Travel Grant Report by Marija Brankovic
11.09.2016, by Sibylle Classen in grant report
Singidunum University, Belgrade, Serbia; Visit to University of Ulm, Germany
Supported by the EASP postgraduate travel grant, I visited Department of Psychology at Ulm University, in Germany in June /July of the current year. The visit was hosted by Prof. Johannes Keller and Svenja Diefenbacher, Ph.D. candidate in Social Psychology.
Prof. Keller and his team visited our Psychology department in Belgrade in October last year and held a workshop with the aim of presenting the on-going research projects at Ulm University and the variety of innovative methodological approaches they utilize. This was meant to be a starting point of a long-term collaboration between the two departments. The purpose of my visit was to further develop the international collaboration between the two psychology departments from Belgrade and Ulm and the joint development of a research project on hand hygiene among medical professionals.
Hand hygiene in the medical context is a highly relevant topic, with literal real-life impacts – this is one of the factors contributing to the prevalence of hospital infections, which have been shown to claim hundreds of thousands of human lives each year (World Health Organization, 2009). Previous research has convincingly shown that medical professionals disinfect their hands in less than half of the situations they should (WHO, 2009). According to the scarce previous research in Serbia, this compliance is even lower than the international average (Lee et al., 2011).
Hand hygiene knowledge, attitudes, and behaviors, are an understudied field with respect to the psychological determinants and mechanisms involved (Edwards et al., 2012; Erasmus et al., 2009). Application of psychological theories has, however, been recognized as a potentially fruitful approach, for at least two reasons: a. the limited impact of previous campaigns (aimed at raising awareness or providing guidelines), as evidenced by the low compliance rates, b. the successful application of psychological and social marketing approach in other areas of health-promotion (Edwards et al., 2012).
We believe that findings from a joint research project would contribute in at least three important respects: a. outlining recommendations for improving procedures in medical institutions regarding hand hygiene and providing decision makers in Serbia with relevant information about the knowledge, attitudes and practices, b. cross-country comparisons would highlight specific as well as more general aspects of the relevant behaviors, c. scientifically, the findings would be of relevance for the study of the attitude-behavior link and persuasion research.
During the research visit, all of the planned activities were conducted in developing a joint research programme to extend the research on hand hygiene to the Serbian context. Before the visit, a small-scale preliminary study was conducted at the Surgical Department of the Clinical Centre in Belgrade. Given the challenges in conducting psychological research at busy surgical wards, a preliminary study is valuable in providing information from the field. The visit provided us with an opportunity to discuss the feedback, as well as preliminary data from the study conducted in Belgrade to make more informed decision about the course of future research. We discussed the methodology which would be best suited to the research issues of interest, as well as the responsiveness of the institution and the participants. We prepared the database and syntaxes for further analyses, and an on-line questionnaire to be launched in the planned continuation studies in Serbia.
The preliminary study revealed relatively high self-reported levels (higher than 50% of the episodes) of hand hygiene behaviors, as assessed by a measure based on the day reconstruction method (Kahneman, Krueger, Schkade, Schwarz, & Stone, 2004). The findings also provided some insight into the determinants of hand hygiene compliance. The self-reported knowledge about the recommendations for hand hygiene was a positive determinant of the compliance. The explicit attitude towards hand hygiene is another important determinant, in particular its component reflecting concerns about potential skin damage resulting from using hand disinfectants. Participants also expressed a less than optimal level of perceived behavioral control, related to dissatisfaction with the availability of the disinfectants. In addition, the experience of personal distress at work is negatively related to hand hygiene compliance.
We hope that the future study, with a larger sample of participants will offer multiple interesting perspectives, as revealing the barriers and facilitators for improved hand hygiene, determining the proximal predictors within the framework of the theory of planned behavior (representing elements of the deliberative route of action control), clarifying the role of habit (representing an element of the impulsive or automatic route of action control) in order to achieve and maintain high compliance rates, as well as specifying further the relations of hand hygiene behavior and empathy (Sassenrath, Diefenbacher, Siegel, & Keller, 2016).
During the visit, we made some initial steps for the planned future publications: a literature review, encompassing both local and international research on hand hygiene, along with several paper proposals. Finally, an activity plan was devised for further collaboration, outlining the activities and timelines for future joint studies. In addition to these specific tasks, the hosts provided me with training in the relevant methodology used in Ulm Social Laboratory research. I had the opportunity to familiarize myself with the day reconstruction and experience-sampling methods, and to discuss the potentials of their application in different lines of research. Several researchers from the Social Psychology Laboratory were also kind enough to share their current research projects with me and discuss the application of sophisticated statistical techniques, as multi-level modeling. This exchange has been very useful in opening up new perspectives for future research projects.
I would like to thank the European Association of Social Psychology for providing me with this grant and the hosts for making this visit a memorable experience. The visit facilitated further steps to develop and enhance the collaboration between two laboratories and departments. It also enabled me with a first-hand experience and the opportunity to learn about work done at Ulm University, which I believe is a great benefit for my professional development.
- Edwards, R., Charani, E., Sevdalis, N., Alexandrou, B., Sibley, E., Mullett, D., ...& Holmes, A. (2012). Optimisation of infection prevention and control in acute health care by use of behaviour change: a systematic review. The Lancet infectious diseases, 12(4), 318-329.
- Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., & van Beeck, E. F. (2010). Systematic review of studies on compliance with hand hygiene guidelines in hospital care.Infection Control & Hospital Epidemiology, 31(03), 283-294.
- Kahneman D., Krueger A.B., Schkade D.A., Schwarz N. & Stone A. (2004). A survey method for characterizing daily life experience: The day reconstruction method. Science, 306, 1776-1780.
- Lee, A., Chalfine, A., Daikos, G. L., Garilli, S., Jovanovic, B., Lemmen, S., ...&Rubinovitch, B. (2011). Hand hygiene practices and adherence determinants in surgical wards across Europe and Israel: a multicenter observational study. American Journal of Infection Control, 39(6), 517-520.
- Sassenrath, C., Diefenbacher, S., Siegel, A., & Keller, J. (2016). A person-oriented approach to hand hygiene behavior: Emotional Empathy Fosters Hand Hygiene Practice. Psychology & Health, 31, 205-227.
- World Health Organization. (2009). WHO guidelines on hand hygiene in health care: first global patient safety challenge. Clean care is safer care.World Health Organization.