IPC and the pursuit of behaviour change

For Journal Club this week (in partnership with IPS), I’ll be reviewing this article, a scoping review of using behaviour change theory for IPC. You can register for this Wednesday’s Journal Club here.

The further into my career I get, the more important behaviour change seems to become. In fact, you could even argue that IPC is behaviour change (or, at least, the pursuit of behaviour change) in frontline staff, IPC staff, patients, and in other stakeholders. If we can successful change behaviour, then we will have a successful IPC service!

Why I chose this article:

• I know that behaviour change is important but lack the detailed understanding of the science behind changing behaviour.
• There are many different theories of behaviour change, and it’s not clear to me which would be most useful for me to adopt.

Background:

• When you break it down, there are some fundamental determinants of human behaviour, which are described in several inter-related theories of behaviour change.
• Traditional interventions may fail because they overlook behavioural determinants.
• Behaviour change theories offer structured approaches to understanding and influencing behaviour.
• Behaviour change theories typically incorporate individual factors (e.g. motivations and beliefs), environmental factors (e.g. availability of equipment), and other factors such as complex interactions between individuals and their environment.
• Capability, Opportunity, Motivation – Behaviour (COM-B) is the highest level, showing how the three domains in its title (“COM”) determine behaviour.
• Theoretical Domains Framework (TDF) is more detailed, identifying 11 domains that influence behaviour.
• TDF can be mapped onto COM-B.
• The Behaviour Change Wheel (BCW) incorporates elements of 19 behaviour change theories in a visual schematic to support behaviour change.

Design and methods:

• A scoping review of the literature.
• The main review question was: “How have behaviour change theories been applied to IPC practices in healthcare settings?”
• Relevant theories were TDF, COM-B, and BCW; any type of IPC practice was included.

Key findings:

• 11/1516 articles identified in searches met inclusion criteria.
• These studies covered hand hygiene (7), antimicrobial stewardship (3), and MRSA screening (1).
• Common behavioural determinants: were beliefs about consequences, environmental context and resources, and social/professional role and identity.
• Most studies explored barriers and facilitators rather than designing interventions. Only three developed tools or interventions informed by behavioural theory.
• The impact of including behaviour change theory is illustrated by one study that used two sets of questions to explore barriers to hand hygiene, one set informed by behaviour change theory and one not. The set of questions informed by behaviour change theory uniquely prompted discussion about emotion, habit/routine, and incentives. This suggests that these domains have an unconscious influence on behaviour.

Strengths and limitations:

• Comprehensive mapping of how behavioural theories have been applied to IPC.
• Highlights key domains influencing compliance, offering practical insights for intervention design.
• Only 11 articles covering 3 IPC-related interventions included, but more have used behaviour change theory to influence IPC practice.
• Only 2 countries (UK and Canada) represented in the results.
• Scoping (rather than systematic) review.
• Reliance on self-reported compliance in some studies, risking bias.
• Few examples of theory-informed interventions; more research is needed across diverse settings and IPC practices.

Points for discussion:

• How can IPC practitioners integrate behavioural theory into routine practice?
• Should IPC audits include behavioural determinants alongside compliance metrics?
• What strategies can overcome environmental and social barriers identified in the review?
• How can interventions be tailored for different professional groups (e.g., nurses vs physicians)?

What this means for IPC:

This review underscores the importance of moving beyond education and policy to address behavioural determinants of IPC compliance. IPC practitioners should:

• Use frameworks like COM-B and TDF to identify barriers and facilitators.
• Design interventions that target key domains such as beliefs about consequences and environmental context.
• Consider scalable tools (e.g., theory-based surveys) to assess behavioural influences across organisations.
• Advocate for research that expands theory-informed approaches to other IPC practices, such as PPE use and isolation precautions.