What are healthcare workers' preferences for hand hygiene interventions? A discrete choice experiment

Objectives To understand the key attributes in designing effective interventions for improving healthcare workers' (HCWs') hand hygiene compliance and HCWs' preference for these attributes. Design A discrete choice experiment (DCE) was conducted with five attributes extracted from the framework of Total Quality Management that can be applied in the design of hand hygiene interventions. They were hand hygiene monitoring, open discussion, message framing, resources accessibility and top management involvement. An addition attribute, peer hand hygiene performance, was considered as a contextual factor. Data were analysed by a conditional logit model to evaluate how these attributes impact HCWs' hand hygiene compliance. Setting The DCE was conducted with participants from a university hospital in Taichung. Participants HCWs involved in daily patient-care activities (N=387). Results To enhance their compliance, HCWs had strong and consistent preferences in having open discussion of hand hygiene problems (beta = 0.4977, p < 0.001), easy access to hand hygiene resources (beta = 0.5633, p < 0.001) and top management involvement (beta = 0.4779, p < 0.001). For hand hygiene monitoring (beta = -0.1259, p < 0.1), HCWs preferred to be monitored by infection control staff over their department head if their peer hand hygiene performance was low. On the other hand, when the peer performance was high, monitoring by their department head could improve their hand hygiene compliance. Similarly, how educational messages were framed impacted compliance and also depended on the peer hand hygiene performance. When the peer performance was low, HCWs were more likely to increase their compliance in reaction to loss-framed educational messages (beta = 0.1211, p < 0.1). When the peer performance was high, gain-framed messages that focus on the benefit of compliance were more effective in inducing compliance. Conclusions Each intervention design has its unique impact on HCWs' hand hygiene compliant behaviour. The proposed approach can be used to evaluate HCWs' preference and compliance of an intervention before it is implemented.