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An exploration of the use of theory and visualisation in behaviour change interventions to help healthcare staff prevent and control healthcare-associated infections.

Tsattalios, Konstantinos


Konstantinos Tsattalios


Colin MacDuff

Audrey Stephen

Richard Laing


Changing healthcare staff's behaviours is of paramount importance in improving infection prevention and control (IPC), and decreasing healthcare-associated infections (HAIs). Thus many supportive interventions have been developed in pertinent areas, such as hand hygiene (HH). The concepts of theory and visualisation in behaviour change research are well described and embraced across the social sciences as they provide rigorous and innovative interventional solutions. However, the use of each of these concepts within interventions in IPC and HAI-related research has not been systematically investigated, and neither has their use in combination. The current thesis thus aimed to explore this field in depth, with a view to developing evidence-based recommendations for designing behaviour change interventions combining theory and visualisation. The study comprises a sequential multimethod pragmatic inquiry. This commenced by conducting two separate integrative literature reviews, exploring the wider context of theory-based and visualisation-centred interventions respectively - both in the field of IPC and HAIs. The reviews addressed gaps in relation to the theories and visualisations that have been used in pertinent interventions, the structure and application of these, and which of them seem to work. However, they raised further questions, for example which intervention parts work better than others, and how and why parts or whole interventions work. The above questioning formed the basis for the conduct of a Delphi study, with a participating international panel of key experts (n=18) in the fields of IPC, HAIs, intervention development, theory and/or visualisation. Through three questionnaire and survey rounds, the expert panel provided insights into questions (round 1), and were asked to rank subsequent related statements according to the degree of their agreement (rounds 2 and 3). The experts' responses provided sets of theories and visualisations along with other important intervention elements (e.g. behaviour change techniques), which could be prioritised when considering combinations to use for developing focal interventions (i.e. targeted to specific behaviours of individuals or teams) and systems-based interventions (i.e. targeted to whole healthcare organisations). Finally, four focus groups - with nurses and infection control staff (n=18) from two Scottish Health Boards - aimed to obtain staff opinions and perspectives regarding IPC based on their clinical experiences. Participants were also presented with selected recommendations from the Delphi study, and were asked to comment on them and make further suggestions. Findings indicate that posters are less effective, and that work and time pressure as part of clinical practice should be considered when developing pertinent interventions. Taken together, it was possible to formulate a menu of recommendations that had their foundational basis in the combination of participatory theoretical approaches and dynamic forms of visualisation. This research provides novel insight into the role of theory and visualisation in HAIs and IPC practice. The explicit combination of theory and visualisation has been demonstrated to be very under-researched, thus these findings contribute original knowledge and offer value for practice, education and research.


TSATTALIOS, K. 2019. An exploration of the use of theory and visualisation in behaviour change interventions to help healthcare staff prevent and control healthcare-associated infections. Robert Gordon University, PhD thesis. Hosted on OpenAIR [online]. Available from:

Thesis Type Thesis
Deposit Date Jan 28, 2020
Publicly Available Date Jan 28, 2020
Keywords Infection prevention and control; Healthcare-associated infections; Behavioural change; Behavioural patterns; Healthcare staff; Healthcare service providers
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