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Table 1 Behavioral-change domains and some interview questions to explore behaviour change

From: Using psychological theory to inform methods to optimize the implementation of a hand hygiene intervention

Behavioral-change domains Some interview questions to explore behaviour change
Knowledge Can you describe the guidelines to perform proper HH?
  Can you discuss when to perform HH?
  Can you describe why you should be performing HH?
  Can you describe how the EMS works?
  Do you know what information the EMS can collect?
Skills Can you explain the proper procedure of performing HH?
  How easy or difficult is it to perform HH on your unit?
  Can you describe how to use the EMS?
  Do you know how to respond when the EMS reminds you?
Social/professional role and identity (self-standards) What role will the EMS play in enhancing HH?
  Do you think the EMS should determine how you perform HH?
  Do you feel that the guidelines for performing HH with the EMS are congruent with your professional standards of practice?
  Should proper HH be practiced at all levels of staff?
Beliefs about capabilities (self-efficacy) Difficult or easy is it for you to maintain proper HH?
  What problems have you encountered when trying to practice proper HH?
  What would help you to increase HH compliance?
  How confident are you that you can increase compliance with the barriers and difficulties you face?
  How well equipped and comfortable do you feel in increasing your level of HH compliance? When using the EMS?
  How capable do you feel in maintaining increased compliance with HH? When using the EMS?
  How well will this EMS record your HH?
Beliefs about consequences (anticipated outcomes/ attitudes) Does HH play an important role in your current practice? For yourself? For your patients? Can you explain why?
  Do you believe that this EMS will play an important role in your practice?
  Do you foresee any positive or negative outcomes of increased HH compliance on patient outcomes? Staff outcomes? Do you foresee these outcomes/consequences as long term or short term?
  Do you foresee a negative consequence of using the EMS? For patient outcomes? Staff outcomes?
  What do you think will happen if HH compliance is not increased in terms of patient outcomes? Staff outcomes? Do you think these are short- or long-term consequences?
  How will you feel if you are able to increase HH compliance? How will you feel if you do not?
Motivation and goals (intention) Would you like to increase your HH compliance?
  Do you feel a need to increase your HH compliance?
  What are your reasons for increasing your HH compliance?
  Is there any aspect of your HH performance that you could improve on? Frequency, activity related?
  Are there other things that you would like to achieve that might interfere with increasing your HH compliance?
  Are there incentives to increasing HH compliance? If so, what are they?
  Are there incentives to use the EMS? If so, what are they?
Memory, attention, and decision processes Do you usually perform HH? How often on a regular shift?
  Do you consciously think and make the decision to wash your hands?
  What factors influence that decision? Type of care activity? Type of patient? Time?
  How much attention do you have to pay to perform HH?
  Do you remember to perform HH? How?
  Do you think the reminder system in the EMS will enhance your HH?
  Can you think of times where you might not perform HH, such as competing tasks or time constraints?
Environmental context and resources (environmental constraints) Where do you currently disinfect your hands?
  Have you used a wearable alcohol dispenser device? How does this impact your HH performance?
  To what extent do physical or resource factors, such as the availability and functioning of wall units and technology, facilitate or hinder performing HH?
  Do you think necessary resources are available for staff to increase HH compliance?
  Do you believe that the EMS will enhance your HH performance?
Social influences (norms) Does HH play an important role on your unit? Can you explain why?
  Do you believe that nursing staff on this unit are washing their hands when necessary?
  To what extent do social influences facilitate or hinder performing HH? Social influence from your peers? Managers? Other professional groups? Patients? Relatives?
  Do you believe that there will be social influences from your peers to use the EMS? Managers? Patients? Other groups?
  Will you or have you ever observed others performing HH?
  Do you have role models in performing HH?
Emotion Does performing HH elicit an emotional response? If so, what?
  To what extent will emotional factors facilitate or hinder your HH?
  Do you believe that emotional factors will influence the use of the EMS?
Behavioral regulation What initial steps need to be taken to improve HH compliance/use the EMS on an individual level?
  How about on an organizational level?
  Can you think of any procedures that would encourage increased HH compliance/use of EMS?
Nature of the behaviours How will the EMS increase HH compliance?
  Who needs to work differently for this to occur? When? Where?
  How do you know whether increased HH compliance has occurred?
  What do you currently do in terms of performing HH?
  Is this a new or existing behavior that needs to become a habit?
  Can the context be used to prompt you to perform HH? (prompts: layout, reminders, equipment)
  How long do you think the changes are going to take?
  1. HH = hand hygiene; EMS = electronic monitoring system.