Social marketing: a behavior change technology for infection control

The role of online marketing to engage healthcare workers with infection prevention and control information and resources: A pilot study

BACKGROUND

The successful adoption and application of infection prevention and control (IPC) principles in all healthcare settings is dependent on the degree to which healthcare workers (HCWs) are aware of the requirements, have access to program resources and information, and engage with the IPC program. This study investigates the impact of redesigning the Infection Control Department (ICD) intranet site based on user feedback followed by a targeted marketing campaign to improve website usability, awareness, and access.

METHODS

In this systematic study, we used a survey plus two focus group interviews to elicit user requirements for the content and look of the ICD intranet page and identify the best communication platforms to use for the marketing campaign to launch the redesigned intranet page. The information was used to redesign the intranet page and develop the marketing campaign. The survey was repeated post-intervention and these results, along with a comparison of website analytics monitoring traffic, were used to determine the success of the intervention.

RESULTS

The ICD intranet page redesign increased the information and resources. Post-intervention survey results demonstrated a significant improvement in user satisfaction including ease of navigation and access to IPC information and resources. The marketing campaign resulted in a significant increase in website traffic to the ICD intranet page, demonstrating enhanced engagement with HCWs.

CONCLUSION

This study demonstrated that website redesign based on user feedback, combined with a marketing campaign, can increase the traffic to the website and improve the user experience when accessing and navigating the site making the information and resources more accessible to HCWs.

Social pressure, altruism, free-riding, and non-compliance in mask wearing by U.S. residents in response to COVID-19 pandemic

Human behavior, such as wearing a mask in public, affects the trajectory of the COVID-19 pandemic. A nationally representative survey of 1198 U.S. residents was used to study demographics, perceptions, and stated beliefs of residents who indicated they believe masks have a role in society in response to COVID-19 but self-reported not wearing masks in at least one public place studied. Individuals who believed wearing masks protected others were more likely to report voluntarily wearing them, providing possible evidence of altruism. Perceiving social pressure negatively impacted the probability of voluntary mask wearing amongst those who believed masks have a role in society, suggesting social shaming may not increase compliance among these individuals. Free-riding is one possible explanation for why an individual respondent may self-report belief that mask wearing has a role in society and simultaneously self-report not voluntarily wearing a mask in public locations. Alternatively, incomplete knowledge, confusion about the role of masks in controlling spread of COVID-19, or fatigue are all possible explanations for why adults who believe masks play a role demonstrate less than optimal compliance themselves with mask wearing. Promotion of altruism, rather than social shaming, is more likely to increase mask wearing based on this analysis. Tactics to improve public health initiative compliance and participation may change throughout the duration of the pandemic and/or may differ between segments of the population. Increased understanding of human behavior as it relates to mask wearing can inform public health communications and construction of incentive-aligned messaging to improve public health-related behaviors and associated outcomes.

Promoting a Hand Hygiene Program Using Social Media: An Observational Study

Background

Hand hygiene is an important component in infection control to protect patient safety and reduce health care-associated infection.

Objective

Our aim was to evaluate the efficacy of different social media on the promotion of a hand hygiene (HH) program.

Methods

The observational study was conducted from May 5 to December 31, 2014, at a 2600-bed tertiary care hospital. A 3-minute video of an HH campaign in 8 languages was posted to YouTube. The Chinese version was promoted through three platforms: the hospital website, the hospital group email, and the Facebook site of a well-known Internet illustrator. The video traffic was analyzed via Google Analytics. HH compliance was measured in November 2013 and 2014.

Results

There were 5252 views of the video, mainly of the Chinese-language version (3509/5252, 66.81%). The NTUH website had 24,000 subscribers, and 151 of them viewed the video (connection rate was 151/24,000, 0.63%). There were 9967 users of the hospital email group and the connection rate was 0.91% (91/9967). The connection rate was 6.17% (807/13,080) from Facebook, significantly higher than the other 2 venues (both P<.001). HH compliance sustained from 83.7% (473/565) in 2013 to 86.7% (589/679) in 2014 (P=.13) among all HCWs.

Conclusions

Facebook had the highest connection rate in the HH video campaign. The use of novel social media such as Facebook should be considered for future programs that promote hand hygiene and other healthy behaviors.

Social Marketing Analysis of 2 Years of Hand Hygiene Promotion

Objective.

To assess published hand hygiene behavioral interventions that employed a social marketing framework and to recommend improvements to future interventions.

Methods.

We performed a systematic literature review by searching the PubMed database and the Cumulative Index to Nursing and Allied Health Literature for published articles about hand hygiene behavioral interventions in healthcare facilities, schools, and community settings. Our analysis included articles that describe multifaceted interventions and evaluated them with predefined social marketing benchmark criteria.

Results.

Of 53 interventions analyzed in this review, 16 (30.2%) employed primary formative audience research, 5 (9.4%) incorporated social or behavioral theories, 27 (50.9%) employed segmentation and targeting of the audience, 44 (83.0%) used components of the “marketing mix,” 3 (5.7%) considered the influence of competing behaviors, 7 (13.2%) cultivated relationships with the target audience, and 15 (28.3%) provided simple behavioral messages. Thirty-five (66.0%) of the interventions demonstrated a significant improvement in performance, but only 21 (39.6%) were considered to have a strong evaluative design. The median duration of the interventions was 8.0 months.

Conclusions.

From a social marketing perspective, the promotion of hand hygiene could be improved in several ways. The effectiveness of social marketing in hand hygiene promotion should be tested in future interventions.

A qualitative understanding of patient falls in inpatient mental health units

BACKGROUND

Falls are the leading cause of injury-related deaths among people age 65 and older, and fractures are the major category of serious injuries produced by falls.

OBJECTIVE

Determine market segment-specific recommendations for "selling" falls prevention in acute inpatient psychiatry.

DESIGN

Descriptive using focus groups.

SETTING

One inpatient unit at a Veterans' hospital in the Southeastern United States and one national conference of psychiatric and mental health nurses.

PATIENTS

A convenience sample of 22 registered nurses and advanced practice nurses, one physical therapist and two physicians participated in one of six focus groups.

INTERVENTION

None.

MEASUREMENTS

Focus groups were conducted by expert facilitators using a semistructured interview guide. Focus groups were recorded and transcribed. Content analysis was used to organize findings.

RESULTS

Findings were grouped into fall risk assessment, clinical fall risk precautions, programmatic fall prevention, and "selling" fall prevention in psychiatry. Participants focused on falls prevention instead of fall injury prevention, were committed to reducing risk, and were receptive to learning how to improve safety. Participants recognized unique features of their patients and care settings that defined risk, and were highly motivated to work with other disciplines to keep patients safe.

CONCLUSIONS

Selling fall injury prevention to staff in psychiatric settings is similar to selling fall injury prevention to staff in other health care settings. Appealing to the larger construct of patient safety will motivate staff in psychiatric settings to implement best practices and customize these to account for unique population needs characteristics.

What is the optimum social marketing mix to market energy conservation behaviour: an empirical study

This study attempts to identify the optimum social marketing mix for marketing energy conservation behaviour to students in Malaysian universities. A total of 2000 students from 5 major Malaysian universities were invited to provide their preferred social marketing mix. A choice-based conjoint analysis identified a mix of five social marketing attributes to promote energy conservation behaviour; the mix is comprised of the attributes of Product, Price, Place, Promotion, and Post-purchase Maintenance. Each attribute of the mix is associated with a list of strategies. The Product and Post-purchase Maintenance attributes were identified by students as the highest priority attributes in the social marketing mix for energy conservation behaviour marketing, with shares of 27.12% and 27.02%, respectively. The least preferred attribute in the mix is Promotion, with a share of 11.59%. This study proposes an optimal social marketing mix to university management when making decisions about marketing energy conservation behaviour to students, who are the primary energy consumers in the campus. Additionally, this study will assist university management to efficiently allocate scarce resources in fulfilling its social responsibility and to overcome marketing shortcomings by selecting the right marketing mix.

Using a validated health promotion tool to improve patient safety and increase health care personnel influenza vaccination rates

BACKGROUND

This study employed the risk perception attitude (RPA) framework to determine whether health care personnel (HCP) influenza-related risk perceptions and efficacy beliefs could be used to segment individuals into meaningful groups related to vaccination uptake, absenteeism, and patient safety beliefs.

METHODS

After pilot interviews, a questionnaire was administered to 318 hospital-based HCP (80%) and nonclinical support staff (20%) in Lexington, KY, in 2011. Follow-up interviews were conducted with 29 respondents.

RESULTS

Cluster analysis was used to create 4 groups that correspond to the RPA framework: responsive (high risk, strong efficacy), avoidance (high risk, weak efficacy), proactive (low risk, strong efficacy), and indifference (low risk, weak efficacy). A significant association was found between membership in 1 or more of the 4 RPA groups and the 3 study variables of interest: influenza vaccination uptake (F7,299 = 2.51, P < .05), influenza-related absenteeism (F7,269 = 3.6, P < .001), and perceptions of patient safety climate (F7,304 = 6.21, P < .001). A subset of respondents indicated the principal reasons for not getting vaccinated were "had one before and got sick anyway," "concerned about vaccine safety," and "no convenient time." In follow-up interviews, HCP indicated that employee vaccinations were altruistic, increased herd immunity, and important for patient safety.

CONCLUSION

The RPA framework is a valid health promotion tool for improving patient safety, targeting specific groups for interventions, and improving HCP influenza vaccination rates.

Reducing hospital associated infection: a role for social marketing

PURPOSE

Although hand hygiene is seen as the most important method to prevent the transmission of hospital associated infection in the UK, hand hygiene compliance rates appear to remain poor. This research aims to assess the degree to which social marketing methodology can be adopted by a particular organisation to promote hand hygiene compliance.

DESIGN/METHODOLOGY/APPROACH

The research design is based on a conceptual framework developed from analysis of social marketing literature. Data collection involved taped interviews given by nursing staff working within a specific Hospital Directorate in Manchester, England. Supplementary data were obtained from archival records of the hand hygiene compliance rates.

FINDINGS

Findings highlighted gaps in the Directorate's approach to the promotion of hand hygiene compared to what could be using social marketing methodology. Respondents highlighted how the Directorate failed to fully optimise resources required to endorse hand hygiene practice and this resulted in poorer compliance.

PRACTICAL IMPLICATIONS

From the experiences and events documented, the study suggests how the emergent phenomena could be utilised by the Directorate to apply a social marketing approach which could positively influence hand hygiene compliance.

ORIGINALITY/VALUE

The paper seeks to explore the use of social marketing in nursing to promote hand hygiene compliance and offer a conceptual framework that provides a way of measuring the strength of the impact that social marketing methodology could have.

Inhibitions and implications associated with celebrity participation in health-related social marketing: an exploratory research focused on HIV prevention in Portugal

This article discusses motivations and inhibitions among celebrities to participate in health-related social marketing. The research identifies the implications that this involvement may have upon their lives. Results from in-depth interviews with 27 Portuguese celebrities show that they expect a fee for endorsements of commercial and government social marketing, despite the positive image they may gain from endorsing public health. The results demonstrate an absence of celebrity prejudice against HIV because of its serious nature and the social stigma attached to AIDS. This research suggests there is a positive bias and presents helpful information for negotiations between institutions and celebrities.

Bundling hand hygiene interventions and measurement to decrease health care-associated infections

Proper performance of hand hygiene at key moments during patient care is the most important means of preventing health care-associated infections (HAIs). With increasing awareness of the cost and societal impact caused by HAIs has come the realization that hand hygiene improvement initiatives are crucial to reducing the burden of HAIs. Multimodal strategies have emerged as the best approach to improving hand hygiene compliance. These strategies use a variety of intervention components intended to address obstacles to complying with good hand hygiene practices, and to reinforce behavioral change. Although research has substantiated the effectiveness of the multimodal design, challenges remain in promoting widespread adoption and implementation of a coordinated approach. This article reviews elements of a multimodal approach to improve hand hygiene and advocates the use of a "bundled" strategy. Eight key components of this bundle are proposed as a cohesive program to enable the deployment of synergistic, coordinated efforts to promote good hand hygiene practice. A consistent, bundled methodology implemented at multiple study centers would standardize processes and allow comparison of outcomes, validation of the methodology, and benchmarking. Most important, a bundled approach can lead to sustained infection reduction.

Point-of-care hand hygiene: preventing infection behind the curtain

Best practices for hand hygiene provide indications for performance of hand hygiene at specific points in time during patient care. For hand hygiene to prevent infections, hand hygiene resources must be readily available to health care workers whenever required. This article reviews practices and recommendations intended to facilitate hand hygiene behavior at the point of care (POC) within the health care setting. Key aspects of POC hand hygiene include the provision of alcohol-based hand rub products, integration of dispensing solutions within the patient zone, consideration of patient care workflow, and dispenser designs that optimize acceptance and usage.

Patient safety and healthcare-associated infection

Healthcare-associated infection (HCAI) has become a major patient safety issue in National Health Service (NHS) hospitals. The UK has an HCAI prevalence rate of 8.2% which equates to an annual incidence of approximately 300000 patients (Hospital Infection Society, 2007). HCAI is a safety issue because it is associated with increased morbidity and mortality as well as increased healthcare costs (National Audit Office (NAO), 2009). In 2000, the NAO identified cultural change as a requirement if the NHS is to get a grip of infection prevention and control. This article has taken a 'conceptual culture of safety model' that has been previously described in the literature and applied it to the organization of infection control. It is clear that while there are many areas of good practice, in relation to infection prevention and control, there is still much to do if the NHS is to invoke the type of paradigm shift that will result in a mature sustainable safety culture.

Behavior change strategies to influence antimicrobial prescribing in acute care: a systematic review

BACKGROUND

Antimicrobial use in acute care is widely reported to be suboptimal. Inappropriate use of antimicrobials is a major contributing factor to the emergence of multidrug resistance and health care-associated infection. Addressing prescribing behavior is a key component of antimicrobial stewardship.

METHODS

We performed a novel systematic review of both qualitative and quantitative literature on antimicrobial prescribing behavior in acute care. We assessed the extent to which behavioral sciences and social marketing were used and whether this could be related to the effectiveness of reported outcomes. MEDLINE, Excerpta Medica Database (EMBASE), Applied Social Sciences Index and Abstracts (ASSIA), Business Source Complete, The Cochrane Library, PsychInfo, Database of Abstracts of Reviews of Effectiveness (DARE) and Health Management Information Consortium (HMIC) were searched for studies undertaken during the period January 1999-April 2011 and published in English.

RESULTS

Five qualitative and 5 quantitative studies met the quality criteria. Qualitative studies highlight the predominant influence of social norms, attitudes, and beliefs on antimicrobial prescribing behavior. Quantitative studies reporting interventions to optimize antimicrobial prescribing behavior do not use theoretical science or primary research to inform the design and choice of the interventions deployed.

CONCLUSIONS

Despite qualitative evidence demonstrating the impact of behavioral determinants and social norms on prescribing, these influences are not given due consideration in the design and evaluation of interventions. To ensure a better understanding of prescribing behaviors and to improve the quality of interventions and research in this area, the incorporation and application of behavioral sciences supported by appropriate multidisciplinary collaboration is recommended.

Clean Hands for Life: results of a large, multicentre, multifaceted, social marketing hand-hygiene campaign

A year-long multifaceted hand-hygiene campaign entitled Clean Hands for Life targeting individual, environmental and organisational factors that influence healthcare worker (HCW) hand-hygiene behaviour was implemented in 36 acute and long-term care facilities in Vancouver Coastal Health region. The campaign involved rotation of ten novel posters, two poster contests, and distribution of multiple promotional items. A social marketing approach was used to implement and monitor the effectiveness of the campaign. Evaluation included quality assurance surveys, staff surveys (baseline, mid- and post-campaign), and focus groups. A total of 141 poster contest submissions was received, 5452 staff surveys completed and 14 focus groups conducted. Overall knowledge of the importance of hand-hygiene and intention to clean hands was high at baseline. No significant differences were observed when mid- and post-campaign scores were compared to baseline. The majority (89.5%) of HCWs reported that they preferred soap and water over alcohol hand gel. A significant increase in the self-reported use of hand-hygiene products was observed particularly among HCWs not providing direct patient care. Barriers to hand-hygiene included inappropriate placement of sinks, traffic flow issues, inadequately stocked washrooms, workload and time constraints. Organisational support was visible throughout the campaign. The results showed that social marketing is an effective approach in engaging HCWs. Hand-hygiene campaigns that focus almost exclusively on increasing awareness among HCWs may not be as successful as multifaceted campaigns or campaigns that target identified barriers to hand-hygiene.

‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene

Hand hygiene is a core element of patient safety for the prevention of healthcare-associated infections and the spread of antimicrobial resistance. Its promotion represents a challenge that requires a multi-modal strategy using a clear, robust and simple conceptual framework. The World Health Organization First Global Patient Safety Challenge 'Clean Care is Safer Care' has expanded educational and promotional tools developed initially for the Swiss national hand hygiene campaign for worldwide use. Development methodology involved a user-centred design approach incorporating strategies of human factors engineering, cognitive behaviour science and elements of social marketing, followed by an iterative prototype test phase within the target population. This research resulted in a concept called 'My five moments for hand hygiene'. It describes the fundamental reference points for healthcare workers (HCWs) in a time-space framework and designates the moments when hand hygiene is required to effectively interrupt microbial transmission during the care sequence. The concept applies to a wide range of patient care activities and healthcare settings. It proposes a unified vision for trainers, observers and HCWs that should facilitate education, minimize inter-individual variation and resource use, and increase adherence. 'My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices.