
By focussing on determinants of behaviour change, we found hidden and valuable components in HH improvement strategies. Addressing only determinants such as knowledge, awareness, action control, and facilitation is not enough to change HH behaviour. Addressing combinations of different determinants showed better results. This indicates that we should be more creative in the application of alternative improvement activities addressing determinants such as social influence, attitude, self-efficacy, or intention.
为了解决手卫生（HH）依从性低的问题，已经设计和评估了许多策略。这些策略中哪些最有效，以及它们的作用机制仍不清楚。在此，我们描述了常用的改进策略和相关行为改变的决定因素，以促使良好的 HH 行为，从而更好地概述此类策略的选择和内容。
从 2000 年 1 月至 2009 年 11 月，我们在 Medline、Embase、CINAHL 和 Cochrane 数据库中对 HH 改进策略的实验和准实验研究进行了系统检索。首先，我们使用 EPOC 数据采集清单提取研究特征，包括研究目的、背景、研究设计、目标人群、结果测量、干预措施描述、分析和结果。其次，我们使用行为改变的分类学来确定目标决定因素。
我们回顾了 41 项研究。最常涉及的决定因素是知识、意识、行为控制和行为促进。较少的研究涉及社会影响、态度、自我效能和意图。有 13 项研究使用对照设计来衡量 HH 改进策略对 HH 行为的影响。这些策略的有效性差异很大，但大多数对照研究都显示出积极的结果。这些策略中，只涉及一个决定因素的策略的中位数效果大小为 17.6（相对差异），而涉及五个决定因素的研究的中位数效果大小为 49.5。
通过关注行为改变的决定因素，我们在 HH 改进策略中发现了隐藏的有价值的组成部分。仅解决知识、意识、行为控制和促进等决定因素还不足以改变 HH 行为。解决不同决定因素的组合可以取得更好的效果。这表明，我们应该在应用替代改进活动时更具创造性，这些活动可以解决社会影响、态度、自我效能或意图等决定因素。
