title: Understanding practice: factors that influence physician hand hygiene compliance.
abstract: OBJECTIVE
  To identify the behavioral determinants--both barriers and enablers--that may impact physician hand hygiene compliance.
  
  
  METHODS
  A qualitative study involving semistructured key informant interviews with staff physicians and residents.
  
  
  METHODS
  An urban, 1,100-bed multisite tertiary care Canadian hospital.
  
  
  METHODS
  A total of 42 staff physicians and residents in internal medicine and surgery.
  
  
  METHODS
  Semistructured interviews were conducted using an interview guide that was based on the theoretical domains framework (TDF), a behavior change framework comprised of 14 theoretical domains that explain health-related behavior change. Interview transcripts were analyzed using thematic content analysis involving a systematic 3-step approach: coding, generation of specific beliefs, and identification of relevant TDF domains.
  
  
  RESULTS
  Similar determinants were reported by staff physicians and residents and between medicine and surgery. A total of 53 specific beliefs from 9 theoretical domains were identified as relevant to physician hand hygiene compliance. The 9 relevant domains were knowledge; skills; beliefs about capabilities; beliefs about consequences; goals; memory, attention, and decision processes; environmental context and resources; social professional role and identity; and social influences.
  
  
  CONCLUSIONS
  We identified several key determinants that physicians believe influence whether and when they practice hand hygiene at work. These beliefs identify potential individual, team, and organization targets for behavior change interventions to improve physician hand hygiene compliance.
authors.affiliation: School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Squires
authors.forename: Stefanie
authors.initials: S
authors.lastname: Linklater
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.forename: Katrina
authors.initials: K
authors.lastname: Sullivan
authors.forename: Natalie
authors.initials: N
authors.lastname: Bruce
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gartke
authors.forename: Alan
authors.initials: A
authors.lastname: Karovitch
authors.forename: Virginia
authors.initials: V
authors.lastname: Roth
authors.forename: Karen
authors.initials: K
authors.lastname: Stockton
authors.forename: John
authors.initials: J
authors.lastname: Trickett
authors.forename: Jim
authors.initials: J
authors.lastname: Worthington
authors.forename: Kathryn N
authors.initials: KN
authors.lastname: Suh
mesh_terms: D000328:Adult; D001288:Attention; D001291:Attitude of Health Personnel; D002170:Canada; D002983:Clinical Competence / Q000592:standards*; D003469:Culture; D004777:Environment; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D063373:Hand Hygiene / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000458:organization & administration; D007396:Internship and Residency / Q000592:standards; D008297:Male; D008568:Memory; D010820:Physicians / Q000523:psychology* / Q000592:standards; D036301:Qualitative Research; D058996:Quality Improvement; D012933:Social Identification