Psychosocial determinants of handwashing compliance intention among physicians and nurses in Taiwan: A theory-driven comparison using the Health Belief Model

Abstract

Most healthcare-associated infections are transmitted through the hands of healthcare workers (HCWs). However, handwashing compliance remains a challenge in Taiwan. This study examined handwashing compliance intention among 705 HCWs (103 physicians and 602 nurses), using an extensive set of survey items informed by the Health Belief Model (HBM). Exploratory factor analysis of items measuring the HBM's reflective latent constructs (perceived susceptibility, perceived severity, perceived benefits, and perceived barriers) revealed a 10-factor structure, representing distinct dimensions with nuanced differentiation within HBM's original constructs. These 10 factors, along with cues to action (a formative construct), comprised the 11 HBM factors in this study. Perceived benefits of infection prevention emerged as the strongest driver of HCWs' handwashing compliance intention, followed by cues to action. Conversely, perceived barriers—time constraints significantly decreased compliance intention. Stratified comparisons showed that physicians and nurses endorsed different benefits of handwashing and cues to action, highlighting the need for profession-specific interventions. While physicians were motivated by concerns regarding perceived professional competence, nurses were motivated by infection prevention and praise/respect at work. Notably, a hospital policy mandating handwashing also increased compliance intention. Our findings offer practical insights for developing theory-driven and tailored interventions to enhance handwashing compliance among HCWs.