title: Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices.
abstract: BACKGROUND
  Improving behaviour in infection prevention and control (IPC) practice remains a challenge, and understanding the determinants of healthcare workers' (HCWs) behaviour is fundamental to develop effective and sustained behaviour change interventions.
  
  
  OBJECTIVE
  To identify behaviours of HCWs that facilitated non-compliance with IPC practices, focusing on how appraisals of IPC duties and social and environmental circumstances shaped and influenced non-compliant behaviour. This study aimed to: (1) identify how HCWs rationalized their own behaviour and the behaviour of others; (2) highlight challenging areas of IPC compliance; and (3) describe the context of the working environment that may explain inconsistencies in IPC practices.
  
  
  METHODS
  Clinical staff at a National Health Service hospital group in London, UK were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework.
  
  
  RESULTS
  Three ways in which HCWs appraised their behaviour were identified through accounts of IPC policies and practices: (1) attribution of responsibilities, with ambiguity about responsibility for certain IPC practices; (2) prioritization and risk appraisal, which demonstrated a divergence in values attached to some IPC policies and practices; and (3) hierarchy of influence highlighted that traditional clinical roles challenged work relationships.
  
  
  CONCLUSIONS
  Overall, behaviours are not entirely independent of policy rules, but often an amalgamation of local normative practices, individual preferences and a degree of professional isolation.
authors.affiliation: NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Shah
authors.affiliation: NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK. Electronic address: e.castro-sanchez@imperial.ac.uk.
authors.forename: E
authors.initials: E
authors.lastname: Castro-Sánchez
authors.affiliation: NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Charani
authors.affiliation: Department of Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: L N
authors.initials: LN
authors.lastname: Drumright
authors.affiliation: NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Holmes
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008131:London; D008297:Male; D008875:Middle Aged; D009721:Nurse Midwives / Q000523:psychology*; D009726:Nurses / Q000523:psychology*; D010595:Pharmacists / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research
keywords: Attribution of responsibility; Healthcare workers' behaviour; Healthcare-associated infection; Infection prevention and control; Non-compliance; Risk appraisal