McAteer John, Stone Sheldon, Fuller Christopher, Michie Susan
Scottish Collaboration for Public Health Research and Policy, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK; Department of Psychology, University College London, London, UK.
Royal Free Campus, University College London Medical School, London, UK.
Am J Infect Control. 2014 May;42(5):495-9. doi: 10.1016/j.ajic.2013.12.022. Epub 2014 Mar 20.
The Feedback Intervention Trial was a national trial of an intervention to increase hand hygiene behavior in English and Welsh hospitals. It significantly improved behavior, the effect increasing with fidelity to intervention, but the intervention proved more difficult to implement than anticipated. This study aimed to identify the barriers to and facilitators of implementation as experienced by those who delivered the intervention.
Semistructured interviews were conducted with 17 intervention ward coordinators implementing the intervention. Interview questions were based on the Theoretical Domains Framework. Text relating to each domain was scored according to whether it indicated low or high likelihood of implementation, and thematic analysis conducted.
The lowest scoring domains were "environmental context and resources," "beliefs about capabilities," "social influences," and "emotion." Lack of time and understaffing, perceived negativity from other staff members, and stress were identified as challenges to implementation. The highest scoring domains were "behavioral regulation," "motivation," "skills," "knowledge," and "professional role." Ward coordinators reported that they had the skills, understanding, and motivation to implement the intervention and spoke of consistency of tasks with existing roles.
Implementation might be improved by giving designated time for intervention tasks and ensuring that the ward coordinator role is allocated to staff for whom tasks are commensurate with existing professional roles.
反馈干预试验是一项在英格兰和威尔士医院开展的旨在增加手部卫生行为的全国性干预试验。该试验显著改善了手部卫生行为，且效果随着干预的保真度而增强，但事实证明该干预措施的实施比预期更困难。本研究旨在确定实施干预措施的人员所经历的实施障碍和促进因素。
对17名实施该干预措施的病房协调员进行了半结构化访谈。访谈问题基于理论领域框架。根据文本表明实施可能性低或高，对与每个领域相关的文本进行评分，并进行主题分析。
得分最低的领域是“环境背景与资源”“对能力的信念”“社会影响”和“情绪”。时间不足、人员配备不足、其他工作人员的负面看法以及压力被确定为实施的挑战。得分最高的领域是“行为调节”“动机”“技能”“知识”和“专业角色”。病房协调员报告称，他们具备实施干预措施的技能、理解能力和动机，并提到任务与现有角色的一致性。
通过为干预任务留出指定时间，并确保将病房协调员的角色分配给任务与现有专业角色相称的工作人员，可能会改善实施情况。
