Irish Centre for Applied Patient Safety and Simulation, School of Medicine, National University of Ireland Galway, Ireland.
Galway University Hospital, Galway, Ireland.
J Hosp Infect. 2019 Aug;102(4):407-412. doi: 10.1016/j.jhin.2019.02.003. Epub 2019 Feb 13.
Although the hand hygiene (HH) procedure is simple, the related behaviour is complex and is not readily understood, explained or changed. There is a need for practical tools to provide data that can guide healthcare managers and practitioners not only on the 'what' (the standards that must be met), but also the 'how' (guidance on how to achieve the standards).
To develop a valid questionnaire to evaluate attitudes to the factors that influence engagement in HH behaviour that can be readily completed, administered and analysed by healthcare professionals to identify appropriate intervention strategies. Construct validity was assessed using confirmatory factor analysis, predictive validity was assessed through comparison with self-reported HH behaviour, and convergent validity was assessed through direct unit-level observation of HH behaviour.
The Capability, Opportunity, Motivation-Behaviour (COM-B) model was used to design a 25-item questionnaire that was distributed to intensive care unit (ICU) personnel in Ireland. Direct observation of HH behaviour was carried out at two ICUs.
In total, 292 responses to the survey (response rate 41.0%) were included in the analysis. Confirmatory factor analysis resulted in a 17-item questionnaire. Multiple regression revealed that a model including capability, opportunity and motivation was a significant predictor of self-reported behavioural intention [F(3,209)=22.58, P<0.001]. However, the opportunity factor was not found to make a significant contribution to the regression model.
The COM-B HH questionnaire is reliable and valid, and provides data to support the development and evaluation of HH interventions that meet the needs of specific healthcare units.
尽管手部卫生（HH）程序很简单，但相关行为却很复杂，不容易理解、解释或改变。需要实用的工具来提供数据，以便医疗保健管理人员和从业人员不仅了解“什么”（必须满足的标准），还了解“如何”（如何达到标准的指导）。
开发一种有效的问卷来评估影响 HH 行为的因素的态度，该问卷可以由医疗保健专业人员轻松完成、管理和分析，以确定适当的干预策略。使用验证性因素分析评估结构效度，通过与自我报告的 HH 行为进行比较评估预测效度，通过直接观察 HH 行为的单位水平评估收敛效度。
使用能力、机会、动机-行为（COM-B）模型设计了一个包含 25 个项目的问卷，该问卷分发给爱尔兰的重症监护病房（ICU）人员。在两个 ICU 进行了 HH 行为的直接观察。
共纳入 292 份对调查的回复（应答率为 41.0%）进行分析。验证性因素分析产生了一个包含 17 个项目的问卷。多元回归显示，包括能力、机会和动机的模型是自我报告行为意向的重要预测因素[F(3,209)=22.58, P<0.001]。然而，机会因素并未被发现对回归模型做出显著贡献。
COM-B HH 问卷可靠且有效，提供的数据支持针对特定医疗单位需求开发和评估 HH 干预措施。
