title: Sociocognitive determinants of observed and self-reported compliance to hand hygiene guidelines in child day care centers.
abstract: BACKGROUND
  Although hand hygiene (HH) has proven to be an effective measure to prevent infections, HH compliance is generally low. We assessed sociocognitive determinants of caregivers' HH behavior in child day care centers (DCCs) to develop an effective HH intervention.
  
  
  METHODS
  Caregivers' compliance to HH guidelines was observed. Observed caregivers completed a questionnaire on self-reported HH compliance, sociocognitive determinants, and sociodemographic data. To determine sociocognitive determinants of observed compliance, multilevel logistic regression analyses were performed. Self-reported compliance was analyzed using linear regression.
  
  
  RESULTS
  In 122 participating DCCs, 350 caregivers and 2,003 HH opportunities were observed. The response rate on the questionnaire was 100%. Overall observed HH compliance was 42% (841/2,003). Overall mean self-reported HH compliance was 8.7 (scale, 0-10). Guideline knowledge (odds ratio [OR], 1.27; 95% confidence interval [CI]: 1.03-1.56) and perceived disease severity (OR, 0.93; 95% CI: 0.87-0.99) were associated with observed compliance. Guideline knowledge (β = 0.31; P < .001), guideline awareness (β = 0.16; P < .001), perceived importance (β = 0.20; P = .004), perceived behavioral control (β = 0.24; P < .001), habit (β = 0.27; P < .001), and children at home (β = 0.30; P = .002) were associated with self-reported compliance.
  
  
  CONCLUSIONS
  When developing HH interventions for caregivers in DCCs, improving guideline knowledge should be considered as this was associated with both observed and self-reported HH compliance. Furthermore, increasing guideline awareness, perceived importance, and perceived behavioral control can contribute to better HH, as well as making HH a habitual behavior.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Division of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands. Electronic address: t.zomer@rotterdam.nl.
authors.forename: Tizza P
authors.initials: TP
authors.lastname: Zomer
authors.forename: Vicki
authors.initials: V
authors.lastname: Erasmus
authors.forename: Pepijn
authors.initials: P
authors.lastname: van Empelen
authors.forename: Caspar
authors.initials: C
authors.lastname: Looman
authors.forename: Ed F
authors.initials: EF
authors.lastname: van Beeck
authors.forename: Aimée
authors.initials: A
authors.lastname: Tjon-A-Tsien
authors.forename: Jan Hendrik
authors.initials: JH
authors.lastname: Richardus
authors.forename: Hélène A C M
authors.initials: HA
authors.lastname: Voeten
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D017028:Caregivers; D002656:Child Day Care Centers; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D057566:Self Report; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Behavioral research; Caregivers; Handwashing; Infection control; Preschool child care