By Prof. OSSAMA RASSLAN Secretary General, Egyptian Society of Infection Control

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 How does one affect change? Attitudes & behaviors

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 Assessment Attitudes & behaviors

I. Factors related to the individual H.C.Worker: Sociodemographic characteristics Knowledge & educational level Attitudes Beliefs Components of the Assessment Attitudes & behaviors

II. Organizational Factors Resources Staffing Local & regional laws Organizational support for a behavior Components of the Assessment Attitudes & behaviors

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 Strategies for change Attitudes & behaviors

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 Hints for success 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 Assessment of attitudes & behaviors Attitudes & behaviors

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?) Epidemiol. approach to behavior assessment Attitudes & behaviors

Physicians Nurses Family members Lay health workers & aides Infection control personnel Who: The Target Audience Attitudes & behaviors

Handwashing Use of barriers or isolation procedures Antibiotic prescribing Equipment handling procedures Procedures to protect worker safety What are the behaviors? Attitudes & behaviors

Is it right? Is it important Is there a standard? Is it effective? Is it realistic? Prioritize Look at the behavior Attitudes & behaviors

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 Where is it happening? Attitudes & behaviors

Why: Individual reasons for behavior Age Beliefs Education Attitudes Profession Cues to action Gender Reinforcement Geographic location Self-efficacy Knowledge Attitudes & behaviors

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 Why: Individual reasons for behavior Attitudes & behaviors

Attitudes Time Convenience Opinion of the behavior & its importance Cues to action “Triggers” Reminders Presence of IC personnel Social pressure Why: Individual reasons for behavior Attitudes & behaviors

Reinforcement Positive or negative Performance feedback Self-efficacy Perceived ability to do the desired behavior Perceived control Why: Individual reasons for behavior Attitudes & behaviors

Resources Engineering Staffing Administrative leadership Administrative sanctions Why: Organiz. reasons for behavior Attitudes & behaviors

(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 …? Planning for behavior change Attitudes & behaviors

I. Individuals: Knowledge: Lack of scientific info; wearing gloves Beliefs: (that interfere with HCW-patient relationship) Attitudes: Too busy Cues: Lack of role model Reinforcements: Lacking Self-efficacy: Lack of time: Pt needs priority Hand Hygiene Reasons for noncompliance Attitudes & behaviors

II. Organization: Inaccessible supplies Staffing Lack of institutional priority Lack of administrative sanctions or rewards Hand Hygiene Reasons for noncompliance Attitudes & behaviors

Type of strategy: not always education Too busy: time mgt Peer pressure: assertiveness training Knowledge: education Resources: administrative commitment Planning strategies for behavior change Attitudes & behaviors

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 Strategies for behavior change Attitudes & behaviors

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 Strategies for behavior change Attitudes & behaviors

Use reinforcements & cues - Positive reinforcements - Negative reinforcements (when all else fails) - Repeat over time Strategies for behavior change Attitudes & behaviors

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! Strategies for behavior change Attitudes & behaviors