QAPI 128 - Extending the Theory of Planned Behavior to Evaluate Multiple Infection Prevention Practices

Background: Infection prevention and control (IPC) practices are critical for preventing the spread of pathogens to healthcare workers and patients. One of the most important IPC practices is hand hygiene (HH). Interventions targeting HH adherence have been increasingly rooted in theories of behavior change, such as the Theory of Planned Behavior (TPB). The TPB claims that behavior is driven by perceived behavioral control (PBC) and intentions, which are driven by attitudes, subjective norms, and PBC. While the TPB has been applied to understanding HH adherence, its relevance for understanding adherence to other IPC practices is unknown.

Methods: We distributed three questionnaires to registered nurses across three hospitals in October and November 2023. The three IPC practices evaluated by the questionnaires were HH, personal protective equipment (PPE), and cleaning and disinfection. Each questionnaire used agreement scales to assess attitudes, social norms, and PBC and a sliding scale to assess self-reported adherence. For each IPC practice, we performed two linear regressions: one predicted intention from attitudes, social norms, and PBC and the other predicted adherence from intention and PBC.

Results: 58 nurses completed the questionnaires. Significant (α < .05) predictors of intention varied based on the IPC practice: Attitudes predicted intention in cleaning and disinfection, while subjective norms predicted intention for both PPE and cleaning and disinfection. PBC was the only construct that predicted intention across all three IPC practices; however, PBC did not directly predict adherence to any IPC practice whereas intention predicted adherence for both HH and disinfection practices.

Conclusions: As demonstrated by the relationships between adherence and TPB constructs, we conclude that the TPB is relevant to understanding adherence to IPC practices besides HH. The TPB as a theoretical basis for assessing IPC practices can inform future interventions for healthcare workers to prevent the spread of pathogens.