WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
7.
The relevance of social marketing and social
movement theories
Part I, Section 20.3, provides a comprehensive account of the applicability of social marketing to hand hygiene
improvement. In a systematic review of hand hygiene behavioural interventions, 872 Mah and colleagues found
synergies in many modern-day approaches to hand hygiene improvement and the ethos of social marketing.
Scott and colleagues 1089 extol consumer marketing as a new approach that might overcome some of the
conventional limitations associated with hand hygiene behaviour change outside health care. Social marketing
might add value to the global drive for better hand hygiene in health care, exactly because it has been applied in
both developed and developing countries. 1090 Mah and colleagues 872 suggest that social and behavioural theories
and models are underused in the design of current hand hygiene promotion interventions. They counter the
commonly held belief that social marketing is cost-intensive and conclude that social marketing is not necessarily
an expensive activity due to its scalability. One of the chief advantages of nationally coordinated campaigns with
pooled financial input is that it ensures resource provision that maximizes economies of scale and utilizes the
expertise of the marketing world in spreading hand hygiene improvement messages within health care.
In contrast to the evidence relating to social marketing, the
relevance of social movement theories to hand hygiene
improvement, or health improvement generally, is an unresolved
issue. Social movement theories concerned with largescale
societal change have gained prominence within health
improvement literature in recent years and embody much of
what is aspired to by health policy-makers striving to improve
practices in health care. However, Brown and colleagues 1091
urge caution in drawing conclusions regarding the usefulness
of such a comparison and emphasize that social movements
are defined by the emergence of informal networks based
on shared beliefs and solidarity that mobilize around issues
of conflict and usually involve some form of protest. These
possibilities of applying social movement theories within
general spread strategies offer a new angle to hand hygiene
improvement in health care, and this might hold relevance
in terms of pursuing a global hand hygiene improvement
movement. Within the context of broader patient safety
improvements and the need to mobilize HCWs in a different way
of working, there may be benefits in the concept.
Bate and colleagues 1092 argue that social and organizational
change do have similarities with health-care improvement
and conclude that those considering large-scale change in
health care might benefit from consideration of change from
a perspective of social movements. There is no literature
specifically reviewing hand hygiene campaigns and social
movement theories, and this gap in the literature may benefit
from further study.
Social movements tend to occur spontaneously, and this
contrasts sharply with current examples of national hand
hygiene improvements that rely on centrally constructed
programmes of change implemented in a coordinated
manner using accepted methodologies of health improvement
spread. Whether it is possible to create a contagious hand
hygiene improvement movement using the vehicle of national
programmes is only recently being addressed, and emerging
results of the impact of these approaches are expected in the
coming years.
7.1 Hand hygiene improvement campaigns outside
of health care
While there is little available published literature on national
hand hygiene improvement strategies in health care, the
Global Public–Private Partnership for Handwashing with Soap
(GPPHWS) illustrates a comprehensive strategy for improving
hand hygiene in the community. The partnership was catalysed
around a bold objective: to establish large-scale national
programmes on handwashing, 1088 which involved putting into
place a number of collaborative efforts for success at the
national level including between government, academia, the
private sector, and external support agencies. The partnership
relied on the identification of a national coordinator at the
governmental level. 1088
Within a developing country context, Scott and colleagues 1089
have used a social marketing approach to consider motivations,
environmental factors, and habits that mitigate against the
desired behaviour within their target audiences. This approach
has been rolled out in Ghana and a number of other countries.
In developing countries, this public–private partnership 1093 has
attempted to tackle the problems across nations exacerbated
by low compliance with hand hygiene in the community, rather
than in the health-care setting. This campaign involves close
working with the private sector with the aim of developing and
executing far-reaching improvement strategies. Transferring
such an approach to hand hygiene in health care will raise
ethical issues relating to partnerships working with corporate
bodies. This may not necessarily be a barrier, and <strong>WHO</strong> is
ideally placed to act as a catalyst to this end.
A list of critical factors that are necessary to drive forward this
improvement has been drawn up: political will; policies and
strategies that enable improvement; finance; coalition and
partnerships; local governments and local action; and external
support agencies. Fewtrell and colleagues 1094 emphasize the
importance of selecting interventions for developing countries
based on local desirability, feasibility, and cost–effectiveness.
These factors will differ in a number of ways across developed
and developing countries, not least in the absence of robust
public health infrastructure in developing nations. Finally, they
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