Background:
Many strategies have been designed and evaluated to address the problem of low handhygiene (HH) compliance. Which of these strategies are most effective and how they work isstill unclear. Here we describe frequently used improvement strategies and relateddeterminants of behaviour change that prompt good HH behaviour to provide a betteroverview of the choice and content of such strategies.
Methods:
Systematic searches of experimental and quasi-experimental research on HH improvementstrategies were conducted in Medline, Embase, CINAHL, and Cochrane databases fromJanuary 2000 to November 2009. First, we extracted the study characteristics using the EPOCData Collection Checklist, including study objectives, setting, study design, target population,outcome measures, description of the intervention, analysis, and results. Second, we used theTaxonomy of Behavioural Change Techniques to identify targeted determinants.
Results:
We reviewed 41 studies. The most frequently addressed determinants were knowledge,awareness, action control, and facilitation of behaviour. Fewer studies addressed socialinfluence, attitude, self-efficacy, and intention. Thirteen studies used a controlled design tomeasure the effects of HH improvement strategies on HH behaviour. The effectiveness of thestrategies varied substantially, but most controlled studies showed positive results. Themedian effect size of these strategies increased from 17.6 (relative difference) addressing onedeterminant to 49.5 for the studies that addressed five determinants.
Conclusions:
By focussing on determinants of behaviour change, we found hidden and valuablecomponents in HH improvement strategies. Addressing only determinants such asknowledge, awareness, action control, and facilitation is not enough to change HH behaviour.Addressing combinations of different determinants showed better results. This indicates thatwe should be more creative in the application of alternative improvement activitiesaddressing determinants such as social influence, attitude, self-efficacy, or intention.