HandWashing Compliance amongst HealthCare Workers… · HandWashing Compliance amongst HealthCare...

HandWashing Compliance amongst HealthCare Workers: a

socio-cognitive contribution

Magda Sofia [email protected]

Social and Organizational PsychologistPh.d StudentISCTE, Lisbon

Presentation University of Aberdeen: Doctoral Programme

19th 19th NovemberNovember 20072007

Supervised by:Professor Silvia Silva (ISCTE)

Professor Kathryn Mearns (University of Aberdeen)

February 08 HandWashing amongst HealthCare Workers 2

HealthCareHealthCare Sector: Sector: ProblemProblem

�� InfectiousInfectious PathologyPathology�� HospitalizedHospitalized patientspatients�� IncreasesIncreases hospitalizationhospitalization timetime�� IncreasesIncreases mortalitymortality

�� TwoTwo--wayway hazardhazard noxiousnoxious to to bothboth::�� HealthCareHealthCare WorkersWorkers�� PatientsPatients

�� BacteriaBacteria transmissiontransmission occuroccur::�� CrossCross--InfectionsInfections ((transmittedtransmitted fromfrom patientpatient to to healthcarehealthcare

workerworker))�� Nosocomial Nosocomial InfectionsInfections ((resultresult of of treatmenttreatment inin a hospital, a hospital,

butbut secondarysecondary to to patientspatients original original conditioncondition))e.g. CDC, 2003; Dorsey, Cydulka & Emerman (1996); Fay (1996)


HealthCareHealthCare Sector: Sector: StatisticsStatistics

�� MostMost frequentfrequent crosscross--infectionsinfections

� Hepatitis B (66 thousandHealthCare Workers infectedper year)

� Hepatitis C (16 thousandHealthCare Workers infectedper year)

� HIV (1000 HealthCareWorkers infected per year)

�� PredictedPredicted mortalitymortality� 1.100 HealthCare Workers

may die every year

�� MostMost frequentfrequent nosocomialnosocomialinfectionsinfections� Urinary tract

� Pneumonias

�� AnnualAnnual IncidenceIncidence� 2 million cases per year� 3 cases per minute

�� PredictedPredicted MortalityMortality� 80,000 deaths per year� 9 deaths per hour

Pruss-Uskin, Rapiti & Hutin, 2005; Sekpowitz, 1996; CDC, 1995

HealthCareHealthCare WorkersWorkers andand PatientsPatients are are dailydaily exposedexposed to:to:

3 3 typestypes of of pathogenspathogens ((bloodblood--borneborne, , airair--borneborne, facial/ , facial/ oraloral--borneborne))

Patient Safety in American Hospitals, Health Grades 2004; Starfield, 2000;


HealthCare Sector: Prevention

How to prevent hospital infections?

To comply with safety procedures, namely Universal Precautions

Universal Precautions Definition?

Safety rules that aim to reduce the transmission of virusesamongst patients and HealthCare Workers (e.g. use of

gloves, masks, washing hands properly)

Compliance to Universal Precautions?

Suboptimal adherence amongst HealthCare Workers with data indicating compliance rates lesser than 50%

Health & Safety Executive, 2006; CDC, 2003


Universal Universal PrecautionsPrecautions: : HandWashingHandWashing

HandWashingHandWashing DefinitionDefinition??

Action that decreases the colonization of transient flora foundon the skin

IsIs HandWashingHandWashing thethe mostmost importantimportant Universal Universal PrecautionPrecaution??

1. Since 19th century: hand hygiene is an effective way to decrease hospital infections (e.g. Nogueras, Marinsalta, Roussell, Notario, 2001);

2. Wearing gloves does not provide complete protectionagainst acquisition of infections (e.g. Reingold, Kane, Hightower, 1989);

HandWashingHandWashing ComplianceCompliance??

Compliance rates continue to be less than 50% (e.g. Pittet, 2006; CDC, 2002)


Universal Universal PrecautionsPrecautions & & HandWashingHandWashing: :

findingsfindings (I)(I)

WithinWithin thethe HealthCareHealthCare Sector, Sector, studiesstudies focusingfocusingcompliancecompliance to Universal to Universal PrecautionsPrecautions ororHandWashingHandWashing havehave exploredexplored thethe role of:role of:

1.1. IsolatedIsolated VariablesVariables�� HealthCareHealthCare WorkersWorkers BeliefsBeliefs andand AttitudesAttitudes (e.g. (e.g. WissenWissen, 1993);, 1993);�� HealthCareHealthCare WorkersWorkers BehavioursBehaviours (e.g. (e.g. FergusonFerguson et al., 2004);et al., 2004);

2.2. TheoreticalTheoretical ModelsModels�� TheoryTheory of of PlannedPlanned BehaviourBehaviour (Ajzen, 1988);(Ajzen, 1988);�� PRECEDEPRECEDE--PROCEED PROCEED ModelModel ((GreenGreen & & KreuterKreuter, 1974; 1991);, 1974; 1991);�� OrganizationalOrganizational ModelsModels of of SafetySafety ClimateClimate ((ZoharZohar, 1980);, 1980);


Universal Universal PrecautionsPrecautions & &

HandWashingHandWashing: : findingsfindings (II)(II)

TheoryTheory of of PlannedPlanned BehaviourBehaviour (Ajzen, 1988)(Ajzen, 1988)

�� LimbertLimbert & & LambLamb (2002)(2002)�� IntentionIntention PredictorsPredictors maymay changechange duedue to to HealthCareHealthCare

WorkersWorkers workwork experienceexperience;;�� ModelModel explainsexplains fromfrom 52% to 58% of 52% to 58% of thethe variancevariance inin

intentionintention;;

�� WatsonWatson & & MyersMyers (2001)(2001)�� AttitudesAttitudes are are thethe bestbest intentionintention predictor for predictor for nursesnurses;;�� ModelModel explainsexplains 45% of 45% of thethe variancevariance inin intentionintention;;



HandWashingHandWashing: : findingsfindings (III)(III)

Precede Precede –– ProceedProceed ModelModel(Green & Kreuter, 1974; 1991)

�� CreedonCreedon (2006)(2006)

� Interventional Program based upon Predisposing, Enabling andReinforcing Factors;

� Increased hand hygiene amongst HealthCare Workers;

� Significant changes found in HealthCare Workers Attitudes, Beliefs andKnowledge;

�� DejoyDejoy, , GershonGershon & & SchafferSchaffer (2004)(2004)

�� DirectDirect effecteffect of of PredisposingPredisposing FactorsFactors onon behaviouralbehavioural compliancecompliance;;

�� IndirectIndirect effecteffect of of EnablingEnabling andand ReinforcingReinforcing FactorsFactors onon behaviouralbehaviouralcompliancecompliance;;



HandWashingHandWashing: : findingsfindings (IV)(IV)

OrganizationalOrganizational ModelsModels of of SafetySafety ClimateClimate ((ZoharZohar, , 1980)1980)

� Dejoy, Gershon & Schaffer (2004)

�� SafetySafety ClimateClimate maymay mediatemediate thethe relationshiprelationship amongstamongst WorkWorkEnvironmentEnvironment andand ComplianceCompliance;;

� McGovern, Vesley, Kochevar, Gershon, Rhame et al., (2000)

� Safety Climate as main predictor of compliance, despite therelevance of work experience, knowledge and conservativeattitudes towards risk;


HandWashingHandWashing ComplianceCompliance: : WhyWhy

to to StudyStudy ItIt??

1.1. LackLack of of studiesstudies developeddeveloped usingusing theoreticaltheoretical modelsmodels;

2.2. NeedNeed to explore to explore thethe role role thatthat some some psychosocialpsychosocialvariablesvariables maymay havehave onon compliancecompliance to to HandWashingHandWashing, , namelynamely VulnerabilityVulnerability PerceptionPerception andand Social Social InfluenceInfluence;;

3.3. To To clarifyclarify thethe role of role of SafetySafety ClimateClimate as a as a relevantrelevantvariablevariable for for compliancecompliance to to HandWashingHandWashing;;


Main Goal: Socio-CognitiveContribution

�� To To developdevelop a a sociosocio--cognitivecognitive perspective perspective thatthat embracesembraces threethree theoreticaltheoreticalcontributionscontributions::

1.1. TheoryTheory of of PlannedPlanned BehaviourBehaviour ((AzjenAzjen, 1988);, 1988);

2.2. OrganizationalOrganizational ModelsModels of of SafetySafety ClimateClimate ((ZoharZohar, , 1980);1980);

3.3. ProtectionProtection MotivationMotivation TheoryTheory ((RogersRogers, 1975; 1983);, 1975; 1983);


Individual Individual AntecedentsAntecedents

HealthCare Workers

Experience of Work

Social Social AntecedentsAntecedents

HealthCareHealthCare WorkersWorkers

Professional Professional

EducationEducation

OrganizationalOrganizational

AntecedentsAntecedents

SafetySafety CultureCulture

HealthCareHealthCare

OrganizationOrganization

BehaviourBehaviour BeliefsBeliefs

NormativeNormative BeliefsBeliefs

ControlControl BeliefsBeliefs

DepartmentDepartment SafetySafety

ClimateClimate

TeamTeam SafetySafety

ClimateClimate

AttitudesAttitudes

Subjective Subjective

NormNorm

PerceivedPerceived Moral Moral

NormNorm

PerceivedPerceived

BehaviouralBehavioural

ControlControl

SocioSocio--CognitiveCognitive ModelModel

VunerabilityVunerability PerceptionPerception

IntentionIntention HwHw


PerceivedPerceived Moral Moral NormNorm (I)(I)

�� Moral Moral ConcernConcern

�� ConcernConcern for for otherother´́ss welfarewelfare inin peoplepeople´́ss judgementsjudgements andand choiceschoices ((SparksSparks & & SheperdSheperd, , 2002);2002);

�� WithinWithin thethe TheoryTheory of of PlannedPlanned BehaviourBehaviour (Ajzen, 1988)(Ajzen, 1988)

�� IncreasingIncreasing evidenceevidence of a role for of a role for perceivedperceived moral moral obligationobligation indicatesindicates thetheimportanceimportance of of moralmoral--normativenormative influencesinfluences inin social social behaviorbehavior;;

�� StudiesStudies of moral of moral normnorm inin thethe contextcontext of of thethe TPB TPB werewere reviewedreviewed byby ConnerConnerandand ArmitageArmitage (1998) (1998) whowho estimatedestimated thatthat acrossacross studiesstudies moral moral normsnormspredictedpredicted anan additionaladditional 4% of 4% of thethe variancevariance inin intentionsintentions afterafter controllingcontrolling for for TPB TPB predictorspredictors

�� LiteratureLiterature EvidencesEvidences

�� CommittingCommitting drivingdriving violationsviolations ((ParkerParker et al., 1995); et al., 1995);

�� MilkMilk consumptionconsumption ((RaatsRaats, , ShepherdShepherd, & , & SparksSparks, 1995);, 1995);

�� ConsumingConsuming foodfood producedproduced byby thethe use of, use of, geneticgenetic engineeringengineering techniquestechniques((SparksSparks, , ShepherdShepherd, & , & FrewerFrewer, 1995);, 1995);


PerceivedPerceived Moral Moral NormNorm (II)(II)

�� AttitudesAttitudes�� The degree to which performance of the behaviour is positively oThe degree to which performance of the behaviour is positively or r

negatively valued negatively valued (Azjen,2006, pp.1 )(Azjen,2006, pp.1 )

�� Subjective Subjective NormNorm�� The perceived social pressure to engage or not to engage in a The perceived social pressure to engage or not to engage in a

behaviour behaviour ((AzjenAzjen, 2006, pp.1 ), 2006, pp.1 )

�� PerceivedPerceived Moral Moral NormNorm�� PeoplePeople´́ss perceptionsperceptions of of theirtheir ownown rulesrules of moral of moral conductconduct towardstowards

a a givengiven behaviour behaviour ((GodinGodin, , ConnerConner & & SheeranSheeran, 2005, pp.500), 2005, pp.500)

�� PerceivedPerceived BehaviouralBehavioural ControlControl�� People's perceptions of their ability to perform a given behavioPeople's perceptions of their ability to perform a given behaviourur

(Ajzen, 2006, pp.1)(Ajzen, 2006, pp.1)


PerceivedPerceived Moral Moral NormNorm (III)(III)

ResearchResearch QuestionQuestion: :

PatientPatient needsneeds willwill taketake prioritypriority aboveabove

HealthCareHealthCare WorkersWorkers needsneeds??

�� SelfSelf--reportedreported factor for factor for poorpoor adherenceadherencewithwith HandWashingHandWashing (e.g. (e.g. LymerLymer, , RichtRicht, , IsakssonIsaksson, 2003; , 2003; PittetPittet, 2000), 2000)


StudyStudy OneOne: Main : Main GoalsGoals

I.I. Obtain indicators that may contribute to define Obtain indicators that may contribute to define a a bottombottom--up perspectiveup perspective that could that could clarify clarify the factors that HealthCare Workersthe factors that HealthCare Workersconsider that consider that Predispose, Enable and Predispose, Enable and ReinforceReinforce their behaviour of their behaviour of compliance to compliance to HandWashingHandWashing;;

II.II. ContributeContribute to to overcomeovercome thethe lacklack of of qualitativequalitativestudiesstudies donedone onon HealthCareHealthCare Sector;Sector;


ParticipantsParticipants

19 19 HealthCareHealthCare WorkersWorkers fromfrom severalseveral healthhealthinstituitionsinstituitions

Age Age MeanMean: 39.74 (23: 39.74 (23--56)56)

SortSort of of HealthCareHealthCare WorkersWorkers: 36.8% : 36.8% NursesNurses, 31.6% , 31.6% DoctorsDoctors, 26.3%, , 26.3%, OthersOthers31.6%31.6%


Data Collection

�� SemiSemi-- StructuredStructured InterviewsInterviews (1 (1 hourhour inin averageaverage))

�� OpenOpen--ContentContent AnalysisAnalysis

QuestionsQuestions frameworkframework basedbased uponupon PrecedePrecede--Proceed Proceed ModelModel ((GreenGreen & & KreuterKreuter, 1974; 1991) , 1974; 1991) bybyanalyzinganalyzing::

I.I. PredisposingPredisposing FactorsFactors (e.g. (e.g. HealthCareHealthCare WorkersWorkers BeliefsBeliefs))

II.II. EnablingEnabling FactorsFactors (e.g. (e.g. RiskRisk PerceptionPerception))

III.III. ReinforcingReinforcing FactorsFactors (e.g. Social (e.g. Social InfluenceInfluence))


Data Collection

ExamplesExamples of of questionsquestions ::

�� ““CanCan youyou define Universal define Universal PrecautionsPrecautions/ / HandWashHandWash??””

�� ““WhichWhich factorsfactors do do youyou considerconsider thatthat maymay hinderhinder compliancecompliance to to HandWashHandWash??””

�� ““HowHow cancan youyou describedescribe thethe role of role of youryour supervisor as supervisor as safetysafety suppportersuppporter??””

�� ““WhoWho do do youyou thinkthink thatthat maymay influenceinfluence youyou inin orderorder to to increaseincrease youryourcompliancecompliance to to HandWashHandWash??””

ContentContent AnalysisAnalysis ReliabilityReliability: Cohen : Cohen KappaKappa .79.79


Categories Definitions

Compliance could be promoted Compliance could be promoted by other sort of professionals, by other sort of professionals, not only by HealthCare Workersnot only by HealthCare Workers

Other ProfessionalsOther Professionals

Only HealthCare Workers are Only HealthCare Workers are relevant to promote compliancerelevant to promote complianceHealthCare WorkersHealthCare WorkersProfessionals viewed Professionals viewed

by HealthCare by HealthCare Workers as important Workers as important to promote to promote compliancecompliance

SignificantSignificant OthersOthers

Adequacy between personal Adequacy between personal safety needs and the type of safety needs and the type of safety equipment safety equipment

Safety EquipmentSafety Equipment

Safety practices implemented by Safety practices implemented by colleagues in their teamscolleagues in their teamsTeam RoleTeam Role

Safety practices implemented by Safety practices implemented by supervisors in their unitsupervisors in their unitUnit RoleUnit Role

Perception that Perception that HealthCare Workers HealthCare Workers have about safety have about safety practices amongst practices amongst their organizationtheir organization

Safety ClimateSafety Climate

To underestimate the presence of To underestimate the presence of objective risks on their daily objective risks on their daily routineroutine

Vulnerability PerceptionVulnerability Perception

To give primacy to patients To give primacy to patients security and treatment, as a security and treatment, as a moral imperative, by neglecting moral imperative, by neglecting their personal safety their personal safety

HealthCare Workers Moral NormHealthCare Workers Moral Norm

Incentive the persistence of the Incentive the persistence of the behaviourbehaviourReinforcing FactorsReinforcing Factors

Provide the motivation to the Provide the motivation to the behaviourbehaviourPredisposing FactorsPredisposing Factors

Allow the motivation to be Allow the motivation to be realizedrealized

Enabling FactorsEnabling Factors

Factors that influence Factors that influence the compliance the compliance behaviourbehaviour

AntecedentAntecedent FactorsFactors

DefinitionDefinitionSubSub--CategoriesCategoriesDefinitionDefinitionCategoriesCategories

SuperSuper--OrdinateOrdinate CategoryCategory

ComplianceCompliance to to HandWashingHandWashing


36,836,877Safety Safety ExpertsExpertsProfessionalsProfessionals fromfromotherother sectorssectors

73,773,71414NursesNursesHealthCareHealthCare WorkersWorkersSignificantSignificant OthersOthers

73,773,71414AdequateAdequate safetysafety equipmentequipmentSafety Safety EquipmentEquipment

89,589,51717ColleaguesColleagues / / TeamTeam promotepromote safetysafetyTeamTeam RoleRole

73,773,71414UnitUnit SupervisorsSupervisors promotepromote safetysafetyUnitUnit RoleRoleSafety Safety ClimateClimate

84,284,21616UnderestimateUnderestimate objective objective riskriskVulnerabilityVulnerabilityPerceptionPerception

94,794,71818To To putput patientspatients healthhealth and and safetysafety

alwaysalways onon 1st 1st placeplace


WorkersWorkers Moral Moral

NormNorm

73,773,71414RiskRisk InformationInformationReinforcingReinforcing FactorsFactors

94,794,71818MedicalMedical EmergenciesEmergencies, Stress, , Stress, LackLack of of timetimePredisposingPredisposing FactorsFactors

73,773,71414RecyclingRecyclingEnablingEnabling FactorsFactorsAntedecentAntedecent FactorsFactors

%%[1[1

AbsoluteAbsolute

FrequencyFrequencyExampleExampleSubSub--CategoriesCategoriesCategoriesCategories

[1] The percentage was calculated upon the Absolute Frequency of the Sub-Categories (e.g. 18*100/19 = 94.7)

Categories, frequencies and percentages



HealthCare Workers

Experience of Work




EducationEducation










ClimateClimate


ClimateClimate

AttitudesAttitudes


NormNorm


NormNorm

PerceivedPerceived


ControlControl





SafetySafety ClimateClimate (I)(I)

To To perceiveperceive a positive a positive safetysafety climateclimate maymay enableenable workersworkers motivationmotivation to to complycomply withwith safetysafety proceduresprocedures (e.g. Gonçalves, Silva, Meliá, Lima, 2005)

�� MultiMulti--levellevel interpretationinterpretation of of SafetySafety ClimateClimate amongstamongst HealthCareHealthCare

Sector Sector isis requiredrequired::

�� UnitUnit/ / DepartmentDepartment LevelLevel –– responsibleresponsible for establishment of for establishment of safetysafetypolicies policies andand proceduresprocedures;;

�� TeamTeam –– responsibleresponsible for for aplyingaplying thatthat proceduresprocedures;;

�� SourcesSources of of climateclimate perceptionsperceptions willwill bebe relatedrelated to to twotwo levelslevels of of analysisanalysis

�� MeasuresMeasures

�� SafetySafety ClimateClimate MeasuresMeasures developeddeveloped byby ZoharZohar (2004; 2003; 2002; (2004; 2003; 2002; 1980);1980);


Safety Climate (II)

Can Safety Climate have an impact on Attitudes, Subjective Norm Can Safety Climate have an impact on Attitudes, Subjective Norm and and Perceived Behavioural Control?Perceived Behavioural Control?

� Less progress has been made in understanding the mechanisms by wLess progress has been made in understanding the mechanisms by which safety hich safety climate affect safety behaviour, and the relationship between thclimate affect safety behaviour, and the relationship between these constructs and other ese constructs and other variables (Neal & Griffin, 2002);variables (Neal & Griffin, 2002);

�� SafetySafety climateclimate maymay bebe seenseen as a as a socialsocial--cognitivecognitive constructconstruct, , opposedopposed to to passivepassiveobservationobservation of formal of formal proceduresprocedures andand isolatedisolated practicespractices ((ZoharZohar & & LuriaLuria, 2004, pp.323);, 2004, pp.323);

� A A practicepractice willwill becomebecome a a sourcesource of (of (lowlow) ) climateclimate perceptionsperceptions ifif itit remainsremains unequivocalunequivocalandand stablestable, , contributingcontributing for for thethe workersworkers to to makemake inferencesinferences aboutabout safetysafety ((ZoharZohar & & LuriaLuria, ,

2004, pp.323);2004, pp.323);

TheThe more positive more positive thethe SafetySafety ClimateClimate becamesbecames, , thethe more positive more positive willwill bebe thetheattitudeattitude towardstowards thethe behaviour, behaviour, thethe more more relevancerelevance willwill havehave thethe subjective subjective

normnorm andand thethe more more controlcontrol willwill bebe perceivedperceived towardstowards thethe behaviour?behaviour?



HealthCare Workers

Experience of Work




EducationEducation










ClimateClimate


ClimateClimate

AttitudesAttitudes


NormNorm


NormNorm

PerceivedPerceived


ControlControl





VulnerabilityVulnerability PerceptionPerception

�� AccordingAccording to to thethe ProtectionProtection MotivationMotivation TheoryTheory::

�� itit isis expectedexpected thatthat thethe higherhigher thethe perceivedperceived vulnerabilityvulnerability to a to a negativenegative eventevent, , thethehigherhigher thethe intentionintention to to followfollow thethe recommendationsrecommendations

�� TheThe wayway howhow thethe nonnon--specialistsspecialists thinkthink aboutabout riskrisk developingdeveloping thethe subjective subjective riskrisk oror theirtheir vulnerabilityvulnerability perceptionperception (Lima, 2005)(Lima, 2005)

RelationshipRelationship amongstamongst VulnerabilityVulnerability PerceptionPerception andand SafetySafety BehavioursBehaviours

�� CongruencyCongruency amongstamongst objective objective andand subjective subjective riskrisk maymay increaseincrease thethe tendencytendency to to complycomplywithwith safetysafety rulesrules (e.g. (e.g. BrewerBrewer, , WeinsteinWeinstein, , CuiteCuite & & HerringtonHerrington, 2004), 2004)

�� A subjective A subjective evaluationevaluation of of thethe riskrisk, , oposedoposed to to thethe objective objective riskrisk, , maymay influenceinfluence thetheworkersworkers to to dontdont complycomply withwith safetysafety proceduresprocedures (e.g. Rundmo, 1997)

�� MeasuresMeasures: :

�� To To applyapply thethe measuresmeasures proposedproposed byby Lima (2005; 1999; 1998) Lima (2005; 1999; 1998) focusingfocusing thethe specificspecificmainmain infectioninfection risksrisks ((bloodblood--borneborne pathogenspathogens andand airair--borneborne pathogenspathogens))


Study three: Main Goal

To identify and explore the relationshipbetween Safety Climate, Vulnerability Perception and Safety Behaviour of compliance to HandWash;


Theoretical model

Safety Climate

Vulnerability Perception

HandWash


Participants

�One Public Portuguese Hospital from Lisbon

Workers: 100 nurses from Pediatric Emergencies

Age Mean: 32.06 years (22 - 56)

Workers Gender: 55% female and 45% male


Data Collection - Variables

� Self-report questionnaire

� 5 point-Likert type scales

Measures� Safety Climate (organizational, supervisor and colleagues) – 9 items (3 items

each)(adapted from Zohar, 2000)

� Vulnerability Perception – 3 items (inverted scale)(adapted from Lima, 1998)

� Safety Behaviour – 5 items(adapted from CDC, 2003)

Good Reliability range: Alphas from .72 to .89


1--.14***.14***.59***.59***.58***.58***.53***.53***.713,15 Safety Behaviour

-1--.39***.39***--.41***.41***--.25*.25*.112,8***4 Vulnerability Perception

--1.76***.76***.71***.71***.852,83 Colleagues Safety Climate

---1.68***68***.702,82 Supervisors Safety Climate

----1.742,51 Organizational Safety Climate

543212SD1Mean

Statistical Results

1 Standard Deviation 2 Correlations amongst variables


Results: Theoretical model

Safety Climate


Safety Behaviour

RR2 2 = .43***= .43***

β β β β β β β β = .25*= .25*

β β β β β β β β = = --.16.16

r = r = --.35***.35***


Theoretical model

SafetyBehaviour

SafetySafety ClimateClimate

VulnerabilityVulnerability PerceptionPerception


Moderator ModelThe role of safety climate amongst the relation between Fear Arousal and Risk

Perception

Safety Climate


Safety ClimateX


Safety Behaviour

0.04

0.76*

0.23**

0.68***

0.71**

***p < 0.001; ** p < 0.05

0.009

0.59***



HealthCare Workers

Experience of Work




EducationEducation










ClimateClimate


ClimateClimate

AttitudesAttitudes


NormNorm


NormNorm

PerceivedPerceived


ControlControl





HandWashingHandWashing

�� WillWill bebe decomposeddecomposed inin severalseveral partsparts::

�� WhatWhat shouldshould bebe donedone ((soapsoap, , alcoholalcohol--rubsrubs););

�� WhenWhen shouldshould bebe donedone ((beforebefore andand afterafter seingseing a a patientpatient, , afterafter usingusingglovesgloves););

�� EasyEasy to to measuremeasure

�� EasyEasy to to HealthCareHealthCare WorkersWorkers understandunderstand itit


Future Directions

�� To To prepre--testtest thethe questionnairequestionnaire withinwithin thethe sectorsector

�� ApplyApply thethe modelmodel to to oneone unitunit withinwithin a a HospitalHospital��ReplicateReplicate thethe resultsresults onon a a differentdifferent unitunit fromfrom a a differentdifferent hospital;hospital;

�� ApplyApply thethe modelmodel to to HandWashHandWash SafetySafetyProcedureProcedure��ReplicateReplicate thethe resultsresults withwith a a differentdifferent Universal Universal PrecautionPrecaution, , namelynamely thethe ““Use of Use of GlovesGloves””

Thank you for your attention

Questions are Welcome

Magda Sofia RobertoSocial and Organizational Psychologist

Ph.d StudentISCTE, Lisbon

Presentation University of Aberdeen: Doctoral Programme

19th 19th NovemberNovember 20072007

Supervised by:Professor Silvia Silva (ISCTE)

Professor Kathryn Mearns (University of Aberdeen)

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