Article type
Abstract
Background
Promoting guideline implementation requires interventions based on theories appropriate to achieve intended behavior changes on individual or organizational levels. Correspondingly, “tailored” implementation interventions take account of theoretically derived, prospectively identified determinants of the behavior(s). To improve compliance of physicians and nurses with infection prevention and control (IPC) guidelines in German hospitals, that is, with clinical interventions such as hand hygiene, we have been evaluating implementation interventions based on psychological behavior change models (Health Action Process Approach [HAPA] and Capabilities|Opportunities|Motivation-Behavior [COM-B]).
Objectives
To determine the efficacy of psychologically tailored implementation interventions in promoting IPC compliance relative to nontailored practices.
Methods
In transdisciplinary research projects involving hospital epidemiology and medical psychology, and in part health economics, 3 cluster-randomized controlled trials have been/are being carried out: “Psychological optimized hand hygiene promotion” (PSYGIENE, German Clinical Trials Register ID DRKS00010960), “Wound infections and antibiotics use in surgery” (WACH, DRKS00015502), and “Infection prevention with head and heart: psychological empowerment of IPC teams” (IP-POWER, DRKS00031879). Table 1 lists their key attributes (supporting document PSYGIENE_WACH_COMPARED.docx). Assessments of indicators of compliant guideline implementation (hand hygiene in all trials, and 14 pre-, intra-, and postoperative preventive measures in WACH) use direct observation. Tailoring of interventions for clinicians and IPC teams is defined by selecting behavior change techniques matched to empirically assessed determinants. Patients and the public were not involved because the trials exclusively address professional interactions between IPC teams and clinicians.
Results
As Figure 1(a) shows, HAPA-tailored educational training sessions and feedback rounds with clinicians (PSYGIENE) and COM-B-tailored written reports and multiprofessional workshops for IPC teams and other stakeholders (WACH) led to significantly higher hand hygiene compliance than nontailored usual practice (see supporting document RESULTS.jpg), especially among nurses (not shown). In WACH, bundle compliance in terms of compliance with at least 8/10 pre‐ and intraoperative measures per operative procedure increased after tailoring only (see Figure 1(b)). Results from IP-POWER are pending.
Conclusions
Psychological tailoring of implementation interventions to improve compliance with IPC guidelines in hospitals is effective. Physicians remain a bigger challenge than nurses do. Results underline the value of systematically incorporating and applying behavior change models in implementation science.
Promoting guideline implementation requires interventions based on theories appropriate to achieve intended behavior changes on individual or organizational levels. Correspondingly, “tailored” implementation interventions take account of theoretically derived, prospectively identified determinants of the behavior(s). To improve compliance of physicians and nurses with infection prevention and control (IPC) guidelines in German hospitals, that is, with clinical interventions such as hand hygiene, we have been evaluating implementation interventions based on psychological behavior change models (Health Action Process Approach [HAPA] and Capabilities|Opportunities|Motivation-Behavior [COM-B]).
Objectives
To determine the efficacy of psychologically tailored implementation interventions in promoting IPC compliance relative to nontailored practices.
Methods
In transdisciplinary research projects involving hospital epidemiology and medical psychology, and in part health economics, 3 cluster-randomized controlled trials have been/are being carried out: “Psychological optimized hand hygiene promotion” (PSYGIENE, German Clinical Trials Register ID DRKS00010960), “Wound infections and antibiotics use in surgery” (WACH, DRKS00015502), and “Infection prevention with head and heart: psychological empowerment of IPC teams” (IP-POWER, DRKS00031879). Table 1 lists their key attributes (supporting document PSYGIENE_WACH_COMPARED.docx). Assessments of indicators of compliant guideline implementation (hand hygiene in all trials, and 14 pre-, intra-, and postoperative preventive measures in WACH) use direct observation. Tailoring of interventions for clinicians and IPC teams is defined by selecting behavior change techniques matched to empirically assessed determinants. Patients and the public were not involved because the trials exclusively address professional interactions between IPC teams and clinicians.
Results
As Figure 1(a) shows, HAPA-tailored educational training sessions and feedback rounds with clinicians (PSYGIENE) and COM-B-tailored written reports and multiprofessional workshops for IPC teams and other stakeholders (WACH) led to significantly higher hand hygiene compliance than nontailored usual practice (see supporting document RESULTS.jpg), especially among nurses (not shown). In WACH, bundle compliance in terms of compliance with at least 8/10 pre‐ and intraoperative measures per operative procedure increased after tailoring only (see Figure 1(b)). Results from IP-POWER are pending.
Conclusions
Psychological tailoring of implementation interventions to improve compliance with IPC guidelines in hospitals is effective. Physicians remain a bigger challenge than nurses do. Results underline the value of systematically incorporating and applying behavior change models in implementation science.