Patient and Family Engagement in Infection Prevention During the COVID-19 Pandemic: A Q-Methodology Study with Stakeholders from a Canadian University Health Care Center

Background

Health care–associated infections are frequent complications for hospitalized patients, and the COVID-19 pandemic exacerbated this issue. This study aimed to explore stakeholders’ viewpoints on how patients and families should engage in preventing health care–associated infections in hospital settings.

Methods

The authors employed Q-methodology, a mixed methods approach combining by-person factor analysis with in-depth interviews to capture shared viewpoints among participants. The research was conducted in a university-affiliated adult transplant unit using a purposive sample of staff members, patients, and family members. Participants ranked 40 preselected statements on a tablet using the Q-sorTouch Web application (for example, “Staff members should check that patients and family members wash their hands at key moments”) on a continuum from “most agree” (+2) to “most disagree” (-2). Participants then took part in in-depth interviews to elaborate on their rankings. Data analysis included factor extraction and thematic interpretation.

Results

Nineteen participants completed the study. Analysis revealed three distinct viewpoints on patient and family engagement in infection prevention and control: (1) a controlling approach in which health care professionals ensure patient and family compliance, (2) an enabling approach that supports shared responsibility and emphasizes autonomy, and (3) a view of patients and family members as vigilant partners. Seven consensus statements emerged, indicating agreement on strategies in which patients and families are passive rather than proactive.

Conclusion

Although a paternalistic model emphasizing health care professional oversight prevailed, alternative perspectives emerged advocating for greater autonomy and responsibility among patients and families. These differing opinions indicate ongoing debate about how best to involve patients and their families in infection control, particularly during periods of heightened risk.