Theory-based interventions in the healthcare-associated infections field: an integrative review

Abstract

Background: Healthcare-associated infections’ (HAIs) prevention and control is typically targeted at training staff within a ‘health and safety’ climate. A growing body of research focusses on changing health-related behaviours by applying pertinent theories in dedicated interventions. However, the type of theories and the extent to which they have been applied remains unknown. This review aims to synthesise the best available evidence on theory type, how its implementation aids the prevention and control of HAIs and the effectiveness of these interventions. Methods: Six electronic databases (Web of Knowledge, CINAHL, AMED, MEDLINE, PsycARTICLES, ERIC) were searched. Eligible studies’ references were scrutinised to identify additional studies. Sixteen studies met the inclusion criteria: these employed experimental/non-experimental designs with healthcare populations and explicitly referred to psychological, social and human relations type theories. The CASP and QATSDD tools were used to appraise studies’ quality and findings were synthesised narratively. Findings: A diversity of implemented interventions was detected with only 5 adopting a pure health promotion theory (e.g. PRECEDE model). Also, the diversity of the studies’ structure and quality was reflected in the different strengths of their designs. Finally, theories informed the development of multicomponent interventions, however sustainability was often questioned. Discussion: No single theory-based intervention was evidently better than another, confirming the absence of a ‘gold-standard’ in intervention development in the HAIs field. We propose that the non-immediate consequences of HAIs and their invisibility should be considered in-depth by future research. The heterogeneity of findings and future directions are discussed in the light of existing literature.