title: Using psychological theory to understand the challenges facing staff delivering a ward-led intervention to increase hand hygiene behavior: a qualitative study.
abstract: BACKGROUND
  The Feedback Intervention Trial was a national trial of an intervention to increase hand hygiene behavior in English and Welsh hospitals. It significantly improved behavior, the effect increasing with fidelity to intervention, but the intervention proved more difficult to implement than anticipated. This study aimed to identify the barriers to and facilitators of implementation as experienced by those who delivered the intervention.
  
  
  METHODS
  Semistructured interviews were conducted with 17 intervention ward coordinators implementing the intervention. Interview questions were based on the Theoretical Domains Framework. Text relating to each domain was scored according to whether it indicated low or high likelihood of implementation, and thematic analysis conducted.
  
  
  RESULTS
  The lowest scoring domains were "environmental context and resources," "beliefs about capabilities," "social influences," and "emotion." Lack of time and understaffing, perceived negativity from other staff members, and stress were identified as challenges to implementation. The highest scoring domains were "behavioral regulation," "motivation," "skills," "knowledge," and "professional role." Ward coordinators reported that they had the skills, understanding, and motivation to implement the intervention and spoke of consistency of tasks with existing roles.
  
  
  CONCLUSIONS
  Implementation might be improved by giving designated time for intervention tasks and ensuring that the ward coordinator role is allocated to staff for whom tasks are commensurate with existing professional roles.
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK; Department of Psychology, University College London, London, UK. Electronic address: john.mcateer@ed.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: McAteer
authors.affiliation: Royal Free Campus, University College London Medical School, London, UK.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Stone
authors.affiliation: Centre for Infectious Disease Epidemiology, University College London, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fuller
authors.affiliation: Department of Psychology, University College London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
mesh_terms: D001291:Attitude of Health Personnel; D001521:Behavior Therapy / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D004739:England; D063373:Hand Hygiene / Q000379:methods*; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007407:Interviews as Topic; D011582:Psychological Theory; D013997:Time Factors; D014852:Wales
keywords: Hand washing; Health professional behaviour; Implementation; Theoretical domains framework