Factors influencing hand hygiene compliance among elderly caregivers: based on the theory of planned behavior

This study aimed to identify factors influencing hand hygiene compliance among long-term care workers in long-term care facilities based on the theory of planned behavior (TPB). A cross-sectional survey was conducted with 133 long-term care workers from four long-term care facilities in Daegu Metropolitan City and Gyeongsangbuk-do, South Korea. Self-reported questionnaires assessed hand hygiene-related belief factors (behavioral, normative, and control beliefs), core TPB factors (attitude toward behavior, subjective norms, and perceived behavioral control), intention, and hand hygiene compliance. Descriptive statistics, t-tests, analysis of variance, Pearson correlation, and multiple regression analysis were performed. The mean scores for hand hygiene attitude, subjective norms, and behavioral intention exceeded the scale midpoint, whereas the scores for control beliefs and perceived behavioral control were relatively lower. Hand hygiene compliance was significantly correlated with behavioral beliefs (r=0.23, P=0.008), control beliefs (r=0.26, P=0.002), attitude toward behavior (r=0.18, P=0.038), perceived behavioral control (r=0.41, P<0.001), and intention (r=0.31, P<0.001). Multiple regression analysis identified perceived behavioral control (β=0.33, P=0.002) and intention (β=0.23, P=0.006) as significant predictors of compliance, explaining 19.1% of the variance (Adjusted R ²=0.191). Perceived behavioral control and intention were identified as significant predictors of hand hygiene compliance. Interventions should not only enhance knowledge but also address structural and organizational factors to strengthen caregivers' perceived control and translate intention into practice.