Mobile intervention to promote correct hand hygiene at key times to prevent COVID-19 in the Swiss adult general population: study protocol of a multiphase optimisation strategy

Melanie Alexandra Amrein, Gian Giacomo Ruschetti, Carole Baeder, Melanie Bamert, Jennifer Inauen, Melanie Alexandra Amrein, Gian Giacomo Ruschetti, Carole Baeder, Melanie Bamert, Jennifer Inauen

Abstract

Introduction: Behaviour change is key to the public health measures that have been issued in many countries worldwide to contain COVID-19. Public health measures will only take preventive effect if people adhere to them. Interventions taking health psychology approaches may promote adherence to public health measures. However, evidence from randomised controlled behaviour change trials is scarce during an ongoing pandemic. We aim to use the example of hand washing with soap to optimise and test a digital, theory-based and evidence-based behaviour change intervention to prevent the spread of COVID-19.

Methods and analysis: This protocol describes the multiphase optimisation strategy for the preparation, optimisation and evaluation of a theory-based and evidence-based intervention delivered via app. The app aims to promote correct hand hygiene at key times in the adult general population. The study will be conducted in German-speaking Switzerland. The preparation phase has identified relevant behavioural determinants of hand hygiene during a pandemic from health behaviour theories and formative research with focus groups (n=8). The optimisation phase will identify the most effective and acceptable combination and sequence of three intervention modules in a parallel randomised trial (n=387) with analysis of variance (ANOVA) and regression analysis. Additionally, thematic analysis of qualitative interview data (n=15) will be used to gain insights on the feasibility, usability and satisfaction of the intervention. The evaluation phase will test the optimised intervention against an active control group in a randomised controlled trial (n=205), analysing pre-post differences and 6-month follow-up effects with ANOVA and regression analysis.

Ethics and dissemination: The trial was approved by the Cantonal Ethics Commission Bern of the Swiss Association of Research Ethics Committees (protocol ID: 2021-00164). Final results will be presented in peer-reviewed journals and at conferences.

Trial registration number: NCT04830761.

Keywords: COVID-19; health & safety; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Multiphase optimisation strategy design of the Behavior Change in Context to Contain the Spread of SARS-CoV-2 (BECCCS) study. RCT, randomised controlled trial. TAU, Treatment as usual; FOPH, Federal office of public health.
Figure 2
Figure 2
Procedure study optimisation phase.
Figure 3
Figure 3
Procedure evaluation phase.
Figure 4
Figure 4
Study timetable with the preparation, optimisation and evaluation phases from 2020 to 2022. RCT, randomised controlled trial.

References

    1. World Health Organization . A world at risk: annual report on global preparedness for health emergencies, 2019. Global preparedness monitoring. Available:
    1. World Health organization . Coronavirus disease 2019 (COVID-19) situation report, 2020. Available: [Accessed 13 Jul 2021].
    1. World Health Organization . Survey tool and guidance: rapid, simple, flexible behavioural insights on COVID-19, 2020. Available:
    1. Michie S, West R, Behavioural WR. Behavioural, environmental, social, and systems interventions against covid-19. BMJ 2020;370:m2982. 10.1136/bmj.m2982
    1. Rabie T, Curtis V. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 2006;11:258–67. 10.1111/j.1365-3156.2006.01568.x
    1. Aiello AE, Coulborn RM, Perez V, et al. . Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health 2008;98:1372–81. 10.2105/AJPH.2007.124610
    1. WHO . Who guidelines on hand hygiene in health care: a summary, 2009. Available:
    1. Verplanken B. The psychology of habit: theory, mechanisms, change, and contexts. Springer International Publishing, 2018.
    1. Inauen J, Tobias R, Mosler H-J. The role of commitment strength in enhancing safe water consumption: mediation analysis of a cluster-randomized trial. Br J Health Psychol 2014;19:701–19. 10.1111/bjhp.12068
    1. Inauen J, Mosler H-J. Developing and testing theory-based and evidence-based interventions to promote switching to arsenic-safe wells in Bangladesh. J Health Psychol 2014;19:1483–98. 10.1177/1359105313493811
    1. Little P, Stuart B, Hobbs FDR, et al. . An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. Lancet 2015;386:1631–9. 10.1016/S0140-6736(15)60127-1
    1. White S, Thorseth AH, Dreibelbis R, et al. . The determinants of handwashing behaviour in domestic settings: an integrative systematic review. Int J Hyg Environ Health 2020;227:113512. 10.1016/j.ijheh.2020.113512
    1. van Roekel H, Reinhard J, Grimmelikhuijsen S. Improving hand hygiene in hospitals: comparing the effect of a nudge and a boost on protocol compliance. Behavioural Public Policy 2021:1–23
    1. Cane J, O'Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci 2012;7:37. 10.1186/1748-5908-7-37
    1. West R, Michie S, Rubin GJ, et al. . Applying principles of behaviour change to reduce SARS-CoV-2 transmission. Nat Hum Behav 2020;4:451–9. 10.1038/s41562-020-0887-9
    1. Michie S, Richardson M, Johnston M, et al. . The behavior change technique taxonomy (V1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013;46:81–95. 10.1007/s12160-013-9486-6
    1. McKay FH, Wright A, Shill J, et al. . Using health and well-being Apps for behavior change: a systematic search and rating of Apps. JMIR Mhealth Uhealth 2019;7:e11926. 10.2196/11926
    1. Collins LM, Nahum-Shani I, Almirall D. Optimization of behavioral dynamic treatment regimens based on the sequential, multiple assignment, randomized trial (smart). Clin Trials 2014;11:426–34. 10.1177/1740774514536795
    1. Mayer J, Mooney B, Gundlapalli A, et al. . Dissemination and sustainability of a hospital-wide hand hygiene program emphasizing positive reinforcement. Infect Control Hosp Epidemiol 2011;32:59–66. 10.1086/657666
    1. Srigley JA, Corace K, Hargadon DP, et al. . Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. J Hosp Infect 2015;91:202–10. 10.1016/j.jhin.2015.06.019
    1. Gardner B. A review and analysis of the use of 'habit' in understanding, predicting and influencing health-related behaviour. Health Psychol Rev 2015;9:277–95. 10.1080/17437199.2013.876238
    1. Diefenbacher S, Pfattheicher S, Keller J. On the role of habit in self‐reported and observed hand hygiene behavior. Appl Psychol 2020;12:125–43.
    1. Schwarzer R, Hamilton K. Changing Behavior Using the Health Action Process Approach. In: Hagger MS, Cameron LD, Hamilton K, et al., eds. The Handbook of Behavior Change. Cambridge Handbooks in Psychology. Cambridge University Press, 2020: 89–103.
    1. Ajzen I. The theory of planned behavior. rganizational behavior and human decision processes 1991;2:179–211.
    1. Bandura A. Self-Efficacy. In: The Corsini encyclopedia of psychology. American Cancer Society, 2010: 1–3.
    1. Gollwitzer PM. Implementation intentions: strong effects of simple plans. Am Psychol 1999;54:493–503. 10.1037/0003-066X.54.7.493
    1. Burgess-Allen J, Owen-Smith V. Using mind mapping techniques for rapid qualitative data analysis in public participation processes. Health Expect 2010;13:406–15. 10.1111/j.1369-7625.2010.00594.x
    1. Fishbein M, Ajzen I. Predicting and changing behavior: the Reasoned action approach. Psychology Press, 2010.
    1. Lhakhang P, Lippke S, Knoll N, et al. . Evaluating brief motivational and self-regulatory hand hygiene interventions: a cross-over longitudinal design. BMC Public Health 2015;15:1–9. 10.1186/s12889-015-1453-7
    1. Lim C-Y, In J. Randomization in clinical studies. Korean J Anesthesiol 2019;72:221–32. 10.4097/kja.19049
    1. Faul F, Erdfelder E, Buchner A, et al. . Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009;41:1149–60. 10.3758/BRM.41.4.1149
    1. Allan JL, Sniehotta FF, Johnston M. The best laid plans: planning skill determines the effectiveness of action plans and implementation intentions. Ann Behav Med 2013;46:114–20. 10.1007/s12160-013-9483-9
    1. Schwarzer R, Schüz B, Ziegelmann JP, et al. . Adoption and maintenance of four health behaviors: theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity. Ann Behav Med 2007;33:156–66. 10.1007/BF02879897
    1. Gardner B, Abraham C, Lally P, et al. . Towards parsimony in habit measurement: testing the convergent and predictive validity of an automaticity subscale of the self-report habit index. Int J Behav Nutr Phys Act 2012;9:102. 10.1186/1479-5868-9-102
    1. Ajzen I. Constructing a TPB questionnaire: conceptual and methodological considerations, 2002. Available: [Accessed 19 Jan 2021].
    1. Sniehotta FF, Scholz U, Schwarzer R. Bridging the intention–behaviour gap: planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychol Health 2005;20:143–60. 10.1080/08870440512331317670
    1. Perski O, Blandford A, Garnett C, et al. . A self-report measure of engagement with digital behavior change interventions (DBCIs): development and psychometric evaluation of the “DBCI Engagement Scale”. Transl Behav Med 2019;51. 10.1093/tbm/ibz039
    1. Peres SC, Pham T, Phillips R. Validation of the system usability scale (Sus): Sus in the wild. Proceedings of the Human Factors and Ergonomics Society Annual Meeting 2013;57:192–6. 10.1177/1541931213571043
    1. Schmidt J, Lamprecht F, Wittmann W. Zufriedenheit mit der stationären Versorgung. Entwicklung eines Fragebogens und erste Validitätsuntersuchungen [Satisfaction with inpatient care: Development of a questionnaire and first validity assessments]. Psychotherapie Psychosomatik Medizinische Psychologie 1989;39:248–55
    1. Contzen N, De Pasquale S, Mosler H-J. Over-reporting in handwashing self-reports: potential explanatory factors and alternative measurements. PLoS One 2015;10:e0136445. 10.1371/journal.pone.0136445
    1. Robins D, Brody R, Jeong IC, et al. . Towards a highly Usable, mobile electronic platform for patient recruitment and consent management. Stud Health Technol Inform 2020;270:1066–70. 10.3233/SHTI200325
    1. Palsola M, Renko E, Kostamo K, et al. . Thematic analysis of acceptability and fidelity of engagement for behaviour change interventions: the let's move it intervention interview study. Br J Health Psychol 2020;25:772–89. 10.1111/bjhp.12433
    1. Azevedo V, Carvalho M, Costa F, et al. . Interview transcription: conceptual issues, practical guidelines, and challenges. Rev. Enf. Ref. 2017;IV Série:159–68. 10.12707/RIV17018
    1. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101. 10.1191/1478088706qp063oa
    1. Díaz R, Cova F, Reactance CF. Reactance, morality, and disgust: the relationship between affective dispositions and compliance with official health recommendations during the COVID-19 pandemic. Cogn Emot 2022;36:1–17. 10.1080/02699931.2021.1941783
    1. D'Zurilla TJ, Goldfried MR. Problem solving and behavior modification. J Abnorm Psychol 1971;78:107–26. 10.1037/h0031360
    1. Lally P, Gardner B. Promoting habit formation. Health Psychology Review 2013;7:S137–58. 10.1080/17437199.2011.603640
    1. Pfattheicher S, Strauch C, Diefenbacher S, et al. . A field study on watching eyes and hand hygiene compliance in a public restroom. J Appl Soc Psychol 2018;48:188–94. 10.1111/jasp.12501
    1. King D, Vlaev I, Everett-Thomas R, et al. . "Priming" hand hygiene compliance in clinical environments. Health Psychol 2016;35:96–101. 10.1037/hea0000239
    1. Federal Office of Public Health Switzerland . Flu pandemic: handwashing, 2021. Available:
    1. Faul F, Erdfelder E, Lang A-G, et al. . G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175–91. 10.3758/BF03193146

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