Using psychological theory to understand the challenges facing staff delivering a ward-led intervention to increase hand hygiene behavior: A qualitative study

John McAteer, Sheldon Stone, Christopher Fuller, Susan Michie

Research output: Contribution to journalArticlepeer-review


Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)495-499
Number of pages5
JournalAmerican journal of infection control
Issue number5
Publication statusPublished - May 2014


  • Hand washing
  • Health professional behaviour
  • Implementation
  • Theoretical domains framework

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