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Use of the Health Belief Model to Assess Hand Hygiene Knowledge, Perceptions, and Practices of Saudi Students Studying in the U.S

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Use of the Health Belief Model to Assess Hand Hygiene Knowledge, Perceptions, and Practices of Saudi Students Studying in the U.S Clemson University TigerPrints All Theses Theses 12-2011 Use of the Health Belief Model to Assess Hand Hygiene Knowledge, Perceptions, and Practices of Saudi Students Studying in the U.S. Najla Khateeb Clemson University, [email protected] Follow this and additional works at: https://tigerprints.clemson.edu/all_theses Part of the Food Science Commons Recommended Citation Khateeb, Najla, "Use of the Health Belief Model to Assess Hand Hygiene Knowledge, Perceptions, and Practices of Saudi Students Studying in the U.S." (2011). All Theses. 1286. https://tigerprints.clemson.edu/all_theses/1286 This Thesis is brought to you for free and open access by the Theses at TigerPrints. It has been accepted for inclusion in All Theses by an authorized administrator of TigerPrints. For more information, please contact [email protected]. USE OF THE HEALTH BELIEF MODEL TO ASSESS HAND HYGIENE KNOWLEDGE, PERCEPTIONS, AND PRACTICES OF SAUDI STUDENTS STUDYING IN THE U.S. __________________________________________________________________ A Thesis Presented to The Graduate School of Clemson University In Partial Fulfillment of the Requirements for the Degree Master of Sciences by Najla Khateeb December 2011 Accepted by: Dr. Angela Fraser, Committee Chair Dr. Mary Elizabeth Kunkel Dr. Felix H. Barron ABSTRACT Many factors influence hygiene but those that have the greatest impact vary widely across population groups. Our aim was to characterize hand hygiene practices of Saudi students studying in the U.S. by completing two objectives: (1) assess hand hygiene knowledge, perceptions, and practices of Saudi students studying in the U.S. and (2) determine the relationship among knowledge, perceptions, and practices. A modified version of the Health Belief Model was the theoretical framework to characterize hand hygiene practices. A web-based instrument was posted to the ―Saudis Studying in USA‖ Facebook page. The instrument was prepared in English then translated into Arabic. Data was collected between September 6, 2011, and October 14, 2011. Over 800 individuals (N=831) accessed the survey; 352 completed it [239 males (70%) and 103 females (30%)]. The mean knowledge score out of 9 was 4.26+1.51. The most frequently reported responses across six subpractices--soap, water temperature, wash length, drying method, hand sanitizer use, and frequency before seven situations-- were the correct methods. A probit model was run to determine which five perceptions influenced frequency of handwashing. Frequency was selected as the outcome variable because we wanted to determine what influenced the entire handwashing process and not the individual subpractices. Susceptibility and seriousness of foodborne disease and benefits of handwashing did not significantly influence frequency in any situation. Value of good ii health had a significant influence (p<0.05) on frequency after handling garbage. Barriers to handwashing had a similar significant (p<0.05) negative influence on frequency of handwashing. Importance and motivation had a similar significant (p<0.05) positive influence on frequency of handwashing. Saudi students have limited knowledge about hand hygiene but their hand hygiene practices are generally good across situations. The only two perceptions to significantly influence frequency of handwashing were barriers to handwashing and importance and motivation of handwashing. iii ACKNOWLEDGMENTS It is my pleasure to express my gratitude to a large number of people without whom this edition would be impossible. First of all I would like to acknowledge the advice and guidance of Dr. Angela Fraser, committee chair. I also thank the members of my graduate committee for their guidance and suggestions, Dr. Mary Elizabeth Kunkel, and Dr. Felix H. Barron. I would also like to thank my all group members, Wallace Campbell, Ashley Rivers, Anna Saunders, Cecilia Chen, Emily Dennehy, and Lauren King. A special acknowledgement goes to my best friend: Nisreen Abdulsalam. She has been a true friend ever since we met. Nisreen is an amazing person in many ways. Lastly, this thesis is dedicated to my husband: Majed Al-Madani, who kept praying for me all the time and has given me all of his love and support. Your prayers and love have become the catalyst to my desire to finish this thesis. I would also to dedicate my thesis to my parent‘s spirit, my sisters, and my brothers who are my source of strength and who had a dream of seeing me in a graduation gown. iv TABLE OF CONTENTS Page ABSTRACT ..................................................................................................................... ii ACKNOWLEDGMENTS …………………………………………………………….. iv LIST OF TABLES ................................................................................................... ….viii LIST OF FIGURES ......................................................................................................... x INTRODUCTION ........................................................................................................... 1 LITERATURE REVIEW ................................................................................................ 5 Human Norovirus……………………………………………………………7 The Hajj and Disease Transmission…………………………………………9 Ramadan and Disease Transmission………………………………………..11 Control Strategies for Norovirus…………………………………………...12 Hand Hygiene in the KSA ........................................................................... 13 Assessment of Hand Hygiene Practices ....................................................... 15 The Health Belief Model (HBM) ................................................................. 16 Perceived Susceptibility ............................................................................... 16 Perceived Seriousness .................................................................................. 17 Perceived Benefits of Taking Action and Barriers to Taking Actions ........ 18 Stimulus (or cues to take action) .................................................................. 19 Other Variables ............................................................................................ 21 v METHODS ................................................................................................................ 22 Institutional Review Board Approval……………………………………....22 Development of the Theoretical Framework to Characterize Hand Hygiene Practices .......................................................... 23 Research Design…………………………………………………………....25 Sampling Frame…………………………………………………………….25 Development of the Source Instrument……………………………………26 Hand Hygiene Knowledge…………………………………………………28 Perceptions of Health and Hand Hygiene………………………………….28 Hand Hygiene Practices…………………………………………………….29 Construct and Content Validity…………………………………………….30 Data Collection……………………………………………………………..31 Data Analysis ......................................................................................... …..32 Principal Component Analysis……………………………………………..35 Description of Models……………………………………………………..36 RESULTS AND DISCUSSION .................................................................................... 37 Subjects…………………………………………………………………….37 Hand Hygiene Knowledge…………………………………………………41 Health and Hand Hygiene Perceptions…………………………………….44 Hand Hygiene Practices……………………………………………………51 Factors that Influence the Frequency of Hand Hygiene…………………...76 Limitations…………………………………………………………………80 CONCLUSIONS........................................................................................................ …82 Recommendations for Future Work............................................................. 83 vi APPENDICES ............................................................................................................... 84 A: Operational Definitions of measurement domains and factors ........................ 84 B: Guide for Developing a Survey....................................................................... 86 C: Institutional Review Board Application.......................................................... 88 D: Survey Instrument in English........................................................................ 106 E: Survey Instrument in Arabic ......................................................................... 118 F: Collection Procedures and Timeline ............................................................... 126 LITERATURE CITED ................................................................................................ 127 vii LIST OF TABLES Table Page 2.1 Food safety strategies taken in the Middle East ............................................. 6 2.2 Population groups at risk for Norovirus Gastroenteritis ................................ 8 3.1 Advantages and disadvantages of cross-sectional study design .................. 25 3.2 Factors measured on the web-based survey instrument ............................... 27 3.3 Inferential statistical analyses plan to answer study objectives and the corresponding research questions .................................................... 34 4.1 Demographic characteristics of respondents ............................................... 39 4.2 Hand hygiene knowledge score ................................................................... 41 4.3 Respondents who correctly answered each knowledge item ....................... 43 4.4 Frequency of responses for seven perceptions............................................. 46 4.5 Composite scores for the seven perceptions used to predict handwashing frequency
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