基于能力、机会、动机与行为模型的医务人员手卫生行为现状及影响因素研究  

Current situation and influencing factors of hand hygiene behavior among medical staff:a study based on the capability,opportunity,motivation,and behavior model

作　　者：姜文婧 周萍[1] 张钰涵 宋春丽 何小平[1] 谢贻菊 JIANG Wenjing;ZHOU Ping;ZHANG Yuhan;SONG Chunli;HE Xiaoping;XIE Yiju(Zigong First People's Hospital,Zigong,Sichuan 643000,China)

机构地区：[1]自贡市第一人民医院感染管理科,四川自贡643000

出　　处：《职业卫生与应急救援》2023年第6期678-683,共6页Occupational Health and Emergency Rescue

基　　金：四川省医院协会医务管理分会2022年度资助项目(SCYW030);2022年自贡市哲学社会科学重点研究基地科研项目(JKRWY22-04);自贡市哲学社会科学重点研究基地医学与健康传播研究中心项目(YXJKCB-2022-04)。

摘　　要：目的基于能力、机会、动机及行为(capability,opportunity,motivation-behavior,COM-B)模型调查医务人员手卫生行为现状及其影响因素,探讨手卫生能力、机会及动机对手卫生行为的影响路径。方法2022年5—6月,采用便利抽样法,应用一般资料问卷、手卫生行为量表、手卫生现状问卷对某三级甲等综合性教学医院的医务人员进行横断面调查。采用Pearson相关性分析和多元线性回归分析检验变量之间的关系,采用Bootstrap方法分析影响医务人员手卫生行为的中介效应。结果发放调查问卷1876份,回收有效问卷1722份,有效回收率为91.79%。医务人员手卫生能力、机会、动机及行为得分分别为(4.86±0.32)分、(4.88±0.32)分、(4.88±0.32)分、(4.91±0.26)分。医务人员手卫生能力、机会、动机及行为表现为两两正相关关系(r=0.546~0.814,P<0.01);手卫生机会和动机得分每增加1分,手卫生行为得分分别增加0.220、0.284分(P<0.001)。手卫生能力对医务人员手卫生行为的总体影响效应值为0.449(P<0.001),直接效应不显著,其值为0.019(P>0.05)。手卫生能力分别通过路径1(手卫生能力→手卫生机会→手卫生行为,路径系数=0.206)、路径2(手卫生能力→手卫生动机→手卫生行为,路径系数=0.107)、路径3(手卫生能力→手卫生机会→手卫生动机→手卫生行为,路径系数=0.118)影响手卫生行为(P均<0.05)。结论手卫生机会和手卫生动机在手卫生能力和手卫生行为之间起到了多重中介作用。手卫生行为的提升应基于COM-B模型,构建手卫生能力、机会和动机的综合提升策略,以提高手卫生依从性,预防医院感染。Objective To investigate the current situation and influencing factors of hand hygiene behavior among medical staff based on the capability,opportunity,motivation,and behavior(COM-B)model and to explore the influence paths of capability,opportunity,and motivation of hand hygiene on this behavior.Methods A cross-sectional survey was conducted among medical staff in a tertiary comprehensive teaching hospital from May to June 2022 with the convenience sampling method,using the general information questionnaire,hand hygiene behavior scale,and hand hygiene status questionnaire.Pearson correlation analysis and multiple linear regression analysis were used to test the relationship between variables.Bootstrap method was used to analyze the mediating effect of influencing factors on hand hygiene behavior.Results A total of 1876 questionnaires were distributed,and 1722 valid questionnaires were collected,with an effective recovery rate of 91.79%.The scores of hand hygiene capability,opportunity,motivation,and behavior of medical staff were(4.86±0.32),(4.88±0.32),(4.88±0.32),and(4.91±0.26),respectively.Hand hygiene capability,opportunity,motivation,and behavior of medical staff were positively correlated with each other(r=0.546-0.814,P<0.01).For every one-point increase in hand hygiene opportunity and motivation scores,hand hygiene behavior scores increased by 0.220 and 0.284 points,respectively(P<0.001).The total effect of hand hygiene capability on the behavior of medical staff was 0.449(P<0.001),and the direct effect was not significant,with a value of 0.019(P>0.05).Hand hygiene capability influenced hand hygiene behavior through path 1(hand hygiene capability→opportunity→behavior,path coefficient=0.206),path 2(hand hygiene capability→motivation→behavior,path coefficient=0.107),and path 3(hand hygiene capability→opportunity→motivation→behavior,path coefficient=0.118)(P<0.05 for all paths).Conclusions Hand hygiene opportunity and motivation played multiple mediating roles between hand hygiene capability

关 键 词：医务人员 手卫生 能力 机会 动机及行为模型 影响因素 中介效应 

分 类 号：R192[医药卫生—卫生事业管理] R197[医药卫生—公共卫生与预防医学]