Application of the Theoretical Domains Framework to identify factors that influence hand hygiene compliance in long-term care.

BACKGROUND: Healthcare worker (HCW) hand hygiene compliance is key to patient safety; however, compliance is suboptimal. Nevertheless hand hygiene compliance is not well studied in the long-term care setting. AIM: To apply a behaviour change framework, the Theoretical Domains Framework (TDF), to identify modifiable facilitators and barriers for HCW hand hygiene compliance in long-term care settings. METHODS: HCW hand hygiene compliance facilitators and barriers were examined using a questionnaire for HCWs from long-term care homes in Ontario, Canada. The questionnaire was informed by the TDF, which is based on a synthesis of constructs from a number of relevant psychological theories of behaviour change. FINDINGS: Barriers identified from the questionnaire aligned with the TDF domain environmental context and resources (time pressure, workload, and environmental controls). Facilitators identified from questionnaire results aligned with the TDF domains social/professional role and identity (it is what is expected of HCWs), and beliefs about consequences (risk of transmission of micro-organisms to self or others). CONCLUSION: There are several barriers to hand hygiene compliance that persist in long-term care. A behaviour change theory-informed framework such as the TDF can be helpful to identify those barriers. This study identified several key behavioural constructs aligned with the TDF that can be targeted when developing novel hand hygiene interventions.

Alcohol, sexual arousal, and intentions to use condoms in young men: applying alcohol myopia theory to risky sexual behavior.

Data from 7 studies were aggregated to examine how reported sexual arousal and alcohol intoxication interact to affect attitudes and intentions toward engaging in unprotected sexual intercourse in college-age men (N = 358). When participants were in a sober or placebo condition, their self-reports of sexual arousal had no effect on their responses. When participants were intoxicated, however, those who felt sexually aroused reported more favorable attitudes, thoughts, and intentions toward having unprotected sex than did those who did not feel aroused. These findings support alcohol myopia theory (C. M. Steele & R. A. Josephs, 1990), which states that alcohol intoxication restricts attentional capacity so that people are highly influenced by the most salient cues in their environment. It is suggested that sexual arousal is a powerful internal cue that interacts with alcohol intoxication to enhance attitudes and intentions toward risky sexual behaviors.

Alcohol myopia and condom use: can alcohol intoxication be associated with more prudent behavior?

We tested 2 competing theories about the effects of alcohol on intentions to engage in risky behavior. Disinhibition predicts that intoxicated people will exhibit risky behavior regardless of environmental cues, whereas alcohol myopia (C. M. Steele & R. A. Josephs, 1990) predicts that intoxicated people will be more or less likely to exhibit risky behavior, depending on the cues provided. In 4 studies, we found an interaction between intoxication and cue type. When impelling cues were present, intoxicated people reported greater intentions to have unprotected sex than did sober people. When subtle inhibiting cues were present, intoxicated and sober people reported equally cautious intentions (Studies 1-3). When strong inhibiting cues were present, intoxicated people reported more prudent intentions than did sober people (Study 4). We suggest that alcohol myopia provides a more comprehensive account of the effects of alcohol than does disinhibition.

Decision making in altered states: effects of alcohol on attitudes toward drinking and driving.

A laboratory experiment and 2 field studies tested the hypothesis that alcohol affects attitudes and intentions toward drinking and driving. Sober and intoxicated participants completed a questionnaire assessing their attitudes and intentions to drink and drive in a number of situations. Results indicated that when asked general or noncontingent questions, sober and intoxicated participants were equally negative about this behavior. However, when a contingency was embedded in the question (e.g., "would you drink and drive only a short distance?"), intoxicated participants were significantly less negative about drinking and driving. These results are consistent with alcohol myopia (C. M. Steele & R. A. Josephs, 1990)--the notion that alcohol intoxication decreases cognitive capacity so that people are more likely to attend to only the most salient cues.