By
Prof. OSSAMA RASSLAN
Secretary General, Egyptian Society of Infection Control
How does one affect change?
• Changing H.C. worker behaviors is a challenge
• Before beginning any program to change
the planning process should be undertaken
• The cornerstone of this process is assessment
Attitudes & behaviors
Assessment • Until you understand “who, what, when & why”,
you cannot design a program that will be successful
• Assessment helps the ICP understand both individual
& organizational factors that lead to a behavior
• It helps the ICP determine the priorities for change
• It provides the baseline against which change can
be measured
Attitudes & behaviors
Components of the Assessment I. Factors related to the individual H.C.Worker: • Sociodemographic characteristics • Knowledge & educational level
• Attitudes
• Beliefs
Attitudes & behaviors
Components of the Assessment II. Organizational Factors • Resources • Staffing
• Local & regional laws
• Organizational support for a behavior
Attitudes & behaviors
Strategies for change
• Are based on the assessment & prioritization of the factors found
• Once a plan is implemented, re-assessment can show success or failure in the program
Attitudes & behaviors
Hints for success
• Involve the target audience
• Work at all levels of the org. to get support
• Use positive reinforcements • Acknowledge the inclusion of IC professionals as persons who may need to change
Attitudes & behaviors
Assessment of attitudes & behaviors
Assessment is the cornerstone of program planning (Include programs to change HCW behaviors)
•Systematic evaluation
• Identification of places to intervene
• Establishment of a baseline against which to evaluate change
Attitudes & behaviors
Epidemiol. approach to behavior assessment • Who is doing?
• What are the attributes & behaviors?
• Where does it happen? In what context? • When does the behavior happen? • Why (what are the reasons for the behavior?)
Attitudes & behaviors
Who: The Target Audience
• Physicians
• Nurses
• Family members • Lay health workers & aides • Infection control personnel
Attitudes & behaviors
What are the behaviors?
• Handwashing
• Use of barriers or isolation procedures
• Antibiotic prescribing • Equipment handling procedures • Procedures to protect worker safety
Attitudes & behaviors
Look at the behavior
• Is it right?
•Is it important
•Is there a standard? • Is it effective?
•Is it realistic?
Prioritize
Attitudes & behaviors
Where is it happening?
• What type of facility? • During which activity?
• What are the characteristics of the place in which it occurs? When is it happening? • In emergencies or during normal care • Time of day, day of week, or season
Attitudes & behaviors
Why: Individual reasons for behavior
• Age • Education • Profession
• Gender
• Beliefs • Attitudes • Cues to action
• Reinforcement
• Geographic location
• Knowledge
• Self-efficacy
Attitudes & behaviors
Why: Individual reasons for behavior Knowledge
{It is rarely the only reason for behavior}
Beliefs
• Perceived susceptibility to health threat • Perceived severity of the threat • Belief that the behavior will be beneficial
Attitudes & behaviors
Why: Individual reasons for behavior Attitudes
• Time • Convenience • Opinion of the behavior & its importance
Cues to action
• “Triggers” • Reminders • Presence of IC personnel • Social pressure
Attitudes & behaviors
Why: Individual reasons for behavior Reinforcement
• Positive or negative
• Performance feedback
Self-efficacy
• Perceived ability to do the desired behavior • Perceived control
Attitudes & behaviors
Why: Organiz. reasons for behavior
• Resources
• Engineering
• Staffing • Administrative leadership • Administrative sanctions
Attitudes & behaviors
Planning for behavior change
(should be based on assessment)
Example: Hand Hygiene
to illustrate the many factors that influence behavior • Who: HC workers
• What: compliance with H.W. standards
• Where: a H.C. facility (type?) • When: - In emergency or during normal care - Time …?
Attitudes & behaviors
Hand Hygiene Reasons for noncompliance
I. Individuals: • Knowledge: • Beliefs:
• Attitudes:
Lack of scientific info; wearing gloves (that interfere with HCW-patient relationship) Too busy Lack of role model
• Cues:
• Self-efficacy:
• Reinforcements: Lacking
Lack of time: Pt needs priority
Attitudes & behaviors
Hand Hygiene Reasons for noncompliance
II. Organization: • Inaccessible supplies
• Staffing
• Lack of institutional priority
• Lack of administrative sanctions or rewards
Attitudes & behaviors
Planning strategies for behavior change
Type of strategy: not always education • Too busy: time mgt • Peer pressure: assertiveness training • Knowledge: education
• Resources: administrative commitment
Attitudes & behaviors
Strategies for behavior change
• Begin with OUR behavior • Not proscriptive, but collegial • Appeal to people’s knowledge & logic • Involvement leads to ownership
• Empowerment leads to self-efficacy
• Change social norms to maintain behavior change
Attitudes & behaviors
Strategies for behavior change
• Involve the leaders & influential persons (formal & informal leaders) • Work at every level of the org. to make change happen • Apply the basic concepts • Keep it simple, applicable, achievable & affordable
Attitudes & behaviors
Strategies for behavior change
• Use reinforcements & cues - Positive reinforcements - Negative reinforcements (when all else fails) - Repeat over time
Attitudes & behaviors
Strategies for behavior change
• Celebrate success, review failure - Communicate results: share successes & failures with staff - Repeat assessment & planning process - Include yourself in the change process - Trust in yourself & others!
Attitudes & behaviors