The Influence of Perceived Subjective Norms on Nurses' Hand Hygiene Behavior: Intention as an Intervening Variable

Rondhianto; Fitriani; Ismara Ketut Ima

doi:10.36858/jkds.v12i1.734

Authors

Rondhianto Universitas Jember https://orcid.org/0000-0002-8487-069X
Fitriani Master of Public Health Science, Postgraduate Program, Universitas Jember, Jember, Indonesia
Ismara Ketut Ima Department of Electrical Engineering, Universitas Negeri Yogyakarta, Yogyakarta, Indonesia https://orcid.org/0000-0002-6151-4414

DOI:

https://doi.org/10.36858/jkds.v12i1.734

Keywords:

Behavior, Hand hygiene, Intention, Subjective norm

Abstract

Hand hygiene is one effort to reduce the risk of Healthcare-Associated Infections (HAIs). Nurses' compliance with hand hygiene is still low. The study aimed to analyze the influence of perceived subjective norms on nurses' hand hygiene behavior through intention as an intervening variable. The type of study is observational analytic with a cross-sectional design. The sample was nurses at Hospital X in Jember Regency (116 respondents) using a total sampling technique. The results show that most of the respondents were aged 26 – 35 years (52.59%), male (56.03%), had a diploma (43.97%), and had a working period of 1 – 5 years (39.66%). Model analysis showed the model fit with good predictive relevance (SRMR = 0.090; NFI = 0.851; Q2 = 0.608). Perceived subjective norms and intentions could explain hand hygiene behavior by 74.6% (R2 = 0.746; f2 = 0.146). Perceived subjective norms positively affected hand hygiene behavior directly (p = 0.001) and indirectly through intention (p = 0.001). Perceived subjective norms can increase nurses' hand hygiene intentions and compliance. Leaders of health institutions can improve the nurses' perceived subjective norms through regular monitoring and evaluation to increase hand hygiene intentions and behavior and reduce the risk of HAIs and patient mortality.

References

Ajzen, I. (2020). The theory of planned behavior: Frequently asked questions. Human Behavior and Emerging Technologies, 2(4), 314–324. https://doi.org/https://doi.org/10.1002/hbe2.195

Al-Maani, A., Al Wahaibi, A., Al-Zadjali, N., Al-Sooti, J., AlHinai, M., Al Badawi, A., Al Saidi, A., AlZadjali, N., Elshoubary, W., Al-Harthi, K., & Al-Abri, S. (2022). The impact of the hand hygiene role model project on improving healthcare workers’ compliance: A quasi-experimental observational study. Journal of Infection and Public Health, 15(3), 324–330. https://doi.org/10.1016/j.jiph.2022.01.017

Aschwanden, D., Strickhouser, J. E., Sesker, A. A., Lee, J. H., Luchetti, M., Terracciano, A., & Sutin, A. R. (2021). Preventive Behaviors During the COVID-19 Pandemic: Associations With Perceived Behavioral Control, Attitudes, and Subjective Norm. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.662835

Bosnjak, M., Ajzen, I., & Schmidt, P. (2020). The theory of planned behavior: Selected recent advances and applications. Europe’s Journal of Psychology, 16(3), 352–356. https://doi.org/10.5964/ejop.v16i3.3107

Centers for Disease Control and Prevention. (2021). Healthcare-Associated Infections (HAIs). Centers for Disease Control and Prevention. https://www.cdc.gov/hai/index.html

Daulay, F. C., Sudiro, S., & Amirah, A. (2021). Management analysis of infection prevention: Nurses’ compliance in implementing hand hygiene in the inventories of Rantauprapat Hospital. Journal of Scientific Research in Medical and Biological Sciences, 2(1), 42–49. https://doi.org/10.47631/jsrmbs.v2i1.218

Ghaffari, M., Rakhshanderou, S., Safari-Moradabadi, A., & Barkati, H. (2020). Exploring determinants of hand hygiene among hospital nurses: A qualitative study. BMC Nursing, 19(1), 109. https://doi.org/10.1186/s12912-020-00505-y

Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health Behavior Theory, Research, and Practice (fifth edit). Jossey-Bass.

Hair, J. F., Jr., G. T. M. H., Ringle, C. M., & Sarstedt, M. (2016). A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM) (2nd ed.). SAGE Publications.

Hammerschmidt, J., & Manser, T. (2019). Nurses' knowledge, behavior and compliance concerning hand hygiene in nursing homes: A cross-sectional mixed-methods study. BMC Health Services Research, 19(1), 1–13. https://doi.org/10.1186/s12913-019-4347-z

Han, M.-H., & Choi, S.-E. (2020). Factors Influencing Care Workers' Intention of Implementing Hand Hygiene in Long-term Care Hospitals. Journal of Korean Academy of Community Health Nursing, 31(3), 375. https://doi.org/10.12799/jkachn.2020.31.3.375

Handiyani, H., Ikegawa, M., Hariyati, R. T. S., Ito, M., & Amirulloh, F. (2019). The determinant factor of nurse’s hand hygiene adherence in Indonesia. Enfermería Clínica, 29(Suppl. 1), 257–261. https://doi.org/https://doi.org/10.1016/j.enfcli.2019.04.031

Ismara, K. I., Husudo, A. H., & Prabandari, Y. S. (2018). Model iklim, intensi, dan performansi keselamatan dan kesehatan kerja (K3) terkait cedera tertusuk dan tersayat di Rumah Sakit Pendidikan Dr. Sardjito Yogyakarta [Universitas Gadjah Mada]. https://etd.repository.ugm.ac.id/penelitian/detail/159436

Kementerian Kesehatan RI. (2022). Indikator Nasional Mutu Pelayanan Kesehatan Tempat Praktik Mandiri Dokter dan Dokter Gigi, Klinik, Pusat Kesehatan Masyarakat, Rumah Sakit, Laboratorium Kesehatan, dan Unit Transfusi Darah. Advanced Drug Delivery Reviews, 89–91.

Krishnamoorthi, S., Priyadarshi, K., Rajshekar, D., Sundaramurthy, R., Dhandapani, S., Madigubba, H., Sastry, A. S., Priyadarsh, K., Sarumathi, Cherian, A., KB, C., Joe, G., K, R., Nagarajan, A., Maneo, M. S., Po, P. L., Billoria, A., Antony, T., Renukar, M. K., … Gupta, A. (2022). Impact of conducting hand hygiene audit in COVID-19 care locations of India- A large scale national multicentric study-HHAC study. Indian Journal of Medical Microbiology, 43(September 2022), 39–48. https://doi.org/10.1016/j.ijmmb.2022.09.002

Liddelow, C., Ferrier, A., & Mullan, B. (2023). Understanding the predictors of hand hygiene using aspects of the theory of planned behavior and temporal self-regulation theory. Psychology & Health, 38(5), 555–572. https://doi.org/10.1080/08870446.2021.1974862

Park, J. H., & Jang, Y. (2019). Nurses’ Attitude, Subjective Norm, Perceived Behavioral Control, and Behavior Regarding Pressure Ulcer Prevention Behavior Based on Theory of Planned Behavior. Journal of the Korea Academia-Industrial Cooperation Society, 20(12). https://doi.org/https://doi.org/10.5762/KAIS.2019.20.12.212

Rahimi, G., Kamran, A., Sharifian, E., & Zandian, H. (2019). Predictors of hand hygiene behavior among nurses: A theoretical cross-sectional study. Journal of Medical Sciences (Taiwan), 39(6), 278–283. https://doi.org/10.4103/jmedsci.jmedsci_47_19

Rosdiana, S. W., Hartika, A. Y., Aji, S. P., Febriantika, Nayoan, C. R., Arisanti, D., Trisilawati, R., & Simanjuntak, R. R. (2023). Penerapan Strategi Perubahan Perilaku (N. SUlung (ed.); 1st ed.). Get Press Indonesia.

Rosidah, Z. N., & Mahfiana, L. (2020). Efektivitas Penerapan Prinsip-Prinsip Syariah Dalam Penyelesaian Sengketa Ekonomi Syariah di Badan Arbitrase Syariah Nasional (Basyarnas). TAWAZUN : Journal of Sharia Economic Law, 3(1), 15. https://doi.org/10.21043/tawazun.v3i1.7529

Sands, M., & Aunger, R. (2020). Determinants of hand hygiene compliance among nurses in US hospitals: A formative research study. PLoS ONE, 15(4), 1–29. https://doi.org/10.1371/journal.pone.0230573

Sin, C. S., & Rochelle, T. L. (2022). Using the theory of planned behavior to explain hand hygiene among nurses in Hong Kong during COVID-19. Journal of Hospital Infection, 123, 119–125. https://doi.org/10.1016/j.jhin.2022.01.018

Trifiletti, E., Shamloo, S. E., Faccini, M., & Zaka, A. (2022). Psychological predictors of protective behaviors during the Covid‐19 pandemic: Theory of planned behavior and risk perception. Journal of Community & Applied Social Psychology, 32(3), 382–397. https://doi.org/10.1002/casp.2509

World Health Organization. (2010). Hand hygiene self-assessment framework 2010. In Who Hand Hygiene Self Assessment Framework. www.who.int/gpsc/5may/tools

World Health Organization. (2022). Global report on infection prevention and control (CC BY-NC-SA 3.0 IGO). https://www.who.int/publications/i/item/9789240051164