Understanding the psychological factors influencing hospital patients’ and visitors’ hand hygiene behavior

Hundreds of millions of patients are affected by healthcare-associated infections (HAIs) worldwide. Action is needed to prevent the transmission of pathogens causing HAIs to reduce risks to patients’ health and burdens on healthcare systems. Hand hygiene is the most effective measure for infection prevention in hospitals. However, hand hygiene among healthcare workers and laypeople is insufficient. Little is known about the facilitators and barriers to patients’ and visitors’ hand hygiene practices. Therefore, the present research project aimed to identify the central determinants of laypeople's hand hygiene in hospitals. In Study 1, a total of N = 1,605 patients and visitors were surveyed about their hand hygiene practice in hospitals. Three questionnaires were deployed to test the theoretical models' (TPB, HAPA, and TDF) effectiveness to predict participants' self-reported hand hygiene behavior. Two clusters of variables surfaced as being essential determinants of behavior: self-regulatory and social influence processes. In Study 2, visitors’ hand hygiene behavior was observed, and they were asked why they did or did not use the hand-rub dispenser in an open-answer format. Overall, N = 838 visitors provided explanations, which were consequently coded according to the same theoretical models employed in Study 1. The critical facilitators and barriers were similar to Study 1, implying that future interventions should focus on (1) visibility and accessibility of cleaning products, (2) informing people about their role in infection prevention, and (3) leveraging social influence processes. In Study 3, we used the previous studies' insights to design and test an intervention to improve visitors’ hand hygiene behavior through persuasive messages. Evidence-based signs were displayed in a hospital lobby, which a total of N = 246,098 people entered or left during the field experiment. Two out of seven signs significantly increased visitors’ dispenser usage rate. In summary, Study 1 and Study 2 indicate that knowing about the importance of hand hygiene, having easy access to hand hygiene products, establishing a norm for practicing hand hygiene, and being reminded to practice hand hygiene are the critical drivers for good hand hygiene behavior. Study 3 showed that a simple and cost-efficient intervention using these insights could improve hand hygiene behavior in hospitals

Attitudes Toward the Adoption of 2 Artificial Intelligence-Enabled Mental Health Tools Among Prospective Psychotherapists: Cross-sectional Study

BACKGROUND: Despite growing efforts to develop user-friendly artificial intelligence (AI) applications for clinical care, their adoption remains limited because of the barriers at individual, organizational, and system levels. There is limited research on the intention to use AI systems in mental health care. OBJECTIVE: This study aimed to address this gap by examining the predictors of psychology students' and early practitioners' intention to use 2 specific AI-enabled mental health tools based on the Unified Theory of Acceptance and Use of Technology. METHODS: This cross-sectional study included 206 psychology students and psychotherapists in training to examine the predictors of their intention to use 2 AI-enabled mental health care tools. The first tool provides feedback to the psychotherapist on their adherence to motivational interviewing techniques. The second tool uses patient voice samples to derive mood scores that the therapists may use for treatment decisions. Participants were presented with graphic depictions of the tools' functioning mechanisms before measuring the variables of the extended Unified Theory of Acceptance and Use of Technology. In total, 2 structural equation models (1 for each tool) were specified, which included direct and mediated paths for predicting tool use intentions. RESULTS: Perceived usefulness and social influence had a positive effect on the intention to use the feedback tool (P<.001) and the treatment recommendation tool (perceived usefulness, P=.01 and social influence, P<.001). However, trust was unrelated to use intentions for both the tools. Moreover, perceived ease of use was unrelated (feedback tool) and even negatively related (treatment recommendation tool) to use intentions when considering all predictors (P=.004). In addition, a positive relationship between cognitive technology readiness (P=.02) and the intention to use the feedback tool and a negative relationship between AI anxiety and the intention to use the feedback tool (P=.001) and the treatment recommendation tool (P<.001) were observed. CONCLUSIONS: The results shed light on the general and tool-dependent drivers of AI technology adoption in mental health care. Future research may explore the technological and user group characteristics that influence the adoption of AI-enabled tools in mental health care

Early and Later Perceptions and Reactions to the COVID-19 Pandemic in Germany: On Predictors of Behavioral Responses and Guideline Adherence During the Restrictions

In March 2020, the German government enacted measures on movement restrictions and social distancing due to the COVID-19 pandemic. As this situation was previously unknown, it raised numerous questions about people’s perceptions of and behavioral responses to these new policies. In this context, we were specifically interested in people’s trust in official information, predictors for self-prepping behavior and health behavior to protect oneself and others, and determinants for adherence to social distancing guidelines. To explore these questions, we conducted three studies in which a total of 1,368 participants were surveyed (Study 1 N=377, March 2020; Study 2 N=461, April 2020; Study 3 N=530, April 2021) across Germany between March 2020 and April 2021. Results showed striking differences in the level of trust in official statistics (depending on the source). Furthermore, all three studies showed congruent findings regarding the influence of different factors on the respective behavioral responses. Trust in official statistics predicted behavioral responses in all three studies. However, it did not influence adherence to social distancing guidelines in 2020, but in 2021. Furthermore, adherence to social distancing guidelines was associated with higher acceptance rates of the measures and being older. Being female and less right-wing orientated were positively associated with guidelines adherence only in the studies from 2020. This year, political orientation moderated the association between acceptance of the measures and guideline adherence. This investigation is one of the first to examine perceptions and reactions during the COVID-19 pandemic in Germany across 1year and provides insights into important dimensions that need to be considered when communicating with the public

The relationship between health IT characteristics and organizational variables among German healthcare workers

Health information technologies (HITs) are widely employed in healthcare and are supposed to improve quality of care and patient safety. However, so far, their implementation has shown mixed results, which might be explainable by understudied psychological factors of human–HIT interaction. Therefore, the present study investigates the association between the perception of HIT characteristics and psychological and organizational variables among 445 healthcare workers via a cross-sectional online survey in Germany. The proposed hypotheses were tested using structural equation modeling. The results showed that good HIT usability was associated with lower levels of techno-overload and lower IT-related strain. In turn, experiencing techno-overload and IT-related strain was associated with lower job satisfaction. An effective error management culture at the workplace was linked to higher job satisfaction and a slightly lower frequency of self-reported medical errors. About 69% of surveyed healthcare workers reported making errors less frequently than their colleagues, suggesting a bias in either the perception or reporting of errors. In conclusion, the study’s findings indicate that ensuring high perceived usability when implementing HITs is crucial to avoiding frustration among healthcare workers and keeping them satisfied. Additionally healthcare facilities should invest in error management programs since error management culture is linked to other important organizational variables

Surfing in the streets: How problematic smartphone use, fear of missing out, and antisocial personality traits are linked to driving behavior

Smartphone use while driving (SUWD) is a major cause of accidents and fatal crashes. This serious problem is still too little understood to be solved. Therefore, the current research aimed to contribute to a better understanding of SUWD by examining factors that have received little or no attention in this context: problematic smartphone use (PSU), fear of missing out (FOMO), and Dark Triad. In the first step, we conducted a systematic literature review to map the current state of research on these factors. In the second step, we conducted a cross-sectional study and collected data from 989 German car drivers. A clear majority (61%) admitted to using the smartphone while driving at least occasionally. Further, the results showed that FOMO is positively linked to PSU and that both are positively associated with SUWD. Additionally, we found that Dark Triad traits are relevant predictors of SUWD and other problematic driving behaviors--in particular, psychopathy is associated with committed traffic offenses. Thus, results indicate that PSU, FOMO, and Dark Triad are relevant factors to explain SUWD. We hope to contribute to a more comprehensive understanding of this dangerous phenomenon with these findings

Examining outpatients' hand hygiene behaviour and its relation to COVID-19 infection prevention measures

BACKGROUND: The increasing demand for outpatient care is associated with a higher risk of infection transmission in these settings. However, there is limited research on infection prevention and control practices in ambulatory clinics, and none focuses on patients. AIM: This study aims to examine outpatients' hand hygiene behaviours, their determinants, and their associations with other infection prevention measures during the COVID-19 pandemic. METHODS: We observed the hand hygiene behaviour of one cohort of patients in one outpatient clinic and surveyed a separate sample in five clinics about their hand hygiene practice in outpatient facilities. A questionnaire based on the Theoretical Domains Framework (TDF) was used to examine predictors of the behaviour. Moreover, patients indicated their compliance with COVID-19 infection prevention measures, vaccination status, disease risk perception, and vaccine hesitancy. FINDINGS: Observed hand hygiene rates among 618 patients were low (12.8%), while 67.3% of the 300 surveyed patients indicated sanitising their hands upon entering the clinic. The TDF domains memory, attention, and decision processes, and emotions significantly predicted both current (today's) and general hand hygiene behaviour in outpatient clinics. Hand hygiene behaviour and compliance with COVID-19 infection prevention showed a positive association; however, no significant connection was found with patients' vaccination status, suggesting different behavioural motivators. CONCLUSION: Hand hygiene among outpatients should be improved through interventions focusing on helping patients remember to clean their hands. More research on infection prevention in outpatient facilities is needed to ensure patient safety

Surfing in the streets: How problematic smartphone use, fear of missing out, and antisocial personality traits are linked to driving behavior

Smartphone use while driving (SUWD) is a major cause of accidents and fatal crashes. This serious problem is still too little understood to be solved. Therefore, the current research aimed to contribute to a better understanding of SUWD by examining factors that have received little or no attention in this context: problematic smartphone use (PSU), fear of missing out (FOMO), and Dark Triad. In the first step, we conducted a systematic literature review to map the current state of research on these factors. In the second step, we conducted a cross-sectional study and collected data from 989 German car drivers. A clear majority (61%) admitted to using the smartphone while driving at least occasionally. Further, the results showed that FOMO is positively linked to PSU and that both are positively associated with SUWD. Additionally, we found that Dark Triad traits are relevant predictors of SUWD and other problematic driving behaviors––in particular, psychopathy is associated with committed traffic offenses. Thus, results indicate that PSU, FOMO, and Dark Triad are relevant factors to explain SUWD. We hope to contribute to a more comprehensive understanding of this dangerous phenomenon with these findings

Non-task expert physicians benefit from correct explainable AI advice when reviewing X-rays

Artificial intelligence (AI)-generated clinical advice is becoming more prevalent in healthcare. However, the impact of AI-generated advice on physicians’ decision-making is underexplored. In this study, physicians received X-rays with correct diagnostic advice and were asked to make a diagnosis, rate the advice’s quality, and judge their own confidence. We manipulated whether the advice came with or without a visual annotation on the X-rays, and whether it was labeled as coming from an AI or a human radiologist. Overall, receiving annotated advice from an AI resulted in the highest diagnostic accuracy. Physicians rated the quality of AI advice higher than human advice. We did not find a strong effect of either manipulation on participants’ confidence. The magnitude of the effects varied between task experts and non-task experts, with the latter benefiting considerably from correct explainable AI advice. These findings raise important considerations for the deployment of diagnostic advice in healthcare

Small phytoplankton dominate western North Atlantic biomass

The North Atlantic phytoplankton spring bloom is the pinnacle in an annual cycle that is driven by physical, chemical, and biological seasonality. Despite its important contributions to the global carbon cycle, transitions in plankton community composition between the winter and spring have been scarcely examined in the North Atlantic. Phytoplankton composition in early winter was compared with latitudinal transects that captured the subsequent spring bloom climax. Amplicon sequence variants (ASVs), imaging flow cytometry, and flow-cytometry provided a synoptic view of phytoplankton diversity. Phytoplankton communities were not uniform across the sites studied, but rather mapped with apparent fidelity onto subpolar- and subtropical-influenced water masses of the North Atlantic. At most stations, cells < 20-µm diameter were the main contributors to phytoplankton biomass. Winter phytoplankton communities were dominated by cyanobacteria and pico-phytoeukaryotes. These transitioned to more diverse and dynamic spring communities in which pico- and nano-phytoeukaryotes, including many prasinophyte algae, dominated. Diatoms, which are often assumed to be the dominant phytoplankton in blooms, were contributors but not the major component of biomass. We show that diverse, small phytoplankton taxa are unexpectedly common in the western North Atlantic and that regional influences play a large role in modulating community transitions during the seasonal progression of blooms

Hand(y) hygiene insights: Applying three theoretical models to investigate hospital patients’ and visitors’ hand hygiene behavior

Background Improving hand hygiene in hospitals is the most efficient method to prevent healthcare-associated infections. The hand hygiene behavior of hospital patients and visitors is not well-researched, although they pose a risk for the transmission of pathogens. Therefore, the present study had three aims: (1) Finding a suitable theoretical model to explain patients’ and visitors’ hand hygiene practice; (2) Identifying important predictors for their hand hygiene behavior; and (3) Comparing the essential determinants of hand hygiene behavior between healthcare professionals from the literature to our non-professional sample. Methods In total N = 1,605 patients and visitors were surveyed on their hand hygiene practice in hospitals. The employed questionnaires were based on three theoretical models: a) the Theory of Planned Behavior (TPB); b) the Health Action Process Approach (HAPA); and c) the Theoretical Domains Framework (TDF). Structural equation modeling was used to analyze the data. To compare our results to the determinants of healthcare workers’ hand hygiene behavior, we searched for studies that used one of the three theoretical models. Results Among patients, 52% of the variance in the hand hygiene behavior was accounted for by the TDF domains, 44% by a modified HAPA model, and 40% by the TPB factors. Among visitors, these figures were 59%, 37%, and 55%, respectively. Two clusters of variables surfaced as being essential determinants of behavior: self-regulatory processes and social influence processes. The critical determinants for healthcare professionals’ hand hygiene reported in the literature were similar to the findings from our non-professional sample. Conclusions The TDF was identified as the most suitable model to explain patients’ and visitors’ hand hygiene practices. Patients and visitors should be included in existing behavior change intervention strategies. Newly planned interventions should focus on targeting self-regulatory and social influence processes to improve effectiveness