The Effect of Cognitive Behavioral Therapy (AHIEVRAN)

The Effect of Hand Hygiene Education With Cognitive Behavioral Therapy on Hospital Infection Awareness: a Randomized Controlled Trial

The aim of this study is to investigate the effect of hand hygiene training applied using cognitive behavioural therapy techniques on healthcare workers' attitudes and beliefs regarding nosocomial infections. Another aim is to increase the effectiveness of hand hygiene training and to instil correct hand hygiene behaviour by utilising cognitive behavioural therapy to raise awareness of nosocomial infections among healthcare workers. This is a single-centre, double-blind, randomised, controlled trial with a single parallel group. The hypothesis is that hand hygiene training using cognitive behavioural therapy techniques will influence healthcare workers' attitudes and beliefs regarding nosocomial infections.

Study Overview

• Status: Enrolling by invitation
• Conditions: Intervention (Training) Condition
• Intervention / Treatment: Behavioral: Hand hygiene training using cognitive behavioural therapy techniques

Detailed Description

Although hand hygiene is a significant factor contributing to nosocomial infections, the problem of failure to implement effective hand hygiene has not yet been fully resolved. Hospital infections are generally defined as infections that develop in a patient who has been admitted to hospital for reasons other than infection. If the patient is not in the incubation period when admitted to hospital or does not have the signs and symptoms of that infection, infections that occur in hospital are hospital-acquired infections. Supporting hand hygiene training with Cognitive Behavioural Therapy represents a relatively new approach in the literature. Like many health behaviour interventions developed based on Ajzen's Theory of Planned Behaviour, this study also aimed to achieve lasting behavioural change by targeting cognitive attitudes and norms. Similar interventions have been found to be effective particularly in areas such as diabetes management, smoking cessation, and increasing physical activity. Von Lengerke et al. observed hand hygiene behaviour in their randomised controlled trials. Boscart et al. also utilised psychological theories to promote hand hygiene behaviour. However, the number of studies employing a cognitive behavioural therapy-based approach specifically for hand hygiene is limited. In this respect, this study makes an important contribution to the literature. This study goes beyond classical education models and focuses on transforming healthcare workers' attitudes towards nosocomial infections through an education approach based on a cognitive behavioural foundation. Given the scarcity of hand hygiene training supported by Cognitive Behavioural Therapy in the current literature, this study presents a novel theoretical approach and proposes a robust strategy for preventing hospital infections in practice.

• Study Type: Interventional
• Enrollment (Estimated): 140
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Kırşehir
    • Kırşehir, Kırşehir, Turkey (Türkiye), 40100
      • Kırşehir Ahi Evran University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Being a healthcare worker
2. To have been actively working in a hospital for at least 1 year
3. Agreeing to participate in the research

Exclusion Criteria:

1. Working on the infection control committee
2. Refusing to participate in the research

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Hand hygiene training using cognitive behavioural therapy techniques; The intervention group will receive hand hygiene training using cognitive behavioural therapy techniques. Hand hygiene training using cognitive behavioural therapy techniques will be delivered by a specialist psychologist certified in cognitive behavioural therapy from among the researchers. The training consists of three 1-hour sessions. The information on hand hygiene included in the training has been obtained from data provided by the Turkish Ministry of Health and the World Health Organisation. The aim of this training is to convince healthcare workers of the importance of hand hygiene in the prevention of nosocomial infections and to boost their confidence in their ability to adhere to hand hygiene guidelines. A strong commitment to hand hygiene will be possible through the development of self-regulatory behaviour. The objective is to foster self-regulatory behaviour through hand hygiene training integrated with Cognitive Behavioural Therapy techniques.	Behavioral: Hand hygiene training using cognitive behavioural therapy techniques; The intervention group will receive hand hygiene training using cognitive behavioural therapy techniques. Hand hygiene training using cognitive behavioural therapy techniques will be delivered by a specialist psychologist certified in cognitive behavioural therapy from among the researchers. The training consists of three 1-hour sessions. The information on hand hygiene included in the training has been obtained from data provided by the Turkish Ministry of Health and the World Health Organisation. The aim of this training is to convince healthcare workers of the importance of hand hygiene in the prevention of hospital-acquired infections and to boost their confidence in their ability to adhere to hand hygiene guidelines. A strong commitment to hand hygiene will be possible through the development of self-regulatory behaviour. The objective is to foster self-regulatory behaviour through hand hygiene training integrated with Cognitive Behavioural Therapy techniques.
No Intervention: Routine hand hygiene training; The control group will receive routine in-service training provided by the hospital training unit, the content of which has been approved by the Ministry of Health.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Initial values obtained from the Nosocomial Infection Belief and Attitude Scale	The independent variables of the study are socio-demographic variables, while the dependent variables consist of items from the Nosocomial Infection Belief and Attitude Scale. Isolation, hand hygiene, ventilator-associated pneumonia, surgical site infection, and invasive procedures are measured using a five-point Likert scale consisting of 35 items, which assesses healthcare workers' beliefs and attitudes towards nosocomial infections. In the scale assessment, a score approaching 1 indicates low awareness of hospital-acquired infections, whilst a score approaching 5 indicates high awareness of nosocomial infections.	The first measurement will be taken on the same day following the training provided to healthcare workers.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Three-month change following the Nosocomial Infection Belief and Attitude Scale measurement	Following the provision of hand hygiene training via Cognitive Behavioural Therapy, the Nosocomial Infection Belief and Attitude Scale will be administered again.	The second assessment will take place three months after the training provided to healthcare workers.

Collaborators and Investigators

• Sponsor: Kirsehir Ahi Evran Universitesi
• Investigators: Principal Investigator: AYŞEGÜL TURAN, Kirsehir Ahi Evran Universitesi; Study Chair: Furkan Turan, Kapadokya Üniversitesi; Study Chair: Mustafa Gökhan Gözel, Kirsehir Ahi Evran Universitesi

Publications and helpful links

General Publications

• Von Lengerke T, Lutze B, Krauth C, Lange K, Stahmeyer JT, Chaberny IF. (2017). Promoting hand hygiene compliance: PSYGIENE-a cluster-randomized controlled trial of tailored interventions. Dtsch Arztebl Int, 114: 29-36. DOI: 10.3238/arztebl.2017.0029.
• Michie, S., Abraham, C., Whittington, C., McAteer, J., & Gupta, S. (2009). Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychology, 28(6), 690.
• Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39: 175-191. https://doi.org/10.3758/BF03193146
• Boscart, V.M., Fernie, G.R., Lee, J.H. et al. (2012). Using psychological theory to inform methods to optimize the implementation of a hand hygiene intervention. Implementation Sci 7, 77. https://doi.org/10.1186/1748-5908-7-77.
• Ajzen I. (2011). The theory of planned behaviour: reactions and reflections. Psychology & health, 26(9), 1113-1127. https://doi.org/10.1080/08870446.2011.613995

Study record dates

Study Major Dates

• Study Start (Estimated): June 29, 2026
• Primary Completion (Estimated): June 29, 2026
• Study Completion (Estimated): September 29, 2026

Study Registration Dates

• First Submitted: December 25, 2025
• First Submitted That Met QC Criteria: March 30, 2026
• First Posted (Actual): April 2, 2026

Study Record Updates

• Last Update Posted (Actual): April 2, 2026
• Last Update Submitted That Met QC Criteria: March 30, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Cognitive behavioural therapy; Hand hygiene; Nosocomial infection
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Infections; Iatrogenic Disease; Pathological Conditions, Signs and Symptoms; Cross Infection
• Other Study ID Numbers: AHIEVRAN-2025- HAND HYGIENE

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Study Protocol
• IPD Sharing Time Frame: starting 6 months after publication
• IPD Sharing Access Criteria: The working protocol can be shared upon request.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No