Perceptions of health care workers on involving patients in hand hygiene promotion in selected health facilities of rural and semi-urban districts in Uganda

Abstract

Background

Healthcare-associated infections (HAIs) are rising globally, contributing to significant patient morbidity and mortality, as well as financial strain on healthcare systems. Poor hand hygiene (HH) practices among healthcare workers (HCWs) remain a major contributor. This study explored HCWs’ perceptions of patient involvement in promoting HH practices.

Methods

An exploratory qualitative study was conducted in sixteen healthcare facilities across rural and semi-urban districts of Uganda. Sixteen key informant interviews (KIIs) were conducted with HCWs working in medical, surgical, and maternity wards. Interviews were audio recorded, transcribed verbatim, and analyzed thematically in Atlas.ti (version 24), guided by constructs of the Health Belief Model (HBM).

Results

Six major themes aligned with HBM constructs emerged: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Additional themes included power dynamics, professional hierarchy, and cultural norms. Participants generally viewed patient involvement in HH promotion as beneficial, noting that patients could remind HCWs to perform HH, reduce HH lapses, and enhance accountability. Patient engagement was also seen as a way to empower patients and strengthen their role in care. However, some HCWs expressed concern that patient reminders could be perceived as disrespectful or confrontational, particularly in hierarchical and culturally sensitive contexts.

Conclusion

Patient involvement in HH promotion is perceived as a promising strategy to improve adherence. However, cultural norms and professional hierarchies remain key barriers that may limit HCWs’ acceptance of patient-initiated reminders.