Infection prevention and control is an important component of healthcare delivery. Healthcare workers are potentially exposed to infections on a daily basis which can pose a threat to their health, as well as to the health of patients under their care. Strategies to decrease risks to healthcare workers and to patients alike have been developed in the form of Standard Precautions (SP). The implementation of SP by healthcare workers is far from being systematic and staff often follow an ad-hoc risk assessment of patients, putting themselves and their patients at risk. While researchers have established some of the factors that influence healthcare workers’ adherence to SP, there are no scales designed specifically to assess the factors affecting adherence neither has any theoretical model been used to predict adherence. The aims in this thesis were to: (1) establish the factors that affect healthcare workers and in particular nurses’ and medical doctors’ adherence to SP guidelines; (2) develop and psychometrically test a scale to measure these factors, and (3) test a model of adherence to SP among healthcare workers to further our understanding of the factors which predict their adherence. Study One is a qualitative study of 31 healthcare workers designed to ascertain knowledge of SP guidelines, healthcare workers’ behaviours and the factors influencing their behaviours with respect to adherence. Six males (M age = 36.83 years; SD = 8.93) and 25 females (M age = 41.36 years; SD = 10.25) were recruited. Seven primary themes emerged from the data. The emergent themes were used to construct a scale to examine the factors influencing adherence to SP. In Study Two, the new scale was administered alongside the Impulsive and Sensation Seeking Scale (ImpSS) using a repeated measure design, to determine the factor structure, internal reliability and convergent validity of the Factors Influencing Adherence to SP Scale (FIASPS), and to test its temporal stability over a four-week interval. Three hundred and sixty-three participants completed the questionnaires (49 males) at Time One. Principal Component Analysis of the FIASPS revealed five independent factors: Judgement, Leadership, Culture/Practice, Contextual Cues and Justification. There were no gender differences on these five factors however nurses scored higher on Leadership but lower on Justification for non-use and Contextual Cues than medical doctors. Retest data revealed the FIASPS was stable over a four-week interval. In study Three, the factor structure of the FIASPS was confirmed with a sample of 384 participants (53 males) M age = 43.75; SD = 9.74. In Study Four, a theoretical model based on an extension of the Theory of Planned Behaviour, factors identified in the literature and the five factors of the FIASPS as predictors of adherence to SP guidelines was tested. Two hundred and fifty participants (31 males) were recruited M age = 44.40 years; SD = 9.60. Modifications to the original model yielded a good fit of the data to the model which explained 35% of the variance in adherence to SP. Leadership, Knowledge and Culture/Practice have a direct positive effect on adherence and Justification for not using SP has a direct negative effect. Subjective Norm and Negative Attitude were the only constructs of the TPB to have an effect on adherence, albeit indirectly. Conscientiousness also had a positive indirect effect on adherence via Knowledge. The implications from these studies are discussed, especially the role of education, individual, and organisational factors in promoting adherence to SP as a means of infection control. Limitations of the studies and suggestions for future research are discussed.
|Date of Award
|Kathleen Moore (Supervisor)