A qualitative study of determinants of patient behaviour leading to an infection related hospital admission.
Tonna, Antonella P.
Weidmann, Anita Elaine
Stewart, Derek C.
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TONNA, A.P., WEIDMANN, A.E., LAING, R.B.S., TONNA, I., MACARTNEY, G.M., PAUDYAL, V. and STEWART, D. 2017. A qualitative study of determinants of patient behaviour leading to an infection related hospital admission. Journal of the Royal College of Physicians of Edinburgh [online], 47, pages 40-46. Available from: https://doi.org/10.4997/JRCPE.2017.109
Objective: To describe and understand the determinants of patients' behaviours surrounding admission to hospital for an acute infective episode. Method: Patients admitted to the infection or acute medicine admission units of a major Scottish teaching hospital and commenced on antibiotic therapy after admission were included. Semi-structured face-to-face interviews were conducted using a pre-piloted interview schedule guide that focused on gathering information about patient behaviours and experiences prior to admission to hospital with an acute infection. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework Approach. Emerging themes were matched to the Theoretical Domains Framework of behavioural determinants. Results: Twenty-one patients consented to participate and 18 transcripts were suitable for analysis. The most common infections were those of the skin, soft tissue and respiratory tract. From the patients? perspectives, behavioural determinants that appeared to impact their admission to hospital were principally their knowledge, beliefs of consequences, the environmental context and resources (mainly out-of-hours services), social influences and their own emotions. Determinants such as knowledge of the signs and symptoms, beliefs of consequences and environmental context were facilitators of health seeking behaviours. The main barriers were a lack of awareness of consequences of infection potentially leading to delayed admission impacting infection severity, stay in secondary care and resource utilisation. Conclusions: This study has shown that any initial patient-centred intervention that is proposed to change patient behaviour needs to be based on behavioural determinants emerging in this research. The intervention may include aspects such as patient education on resources available out-of-hours and ways to access the healthcare system, education on recognising signs of infection leading to prompter treatment and positive reinforcement for patients who present with recurrences of infection.