title: Design study to develop screen savers aimed at improving hand hygiene behavior.
abstract: Displaying screen savers with gain-framed messages are effective to improve hand hygiene, but the design of screen savers has not been studied yet.
  
  
  
  Based on the literature, scientific propositions were developed for the design of screen savers, exploring 2 strategies to subconsciously influence hand hygiene behavior; the first was to gain attention, and the second was to exert peer pressure. The designed screen savers were tested for attention with an eye-tracking study (N = 27) and for the influence of peer pressure with a questionnaire (N = 25).
  
  
  
  Twenty-five propositions for gaining attention concerned the format and color of the screen saver itself and color, position, and style of visual and text elements. Seven propositions for peer pressure concerned the influence of peers, role models, and feelings of being watched. Eye-tracking measurements showed that text on the 4 screen savers based on propositions gained more, earlier, and longer attention and the visual elements gained earlier and longer attention than the control screen savers. The questionnaire results showed that feelings of peer pressure were evoked by 3 screen savers; of these, one was not based on propositions.
  
  
  
  Screen savers designed according to scientific propositions for visual attention and peer pressure have the potential to alter hand hygiene behavior.
authors.affiliation: Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands. Electronic address: annemarie@weggelaar.com.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Weggelaar-Jansen
authors.affiliation: Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: van Buren-Jansen
authors.affiliation: Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Sabine
authors.initials: S
authors.lastname: van 't Schip
authors.affiliation: Department of Neuroscience, Erasmus Medical Centrum, Rotterdam, The Netherlands.
authors.forename: Johan J M
authors.initials: JJ
authors.lastname: Pel
authors.affiliation: Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Nieboer
authors.affiliation: Sophia Children's Hospital, Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Onno K
authors.initials: OK
authors.lastname: Helder
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D003196:Computer Graphics; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D000067074:Peer Influence; D011795:Surveys and Questionnaires
keywords: Infection control; design study; eye tracking; hand hygiene; screen saver