COM-B Hand Hygiene Behaviour Questionnaire

Abstract

The COM-B Hand Hygiene Behavior Questionnaire (COM-B HHB) was developed to provide a robust, theory-driven assessment tool for understanding the complex factors influencing hand hygiene (HH) compliance among healthcare professionals. Recognizing that previous assessment tools often lacked a foundation in appropriate theories of behavioural change, the COM-B HHB addresses the dimensions of Capability, Opportunity, and Motivation as predictors of self-reported HH behaviour and intention. This questionnaire is reported to be both reliable and valid, offering essential data to support the targeted development and evaluation of HH interventions tailored to the specific needs of healthcare units.

Keywords

COM-B Model, Hand Hygiene, Healthcare Professionals, Behavioural Change, Capability, Motivation, Opportunity, Psychometrics, Self-report, Infection Control

Authors

Paul O’Connor, Sinead Lydon

Purpose

The primary use of the COM-B HHB Questionnaire is to systematically measure healthcare professionals’ attitudes and perceptions regarding the specific psychological and environmental factors influencing their hand hygiene behaviour and compliance within their working unit. The results are intended to guide the creation of focused and effective behavioural interventions.

Construct

The scale is fundamentally based on the COM-B Model of Behaviour, a theoretical framework asserting that behaviour (B) is generated from the interaction of three necessary components: Capability (C), Opportunity (O), and Motivation (M). The questionnaire operationalizes these constructs specifically within the context of HH compliance:

• Capability: Measures the psychological and physical ability to engage in HH (e.g., knowledge of protocol, physical skill).
• Opportunity: Measures external factors that enable the behaviour (e.g., adequate facilities, time availability, social context).
• Motivation: Measures internal processes that influence decision-making and drive behaviour (e.g., desire to comply, beliefs about importance, social norms).
• Behaviour/Behavioural Intention: Measures the self-reported frequency of engaging in HH at the five key moments.

Validity

The psychometric evaluation of the COM-B HHB suggests that the scale possesses strong validity. Specifically, construct validity was supported by the finding that the theoretical model, including Capability, Opportunity, and Motivation, was a significant predictor of self-reported Behavioural intention (F(3,209) = 22.58, p<0.001). This confirms the theoretical relevance of the COM-B constructs in predicting HH intention. However, the study noted a potential discrepancy in criterion validity, as unit-level comparisons indicated a tendency for self-report measures to overestimate HH behaviour when directly contrasted with data gathered through observation.

Reliability

The COM-B HHB questionnaire is reported to be a reliable measure of factors influencing hand hygiene behaviour. While specific reliability coefficients (e.g., Cronbach’s Alpha) were not detailed in the summary, the conclusion of the psychometric study affirms its suitability as a stable and consistent assessment tool for healthcare units aiming to develop targeted interventions.

Factor Analysis

The scale’s structure was confirmed using Confirmatory factor analysis (CFA). This analysis resulted in a refined, 17-item questionnaire structure reflecting the core COM-B constructs. Subsequent multiple regression analysis was performed to test the predictive power of the three main factors (Capability, Opportunity, Motivation) on self-reported Behavioural intention. Although the overall model was highly significant (p<0.001), it was specifically found that the Opportunity factor did not make a significant independent contribution to the regression model, suggesting that while environmental factors are present, they may not be the primary driver of self-reported intention in this specific population compared to Capability and Motivation.

Instrument

Test Type: Self-report Questionnaire

Format: Multi-item Likert scale (5-point agreement scale for C, O, M dimensions; 5-point frequency scale for Behaviour dimension)

Language Available: English (Original)

Population Group: Healthcare Professionals

Age Group: Adult

Population Details: The initial psychometric validation study included 292 responses from healthcare professionals, achieving a response rate of 41.0%.

Test Methodology: Survey administered, followed by Confirmatory factor analysis and multiple regression analysis for psychometric validation.

Keywords

COM-B, Hand Hygiene, Compliance, Healthcare Quality, Psychological Assessment, Behavioural Intention, Lydon, O’Connor

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: Not provided in source content.

Correspondence Address: Not provided in source content.

Permissions & Fee and Test Year

Permissions: Information regarding permissions and usage fees is not provided in the source content.

Test Year: The key reference is listed as “under review,” indicating the scale and its psychometric data were recently developed or validated around the time of the reference publication.

Reference’s

The primary reference detailing the psychometric evaluation of the COM-B Hand Hygiene Behavior Questionnaire is:

• Lydon, S., Greally, C., Tujjar, O., Reddy, K., Lambe, K. Madden, C., Walsh, C., Fox, S. O’Connor, P. (under review). Psychometric evaluation of a theory-based measure of factors influencing hand hygiene behaviour.

Items of the COM-B Hand Hygiene Behavior Questionnaire

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Please read each item below and circle the number that best captures the extent to which you agree with each statement.

Scoring Key

For each of the four subscales, add the item responses within that subscale together and then divide by the number of items in the subscale order to obtain a mean subscale score. For example, for the Capability subscale, add the responses to the five items and then divide by five in order to obtain the mean subscale score.