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