Capability, Opportunity, Motivation, and Hand Hygiene Behavior in Healthcare Workers: A Structural Equation Modeling

Abstract

Shuangjiang Zheng,1,2 Qiuxia Yang,3 Xuemei Wang,4 Xinping Zhang,1 Qian Zhou5 1School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 2Department of Medical Affairs, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Administration Department, Wuhan Hospital of Traditional Chinese Medicine, Wuhan, People’s Republic of China; 4Administration Department, Nanjing Drum Tower Hospital, Nanjing, People’s Republic of China; 5Department of Hospital Infection Management, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of ChinaCorrespondence: Qian Zhou, Department of Hospital Infection Management, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, No. 100 Xianggang Road, Wuhan, Hubei Province, People’s Republic of China, Tel [phone], Email [email protected] Xinping Zhang, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13. Hangkong Road, Wuhan, Hubei Province, People’s Republic of China, Tel [phone], Email [email protected]: Hand hygiene among healthcare workers is the leading measure to reduce healthcare-associated infections. However, hand hygiene behavior is complex and not readily understood. This study aimed to identify the determinants and the underlying mechanism of hand hygiene behavior based on the capability, opportunity, motivation-behavior model.Methods: A self-constructed questionnaire survey was conducted among healthcare workers in Chongqing, China. Capability, opportunity, and motivation were designed as independent variables, and hand hygiene behavior was measured as a dependent variable. Internal consistency reliability analysis and confirmatory factor analysis were applied to examine the reliability and validity of the questionnaire. Structural equation modeling was performed to explore the relationships among capability, opportunity, motivation, and hand hygiene behavior.Results: Four hundred and ninety-nine physicians and nurses were investigated. The Cronbach’s α coefficients were above 0.764. Confirmatory factor analysis was confirmed with good data fitness. The structural equation modeling had a good fit (root mean square error of approximation=0.070, comparative fit index=0.960, Tucker–Lewis index=0.956). Both opportunity (β=0.265, p< 0.05) and motivation (β=0.333, p< 0.05) directly affected hand hygiene behavior. Both capability (β=0.194, p< 0.001) and opportunity (β=0.719, p< 0.001) were indirectly linked to hand hygiene behavior through motivation.Conclusion: To improve hand hygiene behavior, more efforts need to be focused on resource provision and motivation enhancement in the future compared to training.Keywords: hand hygiene, behavior, COM-B model, healthcare workers

Keywords

• hand hygiene
• behavior
• com-b model
• healthcare workers