To tackle the first step of the approach, understanding behavior, people, and environment is key. Some of the behaviors
of particular interest in the healthcare setting consist of the following: sanitizing hands when going in and out of patient rooms, making sure healthcare workers are vaccinated or staying home when they are ill, antimicrobial stewardship, and adhering to guidelines for standard procedures such as removing catheters or central lines, among others. Doctors, nurses, and other healthcare workers are the people
who are expected to perform these behaviors. They are all committed to improving their patients’ outcomes, but they may also have a little bit of what Dr. Kreuter refers to as “a curse of smartness,” which means that they may rely on their instincts or memory more than guidelines or checklists. The environment
that all of this is happening in is also important, and in this instance it is hospitals and healthcare systems, which are complex, making the coordination of “getting everybody moving in the same direction” challenging. Furthermore, “the degree to which different systems are designed to support infection prevention can also vary,” Dr. Kreuter noted.
After gaining understanding, you must focus on identifying determinants of behaviors, or the factors that influence behaviors. According to Dr. Kreuter, there are three types: predisposing factors, enabling factors, and reinforcing factors.
Dr. Kreuter explained, “Predisposing factors
are those that increase or decrease a person’s motivation to engage in behavior change, [while] enabling factors
are those that support or hinder a person’s efforts to make a desired behavior change. ‘I’ve decided to change, I’m attempting to change this behavior, what is it that makes it easier or harder for me to do that?’ And then, reinforcing factors
. ‘When I’ve actually engaged in the behavior, what happens next that encourages me or discourages me from continuing that desired behavior?’”