Schutte Miriam, Dekker Mireille, Sikkens Jonne, van Mansfeld Rosa
Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands.
Antimicrob Resist Infect Control. 2025 May 15;14(1):50. doi: 10.1186/s13756-025-01572-z.
Application of standard infection prevention and control (IPC) measures is crucial to prevent hospital-acquired infections, but compliance by physicians is suboptimal. Interventions aimed to improve compliance are often generic and lack sustained effects. A better understanding of physicians' trade-offs regarding application of IPC and influences on their behavior is needed to develop effective behavior change interventions. We aimed to understand physicians' decision-making processes around application of IPC and the factors that influence their behavior.
This qualitative study involved semi-structured interviews with 18 physicians and 7 nurses from five different hospitals in the Netherlands. Reflexive thematic analysis involved inductive coding followed by deductive analysis using mechanisms of action, including the Theoretical Domains Framework, that link to behavior change techniques.
We found heterogeneity in physicians' approaches to decision-making around application of IPC. Some physicians relied on heuristics, while others applied logical reasoning. The latter group made an autonomous assessment of the risks for infection associated with a situation and traded off the costs and benefits of IPC application. The decision was further influenced by personal beliefs about the value of IPC and a supporting physical and social environment. Eighteen out of 26 mechanisms of action underlying the influences on IPC behavior were matched to our results; most important are "memory, attention and decision processes", "behavioral cueing", "beliefs about consequences", "values", "norms", "social influences", "social learning/imitation" and "environmental context and resources". These findings suggest that interventions are most likely to be beneficial if these focus on developing heuristics, changing risk beliefs, using social norms and imitation and generating a supportive environment.
The heterogeneity in physicians' decision-making and autonomous risk assessment which is different from other healthcare professionals calls for tailored interventions targeting heuristic decision making, personal beliefs, social norms and the environmental context.
应用标准的感染预防与控制（IPC）措施对于预防医院获得性感染至关重要，但医生的依从性并不理想。旨在提高依从性的干预措施通常比较笼统，且缺乏持续效果。为了制定有效的行为改变干预措施，需要更好地理解医生在应用IPC方面的权衡以及对其行为的影响。我们旨在了解医生围绕IPC应用的决策过程以及影响其行为的因素。
这项定性研究包括对荷兰五家不同医院的18名医生和7名护士进行半结构化访谈。反思性主题分析包括归纳编码，随后使用行动机制进行演绎分析，这些行动机制包括与行为改变技术相关的理论领域框架。
我们发现医生在围绕IPC应用的决策方法上存在异质性。一些医生依赖启发式方法，而另一些医生则运用逻辑推理。后一组医生会自主评估与某种情况相关的感染风险，并权衡应用IPC的成本和收益。该决策还受到对IPC价值的个人信念以及支持性的物理和社会环境的进一步影响。对IPC行为产生影响的26种行动机制中有18种与我们的结果相匹配；最重要的是“记忆、注意力和决策过程”、“行为提示”、“对后果的信念”、“价值观”、“规范”、“社会影响”、“社会学习/模仿”以及“环境背景和资源”。这些发现表明，如果干预措施侧重于开发启发式方法、改变风险信念、利用社会规范和模仿以及营造支持性环境，那么这些干预措施最有可能产生有益效果。
医生决策的异质性以及与其他医疗专业人员不同的自主风险评估要求针对启发式决策、个人信念、社会规范和环境背景制定量身定制的干预措施。
