감염관리를위한행동변화전략 가톨릭대학교간호대학 김경미

Key determinants of infection control programmes Pittet, J Hosp Infect 2004: 58, 1 13

Behavioural sciences in infection control

KNOWLEDGE

Compliance VS

Coercive power Reward power Cinema Power Referent power expert power

BEHAVIRAL THEORIES

Health belief model(hbm) Health locus of control Protection motivation Theory Self efficacy model Theory of Reasoned Action(TRA) /Theory of Planned Behavior(TPB)

Health Belief Model Construct of HBM Susceptibility personal perception on the risk of acquiring a certain disease or condition Severity Benefits Barriers Added construction Personal perception of the seriousness of a certain disease, behavior or condition personal perception on the effectiveness and positive consequences when adopting a new behavior Personal perception of the obstacles that may prevent him/her to adopt a new behavior Cues of action Self efficacy Factors that trigger a behavior personal perception on his/her ability to adopt a behavior

Health Belief Model Perceived susceptibility to problem Perceived threat Sociodemographic factors Perceived severity of problem Perceived benefits of specific action Outcome expectation Likelyhood behavior Perceived barriers to taking action

Factors influencing nurses compliance with Standard Precautions in order to avoid occupational exposure to microorganisms: A focus group study Susceptibility Risk of being infected, Vulnerable to diseases Severity Fear, Serious disease-death-negative impact on life, Costs from being infected Benefits Barriers Added construction Protection from being infected, Psychological factors, Patients personal characteristics, Provision of nursing care to foreign patients, Significant others, Emergency situation, Availability of equipment, Negative influence of protective equipment on nurses, Patients discomfort, Too busy, lack of nursing personnel, implementation of guidelines is time consuming, Too busy, lack of nursing personnel, implementation of guidelines is time consuming, Influence on nurses appearance, Working experience as a nurse, Psychological factors, Physician s influence Cues of action Self efficacy Provision of nursing care to adult patients, Previous exposure, Continuous reminding-continuous education-guidelines, Many participants said that it is difficult for them to change their behaviour, even though they know that It is not correct.

Health locus of control Internal locus of control External locus of control

Protection motivation Theory

Self-efficacy self-efficacy is a person s belief in his or her ability to succeed in a particular situation.

Staples, Hulland, Higgins, JCMC, 3(4), Jun, 1998

Theory of Planned Behavior(TPB) http://people.umass.edu/aizen/tpb.diag.html

행위신념 (Behavioral beliefs) : 어떤행위를수행할때나타나는특정결과에대한믿음 태도 (Attitude toward the behavior) : 개인이특정행위를수행하는것에대해내리는긍정적 또는부정적평가의정도

규범신념 (normative beliefs) : 타인이대상자가특정행위를해야한다고기대할것이라 여기는믿음 주관적규범 (subjective norm) : 특정행위를수행하도록부과되는사회적압력을대상자가 지각하는정도

통제신념 (Control beliefs) : 대상자가특정행위를수행하는것에대하여지각하는 용이함의정도 지각된행위통제 ( Perceived behavioral control) : 대상자가특정행위를수행하는것에대하여지각하는 용이함의정도

Strategies for behavior change Social proof Positive Deviance Frontline ownership

Social proof

Positive Deviance In every community there are people whose unusual practices or behaviors enable the to fine better solutions to problems than their neighbours who have access to the same resources. Identifying solutions to community problems within the community today. Focus on practice rather than knowledge

Finding successful outliers!

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Jane Lewis & Susan Ritchie. http://www.slideshare.net/involvefoundation/jane-lewis-and-susan-ritchie-positivedeviance

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Frontline ownership Buy In ownership

This work is about the HOW rather than the WHAT

Front Line Ownership vs. Sharing Best practice Front Line Ownership Winning practices are highly sensitive to the local context Winning practices come from those who are touching the problem Practice are spread virally peer to peer sustained Sharing Best Practice What worked there should work here. Variability is discouraged Winning practices come from experts Practices are spread in top down fashion Often not sustained

Modelling human behavior Infrapersonal (indivisual) factor : knowledge, attitude, beliefs, personality traits Inter personal factor :interpersonal process, family, friends, peers Community factor : social networks,

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